CHIROPODY QUIZ COMPEND CHIROPODY QUIZ COMPEND 
Published Under the Auspices 
of the 
EDUCATIONAL COMMITTEE 
NATIONAL ASSOCIATION OF CHIROPODISTS, INC. 
Arranged and Edited by 
REUBEN H. GROSS, M. Cp. 
FIRST EDITION 
—1923— 
PRICE FOUR DOLLARS COPYRIGHT 1923 BY 
THE NATIONAL ASSOCIATION OF CHIROPODISTS FOREWORD 
With the publication of this volume the National 
Association of Chiropodists hopes to bring to those 
of its members who have not had the privileges, 
and benefits of modern professional schooling, a: 
stepping stone to educational advancement. 
The Association does not claim nor does it pre- 
sume that a volume of this kind can he complete, 
but it is presented with the hope that it may serve 
as an outline to those who wish to improve their 
knowledge and encourage them to deeper study 
along scientific lines. 
With this in mind, the officers dedicate this 
volume to those pioneers in the profession, dead 
and living, whose vision, energy, and enthusiasm 
have made possible chiropody’s unprecedented ad- 
vance. 
Acknowledgment is made to those members 
whose generosity has made possible the publication 
of this compend, the monies for which were raised 
entirely by voluntary subscription. INDEX 
Anatomy 11 
Histology 26 
Physiology 38 
Bacteriology 57 
Patholocy 67 
Physical Diagnosis 74 
Dermatology and Syphilology 82 
Surgery 96 
Practical Chiropody 122 CHAPTER I. 
ANATOMY 
1. What is anatomy? Anatomy is the science that deals with the 
study of the structure of organized bodies. 
2. What is human anatomy? Human anatomy is the study of the 
structure of the human body. 
3. Mention the divisions into which the study of anatomy is divided. 
The study of anatomy is divided into osteology, syndesmology, 
myology, angiology, neurology, the organs of special sense and 
the study of the viscera. 
4. What is osteology? Osteology is the study of the bones of the 
body. 
5. What is syndesmology? Syndesmology is the study of the liga- 
ments and joints of the body. 
6. What is myology? Myology is the study of the muscles of the body. 
7. What is angiology? Angiology is the study of the blood vessels 
and lymphatics of the body. 
8. What is neurology? Neurology is the study of the nerves of the 
body. 
9. What are the organs of special sense? The organs of special 
sense are the eyes, the ears, the nose, the tongue, and the skin. 
10. What are the viscera? The viscera (singular, viscus) are the in- 
ternal organs of the body and are found in the abdomen and 
thorax, and include the heart, lungs, liver, stomach, kidneys, etc. 
11. What are the other divisions of the study of anatomy? The divi- 
sions of the study of anatomy are applied anatomy, comparative 
anatomy, gross anatomy, minute anatomy, practical anatomy, and 
surgical anatomy. 
12. What is applied anatomy? Applied anatomy is the application of 
anatomy in the diagnosis of disease and in treatment, especially 
surgical treatment. 
13. What is comparative anatomy? Comparative anatomy is the study 
of the structure of the human body compared with the lower 
animals. 12 
QUIZ COMPEND 
14. What is gross anatomy? Gross anatomy is the study of the body 
without the use of the microscope. 
15. What is minute anatomy? Minute anatomy is the study of the 
intimate structures of the body invisible to the naked eye and re- 
quiring the use of the microscope; histology. 
16. What is practical anatomy? Practical anatomy is the study of the 
structures of the body by means of actual dissection. 
17. What is surgical anatomy? Surgical anatomy is applied anatomy 
in reference to surgical diagnosis and treatment. 
18. Why is a knowledge of anatomy essential to the chiropodist or 
podiatrist? To successfully and intelligently treat the foot it is 
necessary to know intimately the structures with which one is 
dealing. It is impossible to make correct diagnoses unless the 
structure is thoroughly understood. It is impossible to tell a devi- 
ation from normal, unless the normal parts are known. 
Osteology of the Foot 
19. How many bones are in the foot? There are twenty-six bones in 
the foot. 
20. How are they divided or classified? They are divided into three 
groups: the tarsus, the metatarsus, and the phalanges. 
21. How many bones are in the tarsus? There are seven (7) bones in 
the tarsus. 
22. How many bones are in the metatarsus? There are five (5) bones 
in the metatarsus. 
23. How many phalanges are there? There are fourteen (14) pha- 
langes. 
24. Name the bones of the tarsus? The os calcis, the astragalus, the 
cuboid, the scaphoid, the internal cuneiform, the middle cuneiform, 
and the external cuneiform. 
25. Name the bones of the metatarsus? There are five bones, one for 
each toe and numbered from one to five, from within outward. 
26. Name the phalanges. There are fourteen bones, three for each 
of the four lesser toes and two for the great toe. 
27. Describe the os calcis. The os calcis is the largest of the tarsal 
bones and forms the heel. It articulates with the astragalus above 
and the cuboid in front. On its inner side it has a prominence 
called the sustentaculum tali, to which is attached the inferior 
calcaneo-navicular ligament or spring ligament. It is also called 
the calcaneus or heel bone. 
28. Describe the astragalus. The astragalus is found above the os 
calcis and forms the ankle. It articulates with the os calcis below 
and the scaphoid in front. It also articulates with the two bones ANATOMY 
13 
of the leg, the tibia on the inner side and the fibula on the outer 
side. It fits into a mortice formed by these latter bones, all of 
which is called the ankle joint. 
29. Describe the cuboid. The cuboid is found on the outer side of the 
foot in front of the os calcis and behind the base of the fifth 
metatarsal bone. It articulates with the os calcis behind, with 
the external cuneiform on the inner side and with the fourth and 
fifth metatarsal bones in front. It is found on the outer side of the 
scaphoid but does not articulate with that bone. 
30. Describe the scaphoid. The scaphoid or navicular bone, is a boat- 
shaped bone found on the inner side of the foot in front of the 
astragalus. It has a prominence which can be easily felt on the 
inner side of the foot about one inch in front of the inner malle- 
olus. It articulates with the astragalus behind and with the 
three cuneiform bones in front. 
31. Describe the cuneiform bones. These bones are found in front of 
the scaphoid and are sometimes called wedge bones. The internal 
cuneiform is the largest and articulates with the scaphoid, the 
middle cuneiform, and the first and second metatarsals. The 
middle cuneiform articulates with the internal and external cunei- 
forms, with the scaphoid and with the second metatarsal. The 
external cuneiform articulates with the scaphoid, the middle cunei- 
form, the cuboid, and with the second, third, and fourth meta- 
tarsal bones. 
32. Describe the metatarsal bones. The metatarsal bones are five in 
number. They articulate with the tarsal bones behind and with the 
bases of the proximal phalanges in front. They are long bones, 
having a shaft and two extremities. The first metatarsal is the 
thickest and below its head are found two sesamoid bones. The 
heads of the metatarsal bones form the metatarsal or anterior 
arch. 
33. Describe the phalanges. The phalanges are fourteen in number, 
two in the great toe and three in each of the four lesser toes. 
Those that articulate with the heads of the metatarsals are called 
the proximal phalanges and those that are found at the ends of 
the toes are called the distal phalanges. These are flattened for 
the reception of the nails. The phalanges found between the distal 
and the proximal ones are called the middle phalanges. The 
phalanges, like the metatarsals, are long bones, having a shaft and 
two extremities. 
Syndesmology 
34. What is an articulation or joint? An articulation or joint is a 
connection between two bones of the skeleton. 
35. What enters into the formation of joints? Joints are made up of 
bone, cartilage, fibro-cartilage, ligaments, and synovial membrane. 14 
QUIZ COMPEND 
36. What is cartilage? Cartilage is a non-vascular structure of the 
connective tissue variety. 
37. How many kinds of cartilage are there? Three: hyaline cartilage, 
white fibro-cartilage, and yellow or elastice fibro-cartilage. 
38. What are ligaments? Ligaments are bands of dense white fibrous 
tissue which bind bones together in joints. 
39. What are synovial membranes? Synovial membranes are smooth 
membraneous structures which are found in joints and which se- 
crete the synovia, a viscid, glairy fluid. 
40. Into how many classes are articulations divided? Three classes: 
synarthrosis, amphiarthrosis, and diarthrosis. 
41. What is synarthrosis? Synarthrosis is an immovable joint such as 
the sutures of the skull. 
42. What is amphiarthrosis? Amphiarthrosis is a mixed articulation 
having limited motion as in the joints of the spinal column. 
43. What is diarthrosis? Diarthrosis is a freely movable joint and is 
subdivided into (1) Ginglymus or hinge joint, example the elbow 
and ankle joints; (2) Condyloid, where an ovoid head fits into an 
elliptical cavity, example the wrist joint; (3) Enarthrosis, ball 
and socket joint, the hip and shoulder joints and the astragalo- 
scaphoid joint; (4) Arthrodial, gliding joint, the tarsal joints. 
44. What are the varieties of motion in joints? The varieties of mo- 
tion are four in number, viz., gliding, angular movement (includ- 
ing adduction, abduction, flexion, and extension), circumduction 
and rotation. These movements are often combined in the various 
joints. 
45. Describe the ankle joint. The ankle joint is a ginglymus or 
hinge joint formed by the lower portions of the tibia and fibula 
with the astragalus. It has four ligaments, anterior, posterior, in- 
ternal lateral, and external lateral. The internal lateral is called 
the deltoid and is involved in flat and weak foot. 
46. Describe the ligaments that connect the tarsal articulations. The 
tarsal articulations are connected by the following ligaments, viz., 
the— 
Os Calcis and astragalus by three ligaments, external, internal, and 
posterior. 
Os Calcis and cuboid by four ligaments, superior, internal, long and 
short. 
Os Calcis and scaphoid by two ligaments, superior and inferior. 
Astragalus and scaphoid, one, superior. 
47. What are the dorsal and plantar ligaments of the tarsus? The 
dorsal and plantar ligaments of the tarsus connect the scaphoid 
with the three cuneiform and with the cuboid, the three cunei- 
forms with each other and the external cuneiform with the cuboid. ANATOMY 
15 
48. What are the interosseus ligaments of the tarsus? The interosseus 
ligaments connect the os calcis with the astragalus, the scaphoid 
with the cuboid, the cuneiform bones with each other, and the 
external cuneiform with the cuboid. 
49. What is the nerve supply to the joints of the tarsus? The an- 
terior tibial nerve supplies all of the joints of the tarsus. 
50. Describe the tarso-metatarsal articulations. The tarso-metatarsal 
articulations are five arthrodial joints formed by the bases of the 
metatarsal bones with the adjacent bones of the tarsus. The joints 
are bound by dorsal, plantar, and three interosseus ligaments. 
51. How many synovial membranes are there in the tarsus and meta- 
tarsus? There are six synovial membranes in the tarsus and 
metatarsus. 
52. Where is the first synovial membrane situated? It is found be- 
tween the os calcis and the astragalus, behind the interosseous 
membrane. 
53. Where is the second synovial membrane found? It is found be- 
tween the os calcis and the astragalus, in front of the interosseous 
membrane. 
54. Where is the third synovial membrane situated? It is found be- 
tween the os calcis and the cuboid. 
55. Where is the fourth synovial membrane found? This is the largest 
and most important of the six membranes. It is found between the 
scaphoid and the three cuneiform bones, running backwward be- 
tween the scaphoid and the cuboid, forward between the cunei- 
form bones, between the external cuneiform and the cuboid, be- 
tween the middle and external cuneiform and the bases of the 
second and third metatarsal, passing also between the bases of 
these bones and the fourth metatarsal. 
56. Where is the fifth synovial membrane found? It is found between 
the internal cuneiform and the base of the first metatarsal bone. 
57. Where is the sixth synovial membrane found? It is found be- 
tween the cuboid and the fourth and fifth metatarsal bones, also 
running forward between their bases. 
58. How are the metatarsal bones bound together? The metatarsal 
bones, except the first, are bound at their bases by dorsal, plantar, 
and interosseous ligaments. The base of the first metatarsal bone 
is not connected with the base of the second by any ligaments, 
thus resembling the thumb in this respect. 
59. Describe the articulations of the phalanges with the metatarsal 
bones and the phalanges with each other. These articulations are 
similar to those of the hand, each joint having a plantar and two 
lateral ligaments. There are no ligaments on the dorsum of these 
joints, the extensor tendons taking their places. 16 
QUIZ COMPEND 
The Muscles and Fasciae 
60. What are muscles? Muscles are the active organs of locomotion, 
formed of bundles of reddish fibres endowed with the power of 
shortening themselves upon irritation. 
61. What is this power called? The power that the muscles have to 
become shorter is called “Muscular Contractility.” 
62. Into how many classes are muscles divided? Two: voluntary, 
striped or skeletal muscle, and involuntary or unstriped muscle. 
63. What is the difference between the two classes of muscle, other 
than in structure? The voluntary muscles are under the control 
of the will, while the involuntary muscles are not under the con- 
trol of the will. 
64. How are muscles attached to bones? Muscles are attached to 
bones by tendons and by aponeuroses. 
65. What are tendons? Tendons are white glistening cords made up 
of white fibrous tissue. They connect the muscles to the struc- 
tures upon which they act. 
66. What are aponeuroses? Aponeuroses are fibrous membranes 
which join the muscle to the bone. They are structurally the 
same as a tendon except that they are flattened out. They appear 
in connection with flat muscles. 
67. What are fasciae? Fasciae are flat structures which invest and 
bind the soft structures and muscles. 
68. How many kinds of fasciae are there? There are two such struc- 
tures: the superficial fascia and the deep fascia. 
69. Describe the superficial fascia. The superficial fascia is made up 
of fibrous and areolar tissue and is found beneath the skin. It is 
almost continuous throughout the entire body. 
70. Describe the deep fascia. The deep fascia is made up of fibrous, 
dense, inelastic tissue and ensheaths the muscles. It offers at- 
tachment to muscles and also encloses the vessels and nerves. It 
binds down these structures into a shapely mass. 
71. How do tendons terminate? The tendons are attached to the 
periosteum of the bone, blending with the outer layer of that 
structure. 
72. How many muscles are there in the leg? There are thirteen mus- 
cles in the leg, twelve of which are inserted in the foot. 
73. How are these muscles divided? They are divided into four 
groups: (1) the anterior group, (2) the superficial posterior 
group, (3) the deep posterior group, (4) the external group. 
74. Name the muscles in the anterior group. The tibialis anticus, the 
extensor longus hallucis, the extensor longus digitorum, and the 
peroneus tertius. ANATOMY 
17 
75. Name the muscles in the superficial posterior group. These mus- 
cles are called the calf muscles and are the gastrocnemeus, the 
soleus, and the plantaris. 
76. Name the muscles in the deep posterior group. The popliteus, the 
flexor longus hallucis, the flexor longus digitorum, and the tibialis, 
posticus. 
77. Name the muscles in the external group. The peroneus longus and 
the peroneus brevis. 
78. Describe the tibialis anticus. Origin, from the outer tuberosity 
and upper two-thirds of the shaft of the tibia externally; insertion,, 
the inner and under surface of the internal cuneiform bone andl 
the first metatarsal bone. Action, to flex the foot on the leg and to 
raise the inner border. Nerve, anterior tibial. 
79. Describe the extensor longus hallucis. Origin, from the middle 
two-fourths of the fibula anteriorly; insertion, into the base of the 
last phalanx of the great toe; action, to extend the great toe; 
nerve, anterior tibial. 
80. Describe the extensor longus digitorum. Origin, from the outer 
tuberosity of the tibia and the upper three-fourths of the shaft of 
the fibula anteriorly; insertion, into the second and third pha- 
langes of the four lesser toes by four tendons; action, to extend 
the lesser toes; nerve, anterior tibial. 
81. Describe the peroneus tertius. Origin, from the outer lower fourth 
of the fibula; insertion, into the base of the fifth metatarsal bone; 
action, to flex the tarsus; nerve, anterior tibial. 
82. Describe the gastrocnemeus. Origin, by two heads from the con- 
dyles of the femur; joins the tendon of the soleus to form the 
tendo Achillis; insertion, the posterior tuberosity of the os calcis;, 
action, to extend the foot; nerve, internal popliteal. 
83. Describe the soleus. Origin, from the head and upper third of the; 
shaft of the fibula posteriorly and from the oblique line of the 
tibia; insertion, as the tendo Achillis with the gastrocnemeus into 
the posterior tuberosity of the os calcis; action, to extend the 
foot; nerves, internal popliteal and posterior tibial. 
84. Describe the plantaris. Origin, from the outer division of the 
linea aspera of the femur; insertion, by a long delicate tendon into 
the posterior surface of the os calcis; action, to extend the foot; 
nerve, internal popliteal. 
85. Describe the popliteus. Origin, from the outer condyle of the 
femur; insertion, into the posterior portion of the tibia, above the 
oblique line; action, to flex the leg; nerve, internal popliteal. 
This is the one muscle in the leg that does not terminate in the 
foot. 
86. Describe the flexor longus hallucis. Origin, from the lower two- 
thirds of the shaft of the fibula internally; insertion, into the base 18 
QUIZ COMPEND 
of the last phalanx of the great toe; action, to flex the great toe; 
nerve, posterior tibial. 
87. Describe the flexor longus digitorum. Origin, from the shaft of 
the tibia posteriorly, below the oblique line; insertion, into the 
bases of the last phalanges of the four lesser toes by four tendons 
which perforate the tendons of the flexor brevis digitorum; action, 
to flex the lesser toes and extend the foot; nerve, posterior tibial. 
88. Describe the tibialis posticus. Origin, by two processes, between 
which pass the anterior tibial vessels (see Angiology) from the 
upper half of the shaft of the tibia posteriorly and the upper two- 
thirds of the shaft of the fibula internally; insertion, into the 
tuberosity of the scaphoid and internal cuneiform bones; action, 
to extend the tarsus and invert the foot; nerve, posterior tibial. 
89. Describe the peroneus longus. Origin, from the head and upper 
two-thirds of the shaft of the fibula externally; insertion, into the 
outer side of the base of the first metatarsal bone and the internal 
cuneiform bone, having crossed the sole of the foot from the outer 
side in an oblique line; action, to extend and evert the foot; 
nerve, musculo-cutaneous. 
90. Describe the peroneus brevis. Origin, from the lower two-thirds of 
the shaft of the fibula externally; insertion, into the dorsum of the 
base of the fifth metatarsal bone; action, to extend the foot; nerve, 
musculo-cutaneous. 
91. Mention the fasciae of the foot. The anterior annular ligament, 
the internal annular ligament, the external annular ligament, the 
plantar fascia, and the dorsal fascia. 
92. Describe the anterior annular ligament. This structure is found 
in front of the ankle joint and is a continuation of the superficial 
fascia. It is attached to the lower ends of the fibula and tibia, the 
os calcis and the plantar fascia. It contains sheaths or grooves 
which are lined with synovial membrane through which pass the 
extensor tendons. 
93. Describe the internal annular ligament. This structure passes 
from the internal malleolus to the os calcis forming canals lined 
with synovial membrane for the passage of the flexor tendons and 
the posterior tibial vessels and nerve. 
94. Describe the external annular ligament. This structure passes 
from the outer malleolus to the os calcis binding the peronei 
tendons in one synovial sac. 
95. Describe the plantar fascia. The plantar fascia is the densest 
fascia in the body. It is divided into a central and two lateral 
portions. It is attached to the inner tuberosity of the os calcis, 
passes forward on the sole of the foot and divides into five proc- 
esses, one for each of the toes. The lateral portions blend with 
the dorsal fascia. ANATOMY 
19 
96. Describe the dorsal fascia. The dorsal fascia is a thin membrane- 
ous structure which is a continuation of the annular ligament. It 
passes forward and becomes gradually lost at the heads of the 
metatarsals, and blending with the plantar fascia laterally. It 
forms a sheath for the tendons on the dorsum. 
Muscles of the Foot 
97. How many muscles are there in the foot? There are twenty mus- 
cles in the foot, one on the dorsum and nineteen on the plantar 
surface. 
98. Name and describe the muscle on the dorsum of the foot. The 
muscle on the dorsum of the foot is called the extensor brevis 
digitorum. Origin, from the outer side of the os calcis; insertion, 
by four tendons, one into the first phalanx of the great toe and 
the others into the outer sides of the long extensor tendons of the 
second, third, and fourth toes; action, to extend the toes; nerve, 
anterior tibial. 
99. How are the muscles on the plantar surface of the foot divided? 
The muscles on the sole are divided into four layers. 
100. Mention the muscles in the first layer. Abductor hallucis, flexor 
brevis digitorum, and abductor minimi digiti. 
101. Mention the muscles in the second layer. Flexor accessorius and 
four lumbricales. 
102. Mention the muscles in the third layer. Flexor brevis hallucis, 
adductor obliquus hallucis, flexor brevis minimi digiti, and ad- 
ductor transversus hallucis. 
103. Mention the muscles in the fourth layer. Four dorsal and three 
plantar interossei. 
104. Describe the abductor hallucis. Origin, from the inner tubercle 
of the os calcis; insertion, into the inner side of the base of the 
first phalanx of the great toe; action, to abduct the great toe; 
nerve, internal plantar. 
105. Describe the flexor brevis digitorum. Origin, from the inner tubercle 
of the os calcis; insertion, into the sides of the second phalanges 
of the lesser toes by four tendons which are perforated for the 
passage of the long flexor tendons; action, to flex the lesser toes; 
nerve, internal plantar. 
106. Describe the abductor minimi digiti. Origin, from the tubercles 
and under surface of the os calcis; insertion, into the base of the 
first phalanx of the little toe, with the tendon of its short flexor; 
action, to abduct the little toe; nerve, external plantar. 
107. Describe the flexor accessorius. Origin, by two heads from the 
os calcis; insertion, into the tendon of the flexor longus digi- 
torum; action, accessory flexor of the toes; nerve, external plantar. 20 
QUIZ COMPEND 
108. Describe the lumbricales. Origin, the four lumbricales arise from 
the long flexor tendons at the point where the tendon divides; in- 
sertion, into the dorsum of the first phalanx of the four lesser 
toes; action, accessory flexors of the toes; nerves, internal plantar 
to the innermost and the external plantar to the outer three. 
109. Describe the flexor brevis hallucis. Origin, from the cuboid and 
external cuneiform bones; insertion, into both sides of the base 
of the first phalanx of the great toe by two portions in which are 
found the sesamoid bones; action, to flex the great toe; nerve, 
internal plantar. 
110. Describe the adductor obliquus hallucis. Origin, from the tarsal 
ends of the three middle metatarsal bones; insertion, into the 
outer side of the base of the first phalanx of the great toe; action, 
to adduct the great toe; nerve, external plantar. 
111. Describe the flexor brevis minimi digiti. Origin, from the base 
of the fifth metatarsal bone; insertion, into the base of the first 
phalanx of the little toe externally; action, to flex the little toe; 
nerve, external plantar. 
112. Describe the adductor transversus hallucis. Also called the trans- 
versus pedis. Origin, from the plantar ligaments of the three outer 
metatarso-phalangeal joints; insertion, outer side of the first 
phalanx of the great toe, blending with the tendon of the adductor 
obliquus hallucis; action, to adduct the great toe; nerve, external 
plantar. 
113. Describe the dorsal interossei muscles. There are four such mus- 
cles. Origin, each by two heads from the adjacent sides of the 
two metatarsal bones; insertion, into the base of the first phalanx 
of the corresponding toe, the second having two; action, to abduct 
the toes; nerve, external plantar. 
114. Describe the plantar interossei muscles. There are three such 
muscles. Origin, from the shafts of the third, fourth, and fifth 
metatarsal bones; insertion, into the bases of the first phalanges 
of the same toes; action, to adduct the toes toward the median 
line; nerve, external plantar. 
Angiology 
115. Describe the arteries. The arteries are cylindrical tubular ves- 
sels which carry blood from the heart to every part of the body. 
116. Describe the capillaries. The capillaries are minute blood vessels 
which form a network throughout the tissues of the body and con- 
nect the terminating arteries with the commencing veins. 
117. Describe the veins. The veins are the vessels which return the 
blood from the capillaries to the heart. 
118. How many divisions of veins are there? Two, the superficial and 
the deep veins. ANATOMY 
21 
119. Describe the lymphatics. The lymphatics are delicate transparent 
vessels which are distributed throughout the body wherever there 
are blood vessels and they convey the lymph to the blood. The 
larger lymphatics are constructed much like the veins and act as an 
auxiliary venous system. The lymphatic system terminates by 
flowing into the venous system through the thoracic duct and the 
right lymphatic duct. 
120. Describe briefly how the arterial blood reaches the foot from the 
heart. The blood leaves the heart and enters the arch aorta, then 
passes downward through the thoracic aorta, the abdominal aorta 
and enters the common iliac arteries. These divide into an internal 
and external iliac and this latter branch enters the thigh where 
it becomes the femoral artery. The femoral continues down the 
thigh to behind the knee joint where it is called the popliteal 
artery. The popliteal divides a little below the knee joint into 
the anterior tibial and the posterior tibial arteries. These latter 
pass downward into the foot. 
121. Describe the anterior tibial artery. The anterior tibial artery is 
a branch of the popliteal artery. It passes between the two heads 
of the tibialis posticus, over the upper edge of the interosseus 
membrane and then down the front of the leg and at the ankle 
joint it becomes the dorsalis pedis. 
122. Describe the dorsalis pedis artery. The dorsalis pedis artery is a 
continuation of the anterior tibial and extends from in front of the 
ankle joint to the back part of the first intermetatarsal space where 
it terminates in the dorsalis hallucis. It gives off branches as 
follows: tarsal, metatarsal, dorsalis hallucis, and communicating. 
123. Describe the tarsal branch of the dorsalis pedis artery. The tarsal 
branch passes outward along the tarsus. 
124. Describe the metatarsal branch of the dorsalis pedis artery. The 
metatarsal branch passes outward at the metatarsus and gives off 
three interosseus branches which pass forward in the three outer 
interosseus spaces. These three interosseus branches give off 
seven digital branches which supply the three and one-half outer 
toes. 
125. Describe the dorsalis hallucis artery. This artery continues for- 
ward from the dorsalis pedis and supplies the great toe and the 
inner side of the second toe. 
126. Describe the communicating branch of the dorsalis pedis artery. 
This branch dips down into the sole of the foot in the first interos- 
seus space and joins the external plantar artery, thus completing 
the plantar arch. It then gives off a branch on the plantar sur- 
face which is called the dorsalis princeps hallucis or the arteria 
magna hallucis which supplies the great toe and the inner side of 
the second toe on the plantar surface. This is an exceptional situ- 
ation, where a branch of a dorsal artery supplies the plantar sur- 
face. 22 
QUIZ COMPEND 
127. Describe the posterior tibial artery. The posterior tibial artery is 
a branch of the popliteal artery and extends along the back of the 
tibia to the fossa below the inner malleolus where it divides into 
the internal and the external plantar arteries. 
128. Describe the internal plantar artery. The internal plantar artery is 
the smaller of the terminal branches of the posterior tibial and 
passes along the inner side of the foot and the great toe. 
129. Describe the external plantar artery. The external plantar artery 
is the larger of the two terminal branches of the posterior tibial 
artery. It sweeps across the plantar aspect of the foot in a curve, 
the convexity of which is directed forward and outward. It then 
turns inward at the bases of the metatarsal bones, and at the first 
interosseus space it inosculates with the communicating branch of 
the dorsalis pedis, completing the plantar arch, or the stirrup anast- 
mosis. It gives off four digital branches which divide to supply 
the three outer toes and the outer side of the second toe. 
130. Describe the veins of the foot. The veins of the foot are super- 
ficial and deep. On the plantar surface there are no superficial 
veins, these being found only on the dorsum. Deep veins are 
found both on the dorsal and plantar surfaces, and follow the 
course of the arteries, and are named after them. 
131. Describe the venous arch. The venous arch is formed on the 
dorsum of the foot by the superficial venules from the toes which 
meet at about the heads of the metatarsal bones. From the inner 
side of the venous arch the internal or long saphenous vein com- 
mences and from the outer side, the external or short saphenous 
vein takes its origin. 
132. Describe the internal or long saphenous vein. The internal or 
long saphenous vein commences on the inner side of the venous 
arch and runs up the leg and inner side of the thigh and enters 
into the femoral vein. 
133. Describe the external or short saphenous vein. The external or 
short saphenous vein arises from the outer side of the venous 
arch, ascends behind the outer malleolus, up the middle of the 
back of the leg and empties into the popliteal vein. The pop- 
liteal vein in turn empties into the femoral. 
134. Describe the lymphatics of the lower extremity. The lymphatics 
of the lower extremity are in two sets, the superficial and deep. 
The superficial lie in the superficial fascia along the course of the 
saphenous veins. The deep are few in number and accompany the 
deep blood vessels. 
Neurology 
135. How do the nerves reach the foot and leg? The nerves of the 
foot and leg are branches of the great sciatic nerve which comes 
from the lumbo-sacral cord and the four upper sacral nerves. 
These structures come from the spinal cord. ANATOMY 
23 
136. Describe the great sciatic nerve. The great sciatic nerve is the 
largest nervous cord in the body. It passes through an opening 
called the great sacro-sciatic foramen to the back of the thigh, 
giving off branches and terminating in the internal and the ex- 
ternal popliteal nerves. 
137. Describe the internal popliteal nerve. The internal popliteal nerve 
is the larger of the two terminal branches of the great sciatic and 
descends along the back of the thigh and knee where it becomes 
the posterior tibial nerve. It gives off a branch called the com- 
municans tibialis or communicating branch which joins the com- 
municating branch of the external popliteal to form the external 
saphenous nerve. 
138. Describe the external popliteal nerve. The external popliteal nerve 
is the smaller of the two terminal branches of the great sciatic 
nerve and descends obliquely along the outer side of the popliteal 
space and winds around the head of the fibula and about one inch 
below the head of the fibula it divides into the anterior tibial 
nerve and the musculo-cutaneous nerve. It gives off a branch 
called the communicans peronei or the communicating branch 
which joins the communicating branch of the internal popliteal to 
form the external saphenous nerve. This nerve is sometimes called 
the peroneal nerve. 
139. Describe the external saphenous nerve. The external saphenous 
nerve is formed by the both communicating branches of the pop- 
liteals. It descends along the outer side of the leg to the outer 
malleolus and is distributed to the skin on the outer side of the 
foot and the little toe. 
140. Describe the posterior tibial nerve. The posterior tibial nerve is a 
continuation of the internal popliteal nerve and descends along 
the back of the leg to the inner malleolus where it divides into 
the internal and the external plantar nerves. 
141. Describe the internal plantar nerve. The internal plantar nerve is 
one of the terminal branches of the posterior tibial nerve and sup- 
plies the inner plantar muscles, the sole of the foot, and the skin 
of the three and one-half inner toes. 
142. Describe the external plantar nerve. The external plantar nerve 
is one of the terminal branches of the posterior tibial nerve and 
supplies the outer plantar muscles and the skin of the one and one- 
half outer toes. 
143. Describe the anterior tibial nerve. The anterior tibial nerve is one 
of the terminal branches of the external popliteal nerve and passes 
down the front of the leg in company with the anterior tibial ves- 
sels. It supplies the extensor muscles, the ankle joint and the 
skin of the adjacent side of the great and second toes. 
144. Describe the musculo-cutaneous nerve. The musculo-cutaneous 
nerve is one of the terminal branches of the external popliteal 
nerve and passes down the front of the leg superficially. It di- 24 
QUIZ COMPEND 
vides into two branches, the internal and the external branches. 
These in turn divided into two branches also called the internal 
and external branches. 
145. Describe the distribution of the musculo-cutaneous nerve. The in- 
ternal branch of the internal branch supplies the inner side of the 
great toe. The external branch of the internal branch supplies 
the adjacent sides of the second and third toes. The internal branch 
of the external branch supplies the adjacent sides of the third 
and fourth toes. The external branch of the external branch sup- 
plies the adjacent sides of the fourth and fifth toes. 
146. How many divisions of the nervous system are there? There are 
two divisions: (1) the cerebro-spinal system which includes the 
brain and the spinal cord and the peripheral nerves; (2) the sym- 
pathetic system, which includes the great plexuses such as the 
cardiac and solar plexus and ganglia. The first deals more with 
sensation and motion and the second deals more with the func- 
tion of the vessels, viscera, and glands. 
147. What are motor nerves? Motor nerves are efferent nerves which 
convey impulses which excite muscular contraction. 
148. What are sensory nerves? Sensory nerves are afferent nerves con- 
veying stimuli from the outer world which are converted into sen- 
sations by the central nervous system. 
149. What is an efferent nerve? An efferent nerve is one that con- 
veys an impulse from the central nervous system to the periphery. 
150. What is an afferent nerve? An afferent nerve is one that conveys 
an impulse from the periphery to the central nervous system. 
The Skin and its Appendages 
151. What are the divisions of the skin? The skin is divided into two 
main divisions—the epidermis and the derma. 
152. Briefly describe the epidermis. The epidermis, cuticle or scarf 
skin, is made up of epithelial tissue without blood supply and 
with nerves only in the deeper layers. It is made up of four 
layers from without inward: (1) stratum corneum, (2) stratum 
lucidum, (3) stratum granulosum, (4) stratum mucosum or rete 
malpighii. 
153. Briefly describe the derma. The derma, true skin, corium or cutis 
vera, is made up of connective tissue, rich in blood and nerve 
supply and containing the hair follicles, sweat and sebaceous 
glands. It is composed of two layers, the upper or papillary and 
the lower or reticular layer. 
154. Whatare the appendages of the skin? The appendages of the skin 
are nails, hairs, sweat glands, and sebaceous glands. 
155. Mention the structures found in the skin. The papillae which con- ANATOMY 
25 
tain the tactile corpuscles, or touch organs, are found in the 
papillary layer of the derma. The hair follicles are in the reticular 
layer of the derma. The sebaceous glands are found in the 
reticular layer of the derma. The sweat glands are found in the 
subcutaneous tissue. The fat cells are found in the subcutaneous 
tissue. 
156. Briefly describe the nail. The nail is a curved, flat, horny structure 
a modification of the epidermis, molded upon the derma at the 
distal ends of the fingers and toes on the dorsal surface of the 
distal phalanges. The nail is convex on its outward surface and 
is embedded by its root into the posterior nail fold. 
157. What is the nail matrix? The nail matrix is that portion of the 
nail bed immediately beneath the body of the nail and is made up 
of highly vascular papillae. It is from this structure that the nail 
is produced. 
158. What is the lunula? The lunula is a white cresentic portion of 
the nail nearest to its root, produced by the diminution of the 
number and size of the papillae beneath. 
159. Briefly describe the hairs. The hairs are a modified form of epi- 
dermis, found over nearly the whole surface of the body, much 
varied in size and color. Each hair consists of a root and a shaft. 
160. What is the hair root? The hair root is the lower end of the hair 
which is lodged in an involution of the epidermis called the hair 
follicle. The root rests on a vascular papilla which supplies it 
with the material from which it grows. 
161. What is the hair shaft? The hair shaft is the projecting portion 
of the hair. 
162. Briefly describe the sweat glands. The sweat or sudoriferous 
glands consist each of a single convoluted tube which is found 
in the subcutaneous tissue and opening on the surface of the skin 
by a spiral duct. The glands are very numerous varying in differ- 
ent parts of the body, the total being estimated at about two and 
one-half millions. They are most numerous on the palms and 
soles. 
163. Briefly describe the sebaceous glands. The sebaceous glands ara 
small bodies found in the corium almost all over the body, but not 
on the palms and soles. Each gland has a single duct which 
opens into a hair follicle or on the epidermis. CHAPTER II. 
HISTOLOGY 
1. What is histology? Histology is the study of the structural ele- 
ments of animal and plant organisms. The term is usually ap- 
plied to animal tissues only. 
2. What is human histology? Human histology is the study of the 
minute structures of the human body. It is also called minute 
anatomy or microscopic anatomy. 
3. What are the structural elements? The structural elements are 
the cells and the intercellular substance. 
4. How is the character of the various organs and tissues determined? 
The character of the various tissues and organs of the body is 
determined by the relation of the cells and the intercellular sub- 
stance, by the relative quantity of each, by the size and character 
of the cells and by the consistency and character of the inter- 
cellular substance. 
5. What is a cell? A cell is a minute structure, the living active 
basis of animal organization. It is composed of a mass of proto- 
plasm containing a nucleus. 
6. Are all cells in the body alike? No. The cells differ in size, 
shape, and function. 
7. What is a typical cell? A typical cell is a cell that is taken theo- 
retically for description and shows all of the component parts that 
may be considered as being present in nearly every cell at some 
time during its life. 
8. What are the component parts of a typical cell? A typical cell 
is composed of a cell wall, of cytoplasm, of a nucleus, of nucleoli, 
of a paranucleus, and of a centrosome. 
9. What is the cell wall? The cell wall is the outer investment of the 
cell and should be regarded as a condensation or specialization 
of the cytoplasm rather than as a distinct and separate structure. 
It usually appears under the microscope as a single delicate line. 
10. What is the cytoplasm? The cytoplasm, or cell contents, is a semi- 
liquid substance, composed of an elastic portion called the spongeo- 
plasm and within the network of the spongeoplasm is the hyalo- 
plasm. HISTOLOGY 
27 
11. What is the nucleus? The nucleus is a very important part of 
the cell. It is found within the cytoplasm, usually in the center of 
the cell and is limited by a distinct wall called the nuclear mem- 
brane. It is composed of a network called chromatin filaments 
in which is held a semi-liquid substance called the achromatin 
substance. 
12. What are nucleolei? The nucleolei are spherical bodies held in 
the network of the chromatin filaments. The significance of these 
bodies is not known. 
13. What is the paranucleus? The paranucleus, or accessory nucleus, 
is an irregular spherical body, found within the cytoplasm and 
near the nucleus. Little is known of this structure. 
14. What is the centrosome? The centrosome is a very small highly 
refracting body found within the nucleus of the cell. This portion 
of the cell plays an important part during the reproduction of 
the cell. 
15. What are vital manifestations? The vital manifestations are those 
characteristics that distinguish a living cell from inorganic matter. 
16. How are the vital manifestations classified? The vital manifesta- 
tions are classified as metabolism, growth, irritability, motion, and 
reproduction. 
17. What is metabolism? Metabolism is a term applied to that power 
which the cell has to select from surrounding food materials, such 
substances that will suit its needs for nutrition and function and 
making them part of the cell. It also includes the power of the 
cell to expel waste matter. It is divided into anabolism and 
catabolism. 
18. What is anabolism? Anabolism is the term applied to the con- 
structive or assimilative changes in a cell. 
19. What is catabolism? Catabolism is the term applied to the de- 
structive or retrogressive changes in a cell. 
20. What is growth? Growth is the natural outcome of metabolism 
and is the unequal development of the cell. The growth of a cell 
may be equal in all parts, but usually it is unequal. This unequal 
growth exerts a great influence toward the specialization of form 
in the cells. 
21. What is irritability? Irritability is the power of the cell to re- 
spond to external stimuli by changes within the cell itself. 
22. What is motion? Motion is a manifestation of all cells sometime 
during their life history. This power is influenced by the de- 
velopment and specialization of some cells as they mature. In 
some cells external appendages develop, while in others the cyto- 
plasm undergoes specialization, resulting in a peculiar tissue, such 
as voluntary muscle fibres. 28 
QUIZ COMPEND 
23. IF hat is reproduction? Reproduction is the most important of 
the vital manifestations and consists of the division of a cell into 
two cells, etc. This phenomenon occurs in two ways: (a) by di- 
rect cell division or akinesis, (6) by indirect cell division or 
karyokinesis. 
24. What is akinesis? Akinesis or fission or direct cell division oc- 
curs in some cells. It consists of mere constriction and setting 
free of a portion of the cell without the complex changes that 
occur in the indirect method. It is the exception rather than the 
rule in the human body. 
25. What is karyokinesis? Karyokinesis, or indirect cell division, is 
a complex procedure in which changes take place within the cell 
producing two daughter cells from one mother cell. The centro- 
some plays an important part in this form of cell reproduction. 
(The reader is referred to any standard textbook on histology 
for the details of this phenomenon.) 
26. What is the ovum? The ovum is the parent cell from which all 
of the cells of the human body are derived. 
27. Describe the ovum. The ovum is a specially developed cell of 
one of the female generative organs, the ovary. It is one of the 
largest histologic elements and undergoes certain peculiar changes 
preparatory to reproduction. Before the ovum can complete its 
life function, it must be joined by the male sexual element, the 
spermatozoon, which is derived from the testicle. . 
28. Describe the changes that take place in the ovum before it repro- 
duces. The preparatory changes that take place in the ovum are 
called maturation. These changes are as follows: there is an 
unequal division of the ovum and a protrusion of minute portions 
of its cytoplasm. These protrusions are called polar bodies. 
After the formation of the polar bodies a nucleus appears which is 
called the female pronucleus. This completes maturation and the 
ovum is ready to receive the spermatozoon. 
29. Describe the process known as fertilization of the ovum. Fertiliza- 
tion consists of the entrance of the spermatozoon into the ovum 
which results in the formation of a male pronucleus. Subse- 
quently, the male pronucleus joins with the female pronucleus 
and after this fusion there is a period when there is no nucleus 
within the ovum. Shortly afterward a nucleus of segmentation 
appears. This completes fertilization. 
30. What occurs in the ovum after fertilization is completed? After 
fertilization the ovum divides and redivides by indirect cell divi- 
sion and so a large number of cells form which arrange themselves 
into three layers called the blastodermic layers or the blastoderm. 
31. What is the blastoderm? The blastoderm, or blastodermic layers, 
are three more or less distinct layers of cells which are named 
(a) ectoderm, (b) mesoderm, (c) entoderm. 32. Describe the ectoderm. The ectoderm is the outer layer of the 
blastoderm and from it are developed the following tissues of the 
body: the epithelium of the outer surface of the body including 
the appendages, the epithelium of the nasal tract, the epithelium 
of the mouth, the enamel of the teeth, the tissues of the nervous 
system, etc. 
33. Describe the mesoderm. The mesoderm is the middle layer of 
the blastoderm and from it are derived the following tissues of the 
body: the connective tissues, the muscular tissues, the tissues of 
the vascular and lymphatic systems, the kidney and ureter, etc. 
34. Describe the entoderm. The entoderm is the inner layer of the 
blastoderm and from it are derived the following tissues of the 
body: the epithelium of the digestive tract, the epithelium of the 
respiratory tract, the epithelium of the urinary bladder and 
urethra, etc. 
35. Describe the blastodermic development. As the cells develop 
from the ovum and form the three layers called the blastoderm 
there is a gradual advancement in arrangement and then from 
these three layers all the tissues of the body are formed. The 
tissues are classified into five subdivisions called the elementary 
tissues. 
36. What are the elementary tissues of the body? The five elementary 
tissues of the body are epithelial tissue, connective tissue, muscu- 
lar tissue, nervous tissue, and blood and lymph. 
37. How are these tissues differentiated? The differentiation between 
the elementary tissues depends upon the character of the cells, 
the amount and character of intercellular substance, together with 
the relationship between them in quantity. 
38. How is tissue prepared for histologic examination? All tissue 
must undergo special preparation before it can be studied under 
the microscope. The preparation consists of first removing all of 
the water contained therein and then embedding it in some mate- 
rial usually paraffin or celloidin. This makes it possible to cut 
the tissue into thin sections so that it can be easily studied. The 
thin section is then mounted upon a glass slide and when fixed 
thereon, it is stained with dyes of different colors so that different 
parts of the cells and intercellular substance are easily dis- 
tinguished. 
39. What is epithelial tissue? Epithelial tissue is that tissue which 
is found covering all structures connected with the outer air such 
as the entire lining of the digestive tract, the epidermis, the re- 
spiratory tract, etc. 
40. How is epithelium classified? Epithelium is classified according 
to the shape and appearance of the cell as follows: (1) Squamous—- 
(a) simple, consisting of a single layer; (b) stratified, consisting 
of several layers. (2) Columnar—(a) simple, (b) stratified. 
HISTOLOGY 
29 30 
QUIZ COMPEND 
(3) Modified—(a) ciliated, (b) goblet, (c) pigmented. (4) 
Specialized—(a) glandular epithelium, (b) neuro-epithelium. 
41. Describe how epithelium is nourished. Epithelium is without 
blood supply and receives its nourishment through the power of 
absorption from the structures upon which it rests. The nerve 
supply is very irregular, in some places being entirely absent and 
in other structures it is very highly developed, as in the cornea 
of the eye. The epithelial cells usually rest upon a basement mem- 
brane (membrana propria) which is a modification of the con- 
nective tissue. 
42. Describe simple squamous epithelium. Simple squamous epithe- 
lium consists of a single layer of flat, polyhedral plates, with or 
without nuclei, so arranged that their edges are in close apposition 
and held together by a cement substance. This form of epithelium 
is found only in a few places in the human body as in the air sacs 
of the lungs. 
43. Describe stratified squamous epithelium. This form of epithelium 
is more commonly found in the body. The cells vary greatly in 
size and shape depending upon in which layer they are found. 
Those of the deeper strata are not scaly but irregularly columnar 
in shape. The cells become more flattened in the upper layers and 
in the outermost layers the cells are scaly, non-nucleated plates. 
An example is the epidermis. 
44. Describe simple columnar epithelium. This form of epithelium is 
more common than the simple squamous type. It is composed of 
a single layer of cells resting upon a basement membrane. It is 
found in the greater portion of the digestive tract and in other 
places. 
45. Describe stratified columnar epithelium. Stratified columnar epi- 
thelium is composed of several layers of columnar cells. The lower 
strata of cells are more or less flattened out by the superimposed 
cells of the upper layers. The nuclei of the lower cells are found 
near the basement membrane, while those of the upper layers are 
found in the center of the cell. 
46. Describe ciliated epithelium. Ciliated epithelium is composed of 
epithelial cells found on a free surface and showing hair-like 
processes which extend outward and are called cilia. These cilia, 
by the wave-like motion, serve to keep in action the flow of secre- 
tions that pass over the surface and prevent foreign bodies from 
entering structures to which they would be harmful. The cilia 
are specialized prolongations of the cytoplasm of the cell. 
47. Describe goblet-cell epithelium. The goblet cell is a columnar 
cell which contains particles of mucous. In discharging this 
mucous the cell takes on a scooped-out appearance at the upper 
portion with the nucleus crowded down toward the base of the cell. 
48. Describe the pigmented epithelium. The cytoplasm of some epi- 
thelial cells contains a granular substance called melanin which HISTOLOGY 
31 
gives the cell a brown or blackish tint. Such a cell is called a 
pigmented cell and is found in the epidermis of certain races 
such as the negro. These cells are also found in the outer layers 
of the retina. 
49. Describe glandular epithelium. Glandular epithelium is a spe- 
cialized form varying from columnar to polyhedral in shape. The 
cells are modified so that they are able to manufacture a secre- 
tion. The cytoplasm is more or less filled with the secretion and 
sometimes the cytoplasm is almost entirely displaced by, fatty 
substances as in the sebaceous glands. 
50. Describe neuro-epithelium. Neuro-epithelium is a specialized epi- 
thelium toward which the nerves of special sense are directed and 
receives these nerve endings. 
51. What is endothelial tissue? Endothelial tissue, or endothelium, is 
a division closely resembling epithelium and is classified by some 
in that group. On the other hand, it is derived from the meso- 
derm and others classify it with the connective tissues. Endo- 
thelium is found lining all cavities not connected with the outer 
air, such as the pleural and peritoneal cavities, and lines all blood 
vessels. It occurs as a single layer of cells resting upon a sub- 
endothelial stroma. The cells are irregular in size and shape. 
The typical endotheliae cells are large polyhedral plates with a 
round or oval nucleus found in the center of the cell. 
52. What is connective tissue? Connective tissue forms the con- 
nective and supporting framework of the entire body. It is the 
most widely distributed of all the tissues. In connective tissue the 
intercellular substance is very abundant and in some instances, it 
predominates over the cells. This is especially true in tissues 
such as bone or cartilage. 
53. How is connective tissue classified? The important subdivisions 
of connective tissue are: (a) areolar tissue, (6) white fibrous 
tissue, (c) yellow elastic tissue, (d) cartilage, (e) bone, (/) adi- 
pose tissue. 
54. Describe areolar tissue. Areolar tissue is that form of connective 
tissue which is composed of flat stellate cells which are held in 
place by fine delicate fibers, that are prolongations of the cyto- 
plasm of the cells. Areolar tissue is found in the supporting 
framework of the soft organs of the body and in fine layers be- 
tween the muscles. 
55. Describe white fibrous tissue. White fibrous tissue occurs in all 
parts of the body. The cells of this tissue are small and flattened 
and the fibers are found in bundles, either loose or compact, de- 
pending on the locality in which it is found. When found loose, 
the fibers have a wavy appearance, but when found compact as 
in a tendon, the wave is not noticed. 
56. Describe yellow elastic tissue. Yellow elastic tissue is found in 
association with white fibrous tissue and sometimes is classified 32 
QUIZ COMPEND 
with it. The elastic fibers differ from the white fibers, but other- 
wise the tissues are the same. The elastic fibers are found in 
bundles interwoven with white fibers and are much thicker and 
more tortuous than the white fibers. 
57. Describe cartilage. Cartilage is a form of connective tissue which 
shows marked specialization of the intercellular substance depend- 
ing upon the variety of cartilage. 
58. Mention the varieties of cartilage. There are three varieties of 
cartilage: (a) hyaline, (b) fibrous, (c) elastic. 
59. Describe hyaline cartilage. Hyaline cartilage is widely distributed, 
being found at the ends of bones. It appears blue in mass. The 
intercellular substance is called the “matrix” and is made up of 
bundles of white fibers. The cartilage cells occur in spaces within 
the matrix, these spaces being called “lacunae,” each space con- 
taining two or more cells. The free surface of the cartilage is 
covered by a dense fibrous tissue called the “perichondrium.” 
60. Describe fibrous cartilage. Fibrous cartilage is found in only a 
few places in the body, but when found, it is in considerable bulk. 
The inter-vertebral disks are fibro-cartilage. It is made up of 
closely packed bundles of white fibers containing lacunae and 
cartilage cells. It has no distinct perichondrium. 
61. Describe elastic cartilage. The distribution of elastic cartilage 
is limited. The cartilages of the external ear are elastic cartilage. 
It is dull yellow in color, pliable, and tough as compared to the 
bluish, comparatively brittle hyaline cartilage. It appears as a 
net work of wavy fibers in which are found lacunae and car- 
tilage cells. 
62. Describe bone. Bone is one of the dense forms of connective 
tissue. Its structure is similar to that of cartilage, differing in 
that within the matrix lime salts are deposited. There are two 
varieties of bone—(a) compact and (b) spongy. 
63. Describe a cross-section of compact bone. A cross-section of com- 
pact bone shows a number of round or oval openings called the 
“Haversian Canals.” Each such canal is surrounded by calcareous 
plates concentrically arranged and called “lamellae.” Between the 
lamellae are small spaces called “lacunae” and the bone cells are 
found within these lacunae. Connecting the lacunae with each 
other and with the Haversian canals are small channels called 
“canaliculi.” Collectively this is called an Haversian system. 
64. Describe spongy bone. Spongy, or cancellated bone, is made up 
of delicate lamellae united into a bony framework, so arranged 
as to give strength without weight. The structure is very similar 
to compact bone. It is found at the end of long bones, while the 
shaft of such bones is made up of compact bone. 
65. What is the periosteum? The periosteum is a fibrous covering 
found over bone except at the extremity where it blends with the perichondrium. It is composed of two layers, an outer fibrous 
layer and an inner fibro-elastic layer. In early life there is (a 
third layer present called the osteo-genetic layer. 
66. What is the marrow cavity? The marrow, or medullary cavity, is 
found in the center of long bones and contains the marrow. In 
young, growing persons, the marrow is red and has a rich blood 
supply. Later in life, fat deposits form and the marrow takes on 
a yellow appearance. 
67. Describe muscular tissue. Muscular tissue is made up of cells 
which have a highly developed power of contractility. The cells 
are especially constructed for this purpose, being elongated struc- 
tures which shorten so as to exert a direct pull which results in a 
movement of the part upon which the action is exerted. 
68. How does muscular tissue occur in the human body? Muscular 
tissue occurs as striated and non-striated when considered histo- 
logically and as voluntary and involuntary when considered physio- 
logically. The heart muscle is a third variety, being striated but 
involuntary. 
69. Describe non-striated or involuntary muscle. Non-striated muscle 
occurs in bundles and thin sheets, mostly in the walls of vessels 
and the hollow viscera. It is widely distributed, but seldom forms 
large masses. It is found in the digestive tract, the respiratory 
tract, the urinary tract, in the generative organs, and in the skin. 
The non-striated muscle units are called “fiber-cells.” The cells 
are spindle shaped and have a rod-shaped nucleus which is found 
in the center of the cell. Within the cell are found contractile 
fibrillae. 
70. Describe striated or voluntary muscle. This form of muscle tissue 
includes all the muscles attached to the skeleton. The structural 
unit is the striated muscle fiber, which is a highly specialized cell. 
The muscle fiber is an elongated cell which is multi-nucleated and 
consists of a sheath called the “sarcolemma” in which is found 
the “sarcous substance.” The sarcolemma is a transparent elastic 
membrane which corresponds to the cell wall in other cells. The 
sarcous substance is made up of sarcoplasm and contractile fibrillae. 
These latter structures bring about contraction of the muscle 
fiber. The nuclei of a muscle fiber are found immediately beneath 
the sarcolemma. 
71. Describe the heart muscle. The heart or cardiac muscle is a com- 
bination of, or may be classified between, the striated and the non- 
striated varieties. The muscle cell is a short cylindrical fiber which 
has lateral processes or branches. The apposition of these branches 
forms a close, narrow network. There is no sarcolemma and the 
nuclei are found near the center of the cell. 
72. How is nervous tissue divided? Nervous tissue is divided for 
convenience of study into (a) nerve cells, (6) nerve fibers, (c) 
neuroglia. 
HISTOLOGY 
33 34 
QUIZ COMPEND 
73. What are nerve cells? The nerve cells are that portion of nervous 
tissue from which nervous impulses arise. 
74. What are nerve fibers? Nerve fibers are structures which convey 
nerve impulses. 
75. What are neuroglia? Neuroglia are the tissues which act as a 
framework in supporting the cells and fibers. 
76. Describe the nerve cells. Nerve cells are of a great variety of 
shapes and some of them are very large. They consist of a mass 
of granular or striated cytoplasm in which is found a large round 
or oval nucleus. The cytoplasm of every nerve cell extends away 
from the main mass into at least one prolongation or process 
called the axone or axis cylinder. Usually there are two or more 
such processes and in these cases one is called the axone and the 
others the dendrites. According to the number of processes the 
nerve cells are classified as unipolar, bipolar, and multipolar. A 
nerve cell with its processes is called a neurone. 
77. Describe the nerve fibers. The nerve fibers are not independent 
elements, but are prolongations of the processes of neurones. The 
fundamental part of the nerve fiber is the central portion called 
the “axis cylinder,” which is a delicate thread surrounded by the 
“axilemma.” Around the axis cylinder is a thick coat called the 
medullary sheath, or the white matter of Schwann, around which 
is found the neurilemma or sheath of Schwann. 
78. How are nerve fibers classified? Nerve fibers are classified as 
medullary and non-medullary. The difference lies in that the 
medullary sheath, or white matter of Schwann, is present in the 
first class and absent in the second class. 
79. Describe neuroglia. Neuroglia is a special supporting network of 
tissue which holds together the neurones, nerve cells, and nerve 
fibers. The neuroglia consists essentially of the same structures 
throughout the body, varying only in consistency. 
80. Describe the nerve trunks. The nerve fibers are distributed to the 
different parts of the body in cord-like bundles of varying size, 
which are called, anatomically, nerves. These nerves contain all 
kinds of nerve fibers. The nerve fibers are grouped into bundles 
called “funicula.” Each funiculus is surrounded by a connective 
tissue covering called the “perineurium.” The various funicula are 
bound together loosely and are invested by a connective tissue 
envelope called the “epineurium.” In this latter structure are 
found the blood vessels and lymphatics that nourish the nerve. 
81. What is blood? Blood is a fluid circulating within the blood- 
vascular system and is composed of a clear, almost colorless plasma, 
or “liquor sanguinis,” in which is suspended the blood cells. 
82. How are the blood cells classified? The blood cells are classified 
into two chief kinds—(a) colored cells, or erythrocytes, and (6) 
colorless cells, or leucocytes. HISTOLOGY 
35 
83. What imparts the red color to blood? The blood is colored red 
due to the presence of hemoglobin contained in the erythrocytes. 
The individual cells are only faintly tinted, but in mass they give 
the characteristic color to the blood as well as a degree of opacity. 
84. Describe the colored blood cells. The colored blood cells are 
small biconcave disks without nuclei. The average size of the 
erythrocyte is 7.8 microns in diameter. There are about 5,000,000 
red cells in a cubic millimeter of blood in the male and slightly 
less in the female. 
85. Describe the colorless blood cells. The colorless blood cells ap- 
pear as pale, nucleated elements which have a pearly tint. Their 
shape varies, being irregularly spherical or oval. They are larger 
than the erythrocytes and are less numerous. The average size is 
10 to 12 microns in diameter and the range from 5,000 to 10,000 
in a cubic millimeter. On a warm slide, the white blood cells 
show that they have the power of ameboid movement, changing 
both their shape and their position. 
86. How are the colorless blood cells classified? The colorless blood 
cells are classified into five divisions, as follows: (1) small lympho- 
cytes, (2) large lymphocytes, (3) large mononuclear leucocytes, 
(4) polymorphonuclear leucocytes, (5) eosinophiles. 
87. Describe the small lymphocytes. The small lymphocytes are about 
20 to 30 per cent of all colorless blood cells. They are dis- 
tinguished by a large deeply staining nucleus that occupies prac- 
tically the entire cell. The average diameter is 7.5 microns. 
88. Describe the large lymphocytes. The large lymphocytes are about 
5 to 6 per cent, of all colorless cells. These cells are larger than 
the preceding variety (12 to 15 microns) and have a small oval 
nucleus. The cytoplasm is plentiful and non-granular. 
89. Describe the large mononuclear leucocytes. The large mononu- 
clear leucocytes are about 1 to 2 per cent, of all colorless cells. 
They vary in size from 10 to 15 microns and have a palely stained 
nucleus. The cytoplasm is plentiful and fine neutrophilic gran- 
ules are often present. 
90. Describe the polymorphonuclear leucocytes. The polymorphonu- 
clear leucocytes are 70 per cent, of all colorless cells and are the 
most conspicuous. The nucleus is deep staining and at first ob- 
servation appears to be multiple. Close inspection shows the 
nucleus to consist of several segments which are connected by 
delicate filaments. Occasionally two or more isolated nuclei do 
occur. The cytoplasm is abundant and contains fine granules. 
The cells average 10 microns in diameter. 
91. Describe the eosinophiles. The eosinophiles are 2 to 4 per cent, 
of all colorless cells, resemble the polymorphonuclear leucocytes 
in many particulars, but the cytoplasm contains coarse, highly 
refracting granules which have a decided pink hue. 36 
QUIZ COMPEND 
92. Are any other cellular structures found in blood? Yes. Baso- 
philes, mastcells, myelocytes, and blood-plates are also found in 
blood. 
93. Describe lymph. Lymph corresponds very closely to the blood in 
that it is a circulating fluid containing two parts—the plasma and 
the lymph corpuscles. The lymph plasma is like that of the blood, 
representing the intercellular structure. The lymph corpuscles 
possess all of the characteristics of the colorless blood cells, hut 
the quantity and proportion vary more markedly in the lymph than 
in blood. There are no colored cells in the lymph so that the 
red color is absent. 
94. What is the vascular or circulatory system? The vascular, or 
circulatory system, includes the organs concerned in conveying 
throughout the body the fluids which bring to the tissues nutrient 
materials and oxygen necessary for their life and to carry away 
the waste materials produced during metabolism. The vascular 
system is divided into two parts: (a) the blood vascular system, 
which includes the organs that circulate the blood, (b) the lym- 
phatic system, which includes the organs that convey the lymph. 
95. Describe the blood vascular system. The blood vascular system 
consists of (1) the heart, whose action is that of a force pump, 
which drives the blood through (2) the vessels. The vessels are 
divided into three divisions: (a) the arteries, which carry the 
blood from the heart to the tissues; (6) the capillaries, which are 
delicate structures, permitting the nutrient fluid to come in close 
contact with the tissues; (c) the veins, which carry the blood back 
to the heart. The arteries blend into capillaries and these in turn 
blend into the veins. 
96. What is the general structure of blood vessels? All of the vessels 
and the heart are lined with a layer of endothelium which is con- 
tinuous throughout the body. This is called the “tunica intima,” 
and in the capillaries constitutes the entire vessel wall. In the 
other vessels the endothelium rests upon a fibro-elastic structure, 
the elastic portion of which predominates. External to the intima 
except in the capillaries, there occurs a thick coat containing non- 
striated muscle, elastic tissue and fibrous tissue called the “tunica 
media.” The outermost coat is called the “tunica adventitia or 
externa” and is very strong. These three coats of the vessels are 
not clearly separated, the outer two blending into each other, so 
that the classification is more or less theoretic. 
97. the heart. The walls of the heart, like those of the 
larger blood vessels, are composed of three general layers. The 
inner layer is called the “endocardium” and is composed of an 
endothelial lining resting upon a fibro-elastic basement membrane. 
The valves of the heart are folds of endocardium reinforced by 
fibro-elastic tissue. The middle layer of the heart is called the 
“myocardium” and is made up of muscle fibers. The external 
layer is called the “epicardium.” Like other serous membranes, it HISTOLOGY 
37 
consists of a single layer of endothelial cells that covers the free 
surface of the heart. Around the whole is a fibrous structure 
lined with serous membrane called the “pericardium.” 
98. Describe the lymphatic system. The lymphatic or lymph-vascular 
system consists of a universally present system of channels, some 
of which are definite tubes called “lymphatic vessels” and others 
which are ill-defined clefts between the bundles of connective 
tissue called “lymph spaces.” The vessels contain the lymph in 
which is found the lymphocytes or corpuscles. The lymphatics 
resemble the veins from which they probably originate and into 
which they finally pour their contents. 
99. What is mucous membrane? Mucous membrane is the tissue 
which lines all of the cavities within the body connected with the 
outer air. It blends with the skin at the openings of the digestive, 
respiratory, and genitourinary tracts. The mucous membrane not 
alone lines these cavities, but continues into the ducts and tubes 
of the glands. 
100. Describe the structure of mucous membrane. Every mucous mem- 
brane is made up of two definite portions: (a) the free surface 
made up of epithelium and protecting the delicate structures be- 
neath; (b) the tunica or membrana propria, which is a network 
of connective tissue which contains the blood vessels, nerves, 
lymphatics, etc. The epithelium varies in structure depending upon 
its location. Thus, in the upper part of the digestive tract 
where the food passes over it in the rough state, the epithelium is 
of the stratified squamous type. In the intestine, where absorbtion 
takes place, it is the simple columnar form. 
101. What are glands? Glands are composed of specialized epithelial 
structures which secrete substances upon the free surface for vari- 
ous purposes. 
102. How are glands classified? Glands are classified into two main 
classes according to the arrangement of their cells: (a) tubular, 
(b) alveolar or saccular. Either form may be simple or compound. CHAPTER III. 
PHYSIOLOGY 
1. Define animal physiology. Animal physiology is the study of the 
phenomena of growth, movement, mentality, and reproduction. 
2. What is special physiology. Special physiology is the study of the 
vital phenomena or functions exhibited by the organs of any in- 
dividual animal. 
3. What is comparative physiology? Comparative physiology is the 
study of the comparison of the vital phenomena or functions ex- 
hibited by the organs of two or more animals with a view to un- 
folding the points of resemblance and dissimilarity. 
4. What is human physiology? Human physiology is the study of the 
functions of the organs of the human body in a state of health. 
5. How is the body of man divided? The body of man is divided 
into two portions—(1) the axial and (2) the appendicular. 
6. What is the axial portion? The axial portion consists of the head, 
neck, and trunk. 
7. What is the appendicular portion? The appendicular portion con- 
sists of the extremities. 
8. What is the characteristic feature of the axial portion of the body? 
The characteristic feature of the axial portion is the bony, seg- 
mented axis which is called the vertebral column, or backbone. 
All animals having such a vertebral column are classed as 
“vertebrata” or vertebrates. 
9. Of what importance is the vertebral column to the body? The 
vertebral column is regarded as the foundation in the plan of 
organization of all higher animals and the center around which 
the body is developed and arranged with a certain degree of 
conformity. At the top of the column rests the skull and within 
it the brain, and at the lower end the column terminates in a 
short tail-like process called the coccyx. Through the center of the 
vertebral column passes the spinal cord, from which the nerves 
originate and which leave the cord along its course. 
10. How is the trunk of the body divided? The trunk is divided by 
a muscular structure called the diaphragm, into an upper section 
called the thorax and a lower section called the abdomen. PHYSIOLOGY 
39 
11. What is the thorax? The thorax is a cavity which contains the 
heart, lungs, the large blood vessels, and the gullet or esophagus. 
12. What is the abdomen? The abdomen is a cavity which contains 
the stomach, intestines, kidneys, ureters, bladder, liver, pancreas, 
etc. 
13. What is the pleura? The pleura is a serous membrane which lines, 
the lungs and the thoracic cavity. t 
14. What is the peritoneum? The peritoneum is a serous membrane 
which lines the abdominal cavity and covers most of the organs 
found therein. 
15. Describe the physiologic association of the organs of the body. 
While each organ serves some specific purpose, it is found that 
throughout the entire body the various organs functionate in 
harmony and cooperation with other organs. This harmonious co- 
operation is necessary to the life of the body. Thus, we have the 
various organs of digestion, all doing some specific duty, yet 
blending each individual function into what is known as diges- 
tion. Thus, the organs have been grouped and the mouth, stomach, 
intestines, and the glands connected therewith have been classified 
as the digestive apparatus. 
16. Mention the various groups of physiologic apparatus in the body, 
(1) The digestive apparatus, made up of the mouth, stomach, 
and intestines, and the glands connected with them; (2) the ab- 
sorptive apparatus, made up of the lymphatics and the capillary 
vessels connected with the villi of the intestines; (3) the circu- 
latory apparatus, made up of the heart and blood vessels; (4) 
the respiratory apparatus, made up of the lungs and trachea, to- 
gether with the diaphragm and the walls of the chest; (5) the 
urinary apparatus, made up of the kidneys, ureters and bladder; 
(6) the neuro-muscular apparatus, made up of the nerves and 
muscles and which produces motion, etc. 
17. What is the chemical composition of the body? The body is made 
up of numbers of complex chemical compounds which upon 
analysis into the elements show the following: oxygen, 72 per 
cent.; hydrogen, 9.1 per cent.; nitrogen, 2.5 per cent.; carbon, 
13.5 per cent.; phosphorus, 1.15 per cent.; calcium, 1.3 per cent.; 
sulphur, 0.147 per cent.; sodium, 0.1 per cent.; potassium, 0.026 
per cent; chlorin, 0.085 per cent.; flourin, iron, silicon, mag- 
nesium, in small and variable amounts. 
18. What is a cell? A cell is a microscopic structure which is the 
primary unit of the body, to which every exhibition of life is to 
be referred. 
19. Describe the structure of a cell. Cells vary in size and shape 
throughout the body, but a typical cell is made up of a gelatinous 
substance forming the body of the cell and called protoplasm, 
within which is found a small spheric body called the nucleus. 40 
QUIZ COMPEND 
The shape of the cell varies with the tissue in which it is found, 
being round, cylindric, fusiform, polygonal, or stellate. (A de- 
tailed description of the cell will be found in the quiz on his- 
tology.) 
20. What are the manifestations of cell life? All cells exhibit three 
fundamental properties of life, viz, growth, nutrition, and repro- 
duction. 
21. What is metabolism? Metabolism is a term which indicates the 
power of the cell to select from surrounding nutritive materials 
substances necessary for its growth and development and to throw 
off substances for which it has no use. The first stage is called 
anabolism and the second catabolism. 
22. How are the tissues of the body classified? The tissues of the 
body are classified as follows: epithelial, connective, muscular, 
nervous, blood, and lymph. 
23. What are the functions of epithelial tissue? Epithelial tissue serves 
as a protective covering on the surface against injurious influ- 
ences; it promotes absorption in the skin, mucous membranes, 
and in the air vesicles of the lungs; it helps to form secretions and 
excretions, the glands being lined with epithelial cells. 
24. What are the functions of connective tissue? As the name im- 
plies, the connective tissues serve as a bond of connection between 
the individual parts of the body, at the same time affording a 
basis of support for muscle, nerve, and gland tissues. 
25. What are the divisions of connective tissue? Connective tissue is 
divided into the following varieties: areolar, adipose, retiform, 
fibrous, elastic, cartilage, and bone. 
26. What is the function of areolar tissue? The areolar tissue serves 
to unite the skin and mucous membrane to the structures upon 
which they rest. It forms sheaths for the support of blood vessels, 
nerves, and lymphatics and unites into compact masses the muscles 
of the body, etc. 
27. What is the function of adipose tissue? Adipose tissue is widely 
distributed and assists in the prevention of too rapid radiation of 
heat from the body. It acts as a cushion to absorb shock, gives 
form and roundness and diminishes angularities. It is utilized 
by the body when the supply of food is diminished for tissue con- 
struction or for oxidation purposes. 
28. What is the function of retiform tissue? Retiform tissue is a 
modification of areolar tissue and supports the lymph corpuscles. 
29. What is the function of fibrous tissue? Fibrous tissue is abun- 
dantly distributed throughout the body, constituting almost en- 
tirely the ligaments and tendons. It is tough and inelastic, and 
fulfills various mechanical functions in the body. It is very pliant, 
bending easily in all directions. PHYSIOLOGY 
41 
30. What is the function of elastic tissue? The fiber of elastic tissue, 
as the name implies, is quite elastic, stretching as much as 60 
per cent, before breaking. It is usually found mixed with fibrous 
tissue and serves to give elasticity to various structures. In some 
places, such as the middle coat of the large blood vessels and in 
special ligaments, it is found unmixed, thus giving great elasticity 
to these structures. 
31. What is the function of cartilage? Cartilage is of different kinds. 
It is found in joints, where it acts as a protective to the ends of 
the bones, and absorbs shock. In some places it is more fibrous 
and here it helps maintain apposition of the bones, and in di- 
minishing the effects of shock and pressure to the bones. In 
other places it contains elastic fibers and here it permits flexi- 
bility and elasticity. 
32. What is the function of bone? Bone affords attachment for 
muscles, thus making motion possible; in places it forms a hard, 
solid protection for the vital organs, such as the skull and the 
chest. 
33. What is the function of the skeleton? The skeleton, a bony frame- 
work, acts as one of the three primary mechanisms for the ac- 
complishment of work in the body. All of the various move- 
ments of the body, while they depend upon the nerves and muscles, 
must be carried into effect through the skeleton. The axial portion 
of the skeleton gives fixity and rigidity to the body while the ex- 
tremities impart extreme mobility. The bones of the arms and 
legs may be considered a system of levers, moving around the 
joints which act as fulcra for these movements. 
34. What is the physiology of muscles? Muscles produce movement 
of the structures to which they are attached by their property 
of being able to contract when stimulated by an impulse from the 
nervous system. Most of the muscles are attached to the skeleton 
of the body so that when they contract, they change not only the 
position of the bones in relation to each other, but also the indi- 
vidual’s position in relation to surrounding objects. Thus, the 
muscles are the active organs of motion and locomotion, whereas 
the bones and joints are but passive agents. 
35. How are muscles classified? Muscles are classified according to 
the function as voluntary and involuntary muscles. 
36. What are voluntary muscles? Voluntary muscles, also called skele- 
tal muscles, are those whose action is controlled by an act or 
effort of volition. These muscles are under the control of the will. 
37. What are involuntary muscles? Involuntary muscles are those 
muscles that functionate independent of the will. 
38. Describe how the nerves enter a muscle. The nerves which carry 
the stimuli to a muscle enter at the geometric center. Each 
muscle fiber is supplied with a nerve fiber. The nerve fiber enters 
the muscle fiber near its center. The stimulus that is conveyed to 42 
QUIZ COMPEND 
the muscle fiber acts first upon the center and then travels toward 
the ends. 
39. What is rigor mortis? Rigor mortis is a state in the muscle after 
death in which the muscles become extremely rigid and con- 
tracted, and which lasts for from one to five days. The rigidity 
first appears in the muscles of the lower jaw, next in the abdomen 
and upper extremities, and finally in the trunk and lower ex- 
tremities. There are marked chemical changes in the muscles 
during this period. 
40. What is meant by the term tonus? Tonus, or tonicity, is a state 
of normal elastic tension in a muscle, by virtue of which the 
muscle is kept in shape and ready to functionate in response to 
a stimulus. 
41. What is meant by the term clonus? Clonus is a form of con- 
vulsion marked by contractions and relaxations of a muscle, oc- 
curring in rapid succession. 
42. What is meant by the term fatigue? Fatigue as it refers to a 
muscle means that state in which the muscle is completely relaxed 
and will not respond to a stimulus. 
43. What is meant by the term “muscle excitability” or “muscle con- 
tractility”? These terms are employed to denote that property of 
muscle tissue by virtue of which it contracts or shortens in re- 
sponse to various stimuli. This property is usually associated 
with the activity of the nervous system, but it is an independent 
endowment and persists after all nervous connections are destroyed. 
44. How can it be proven that muscles contract without nervous 
stimuli? If the nerve terminals are destroyed the muscles be- 
come completely relaxed. The strongest stimuli to the nerves 
will fail to produce a contraction. However, an external stimulus 
applied directly to the muscle will at once produce the char- 
acteristic contraction. 
45. Hoiv are muscle contractions classified? Muscle contractions are 
classified as either voluntary or reflex. 
4-6. Describe voluntary contraction in muscle. When an individual 
wills to move a certain part of the body an impulse is transmitted 
from the brain through the spinal cord and nerves to the muscle 
or muscles which move that part. 
47. What is a reflex? A reflex is caused by a peripheral stimulus 
which is transmitted to the spinal cord, and here it is reflected 
outward through the same nerves to the muscle which then con- 
tracts. 
48. Can muscles contract without some stimulus? No. Although 
muscle tissue is highly irritable, it will not contract unless some 
form of stimulation is applied. 
49. Classify the stimuli which cause muscle contraction. The stimuli PHYSIOLOGY 
43 
which cause the contraction of muscle are classified as follows: 
(1) mechanical, (2) chemic, (3) physical, (4) electric. 
50. Which of these stimuli are most commonly used to cause muscle 
contraction? Electricity is the most common agent employed to 
produce muscular contractions. 
51. What changes take place in a muscle when it contracts? The 
change in form is the most obvious. The muscle becomes shorter 
and thicker. There is also a shrinking in the volume of the 
muscle in contraction. The extensibility of the muscle is in- 
creased and its elasticity is correspondingly diminished. There 
are several chemical changes that take place; oxygen is absorbed 
and the production of carbon dioxide is increased. The muscle 
also becomes warmer. 
52. How are muscles classified according to their action on the various 
parts of the body? Muscles are classified or grouped in accord- 
ance with the kind of motion they produce: (1) those that alter- 
nately bend and straighten a joint are called flexors and ex- 
tensors, (2) those which turn the bone around its own axis with- 
out producing any great change in position are called rotators, 
(3) those which permit angular motion to and from the median 
line are called adductors and abductors. 
53. What is posture? By posture is meant one of the various positions 
the body can assume owing to its system of joints, levers, and 
muscles, such as standing and sitting. 
54. What is locomotion? Locomotion is the movement of the body 
from one place to another and includes walking, running, swim- 
ming, etc. 
55. What is a lever? A lever is a mechanical device which exerts 
great power. In the body, the muscles working on the bones 
through the medium of the joints, form levers. The muscles fur- 
nish the power, the bone acts as the lever, and the joint acts as 
a fulcrum around which the motion occurs, and the part is thus 
lifted and moved. 
56. How are levers classified? Levers are classified as levers of the 
first order, levers of the second order, and levers of the third order. 
57. What are levers of the first order? In levers of the first order, the 
fulcrum lies between the weight and the power; example, the 
elevation of the trunk from a flexed position and the movement of 
the skull backward and forward on the spine. 
58. What are levers of the second order? In levers of the second 
order, the weight lies between the power and the fulcrum; ex- 
ample, the raising of the body on the toes. 
59. What are levers of the third order? In levers of the third order, 
the power lies between the fulcrum and the weight; example, the 
flexion of the forearm. 44 
QUIZ COMPEND 
60. Describe the posture known as standing. Standing is that posi- 
tion of equilibrium in which a line drawn through the center of 
gravity falls within the area of both feet placed upon the ground. 
61. How is the position of standing maintained? The standing posi- 
tion is maintained by firmly fixing the head on top of the spinal 
column by the action of the muscles on the back of the neck; 
by making the spinal column rigid; the center of gravity now 
behind both hip joints. The trunk is now balanced on the hip 
joints, and is kept from falling backward by contraction of the 
muscles of the thigh and leg. The center of gravity is between 
the sacrum and the last lumbar vertebra, and the vertical line 
touches the ground between the feet and within the base of support. 
62. Describe the sitting position. The sitting position is a posture in 
which the body is balanced on the lower portions of the bones 
of the pelvis called the tuber ischii. The trunk and head together 
form a rigid column and the vertical line passes between these two 
bones. 
63. Describe the physiology of walking. Walking is a complicated act 
in which nearly all of the voluntary muscles of the body are involved. 
The muscles either take part in the actual propulsion of the body 
forward or they assist in maintaining the balance of the body. 
Walking may be defined as a progression in a forward horizontal di- 
rection, due to the alternate action of both legs. In walking, one 
leg becomes for the time being the active or supporting leg, carry- 
ing the head and the trunk, and the other is the passive but pro- 
gressive leg, which later becomes the active leg when its foot 
touches the ground. As the body is thrust forward into space 
when the step is begun, the weight passes from the center, for- 
ward, and when sufficiently advanced, is caught by the leg being 
thrust forward beyond this point. Thus, the body is prevented from 
falling. So that really walking is a series of movements in which 
the body falls forward and is caught by the advancing leg before 
the body actually falls. This requires perfect muscular co-ordina- 
tion of all the muscles, both in the legs and arms as well as in 
the head and trunk. As an evidence of this, if one watches a child 
that is just beginning to walk, occasionally it will fall forward 
and strike the ground on its hands and knees. This is due to the 
fact that muscular co-ordination is not sufficiently well developed 
and the child falls before the advancing leg can catch the body 
weight. 
64. What is running? Running is an act of propelling the body for- 
ward and is distinguished from walking in that at a given mo- 
ment, both feet are off the ground and the body is raised in the 
air. The muscular co-ordination is much the same as in walking, 
except that greater effort is necessary to maintain equilibrium. 
65. What is nerve tissue? The tissue called nerve tissue unites and 
co-ordinates the various organs and tissues of the body and brings 
the individual into relationship with the outer world. It is di- PHYSIOLOGY 
45 
vided into two systems, the cerebro-spinal system and the sympa- 
thetic system. 
66. What are nerve trunks? Nerve trunks, or nerves, are bundles of 
nerve fibers bound together by connective tissue and which 
serve to connect the brain and spinal cord with the rest of the 
tissues. 
67. How are nerves classified? Nerves are classified into two classes, 
the efferent and the afferent nerves. 
68. What are efferent nerves? Efferent nerves are those which trans- 
mit energy or impulses from the brain and spinal cord to the 
peripheral organs. 
69. What are afferent nerves? Afferent nerves are those which trans- 
mit nervous impulses from the peripheral organs to the brain and 
spinal cord. 
70. How are the efferent nerves classified? The efferent nerves are 
classified according to their characteristic form of activity as fol- 
lows: (1) motor or muscle nerves which convey impulses to the 
muscles and cause muscular contraction; (2) secretory nerves, 
which act upon the glands and cause the formation of secretions 
peculiar to the gland; (3) vaso-motor nerves, which convey im- 
pulses to the blood vessels and cause dilation (vaso-dilators) or 
constriction (vaso-constrictors) of the vessel; (4) inhibitor 
nerves, which cause a slowing or complete stopping of the rhyth- 
matic action of organs; (5) accelerator nerves, which cause an in- 
crease in the rhythmatic action of organs. 
71. How are the afferent nerves classified? The afferent nerves are 
classified in accordance with the character of the sensations to 
which they give rise as follows: (1) sensory nerves, which give 
rise to conscious sensations in the brain and divided into nerves of 
special sense, such as the senses of pain, sight, hearing, etc.; and 
the nerves of general sense, such as discomfort, thirst, hunger, 
fatigue, etc.; (2) reflex nerves, which convey impulses to the 
nerve centers and cause a transmission of impulses through effer- 
ent nerves to muscles, glands, etc.; (3) inhibitor nerves, which 
are capable of reflexly retarding the activity of nerve centers or 
peripheral organs. 
72. What is meant by the term nerve degeneration? If any nerve be 
divided in any portion of its course, certain structural changes 
take place in the peripheral portion to which the term degenera- 
tion is applied. The portion connected with the brain and spinal 
cord remains unchanged. 
73. Discuss reflex action. There are many actions taking place in 
the body in which the will plays no part and which are classified 
as involuntary. Among these are the various muscular move- 
ments, the action of the various glands, and the contraction and 
dilation of the blood vessels. All of these various acts are the 
result of stimulation of an afferent nerve and because they take 46 
QUIZ COMPEND 
place independent of the brain or of the will, are called reflex 
actions. Some examples of reflex actions are the extension of the 
leg when the patella is struck a sudden blow; the jerking up of 
the arm if one of the fingers accidentally touches something hot or 
sharp; the increase in the flow of perspiration when the outside 
temperature is increased. 
74. How is a reflex action brought about? When an impulse is car- 
ried from the periphery to the spinal cord by an afferent nerve, 
instead of being carried further up into the brain, it passes into a 
nerve cell from which it is transmitted to an efferent nerve which 
is distributed to the muscle, gland, or vessel as the case might be. 
75. Discuss the stimulation of nerves. Nerves do not possess the 
power of spontaneously generating nerve impulses. The nerves 
become active only when aroused by a stimulus. The stimulus 
may act either on the central or the peripheral portion of the 
nerve. In the case of motor nerves, the stimulus is within the 
nerve cell, while in the sensory nerves, the stimulus is at the 
periphery. Nerves respond to a stimulus according to their ha- 
bitual function; thus, sufficient stimulation of a sensory nerve 
causes the sensation of pain, etc. The peculiarity of nerve func- 
tion depends entirely upon the peculiarities of its central and 
peripheral end organs and not upon the stimulus or any special 
construction of the nerve itself. 
76. How are nerve stimuli divided? Nerve stimuli are divided into 
general stimuli and special stimuli. 
77. Mention the various general stimuli. The general stimuli are 
those agents which are capable of exciting a nerve in any part of 
its course and are as follows: (1) mechanical, such as a blow, 
pressure, puncture, etc.; (2) thermal; (3) chemic; (4) electric; 
(5) the normal physiologic afferent and efferent stimuli. 
78. Name the various special stimuli? The special stimuli are those 
agents which act upon the nerves only through the medium of 
the end organs and are as follows: (1) light acting on the end 
organs of the nerves of the eye; (2) sound acting on the end or- 
gans of the nerves of the ear; (3) heat, acting upon the end organs 
in the skin; (4) chemic agencies, acting upon the end organs 
of the nerves of taste and smell. 
Digestion 
79. What is food? Food is that which is eaten to supply the necessary 
nutritive elements to the body. 
80. How are foods divided? Foods are divided into three great 
classes: (1) carbohydrates, (2) proteids, (3) oils and fats. To 
this is added the inorganic salts, water and accessory foods such 
as tea, coffee, alcohol, etc. 
81. What are carbohydrates and ivhat is their function as a food? 
The carbohydrates, or starches, are chemically composed of carbon, PHYSIOLOGY 
47 
oxygen and hydrogen and when taken into the body are converted 
into sugar and temporarily stored in the liver. The sugar is 
broken up in the process of digestion forming carbon dioxide 
and water and in this reaction a large quantity of heat is pro- 
duced. Examples of carbohydrates are potatoes, bread, cereals, 
etc. 
82. What are proteids and what is their function as a food? Proteids 
or proteins are complex chemical substances found in animals 
and plants and are composed of carbon, oxygen, hydrogen, nitro- 
gen, and sometimes sulphur, phosphorus, and iron. When taken 
into the body they are converted into peptones which are ab- 
sorbed and utilized for tissue repair and tissue building, and in 
breaking down into simpler compounds, some heat is generated. 
Examples of proteids are meat, eggs, green vegetables, etc. 
83. What are oils and fats and what is their function as a food? The 
oils and fats are chemical compounds which are known as esters. 
When taken into the body they are acted upon chemically and are 
absorbed as fatty acids. Some of the oils and fats are taken di- 
rectly into the system in the form of small drops which become 
adipose tissue. Some are oxidized and give off heat. Examples of 
oils and fats are butter, fatty meats, olive oil, etc. 
84. What is the function of water as a food? Water is present in 
all the tissues of the body. It promotes absorption of materials 
from the digestive tract and acts as a solvent for the various in- 
gredients of the blood and lymph. It also hastens the absorption of 
waste matter from the tissues and promotes their speedy elimina- 
tion from the body. 
85. What is the function of the inorganic salts as food? Sodium 
chloride gives taste to the food, excites the flow of digestive fluids, 
promotes absorption of proteids, and furnishes the chlorine for the 
hydrochloric acid found in the stomach. The potassium salts are 
also essential to the body. Animals become weak without them. 
In small doses they increase the force of the heart beat and 
thus increase the circulation of the blood. Calcium phosphate 
and calcium carbonate give solidity to the tissues, especially the 
bones and teeth. 
86. What is the function of the accessory foods? The accessory foods 
when taken in moderation overcome the fatigue and unrest which 
is a result of excessive physical and mental exertion. Coffee in- 
creases the action of the intestinal glands and acts as a laxative. 
The caffein contained therein stimulates heart action and raises 
blood pressure. Alcohol, when taken in small quantites, under- 
goes oxidation, thus supplying heat and force, and thus far is a 
food. It excites the glands of the stomach into increased action, 
thus improving digestion. It also stimulates the action of the 
heart and the nerve centers. When taken in excess, it is elimin- 
ated by the lungs and kidneys. When taken over a long period of 
time, alcohol impairs digestion, and retards muscular power. It 48 
QUIZ COMPEND 
destroys the structure and composition of the brain cells and 
the spinal cord. The connective tissue of the body is increased 
and subsequently contracting, gives rise to sclerosis. 
87. Why is it essential that the body receive a proper combination of 
the three great divisions of food? One class of food will not 
maintain the body for any length of time. If any one is taken 
in excess, or if any one is eliminated from the diet, disease is the 
result. 
88. What is the function of foods generally in the body? The func- 
tion of foods generally is to supply the materials necessary for 
tissue growth and tissue repair and for the maintenance of body 
heat, so as to supply energy, which is expended daily in the form 
of motion and heat. All of the energy of the body is due to the 
chemical changes going on in the body, principally the oxidation 
of food. 
89. What is a calorie? A calorie is the amount of heat required to 
raise the temperature of one kilogram of water one degree centi- 
grade. The calorie is the unit of measuring the heat generated 
by the various foods taken into the body. 
90. What is digestion? Digestion is a physical and chemical process 
by which the food taken into the alimentary canal is liquified and 
its nutritive principles are converted by the digestive juices into 
new substances which are absorbed into the blood. 
91. What is the digestive apparatus? The digestive apparatus con 
sists of the alimentary canal and its appendages, the teeth, salivary, 
gastric and intestinal glands, liver, and pancreas. 
92. What is the alimentary canal? The alimentary canal consists of 
the mouth, the esophagus or gullet, the stomach, the large and 
small intestine and the rectum. 
93. What are the stages of digestion? There are seven stages of di- 
gestion: (1) prehension, (2) mastication, (3) insalivation, (4) 
deglutition, (5) gastric digestion, (6) intestinal digestion, (7) 
defecation. 
94. What is prehension? Prehension is the act of conveying the 
food to the mouth and is accomplished by the hands, lips, and 
teeth. 
95. What is mastication? Mastication is the chewing of the food 
and is accomplished by the teeth and the lower jaw. This process 
divides the food and presents a larger surface for the action of the 
digestive fluids. The teeth vary in shape for different kinds of 
food, and those of the lower jaw move upon those of the upper 
jaw in various movements. During the process of mastication, the 
food is kept between the teeth by the action of the muscles of the 
tongue and cheek. 
96. What is insalivation? Insalivation is the process of incorporating 
the saliva with the food. PHYSIOLOGY 
49 
97. What digestion takes place in the mouth? The saliva contains a 
ferment called ptyalin, which converts starches into sugar. The 
mucine, another substance found in saliva, moistens and clumps 
the food so as to make it easier to swallow. 
98. What is deglutition? Deglutition, or swallowing, is the act o£ 
passing the food from the mouth into the stomach. It is divided 
into several stages the first of which is voluntary and the second! 
reflex and the third involuntary. The first stage consists of closing; 
the mouth momentarily stopping breathing, placing the 
against the roof of the mouth and throwing the bolus of food; 
backward. The second stage is where the palat6 is made tense,, 
the bolus is grasped by the muscle of the pharynx and rapidly* 
forced into the esophagus. In the third stage the bolus is forcedl 
through the esophagus into the stomach by the contraction of the 
involuntary muscles of that organ. 
99. What is gastric digestion? Gastric digestion is the digestion that 
takes place in the stomach. The gastric, or stomach juice, is 
composed of free hydrochloric acid, the enzyme pepsin, and a 
second ferment called rennin. The pepsin converts proteids to 
peptones in the presence of hydrochloric acid, which latter serves 
to keep the food acid and prevents fermentative changes. The 
rennin acts upon milk, converting the caseinogen to casein and 
albumin. 
100. What is intestinal digestion? Intestinal digestion is the digestion 
that takes place in the small intestine. The pancreatic juice which 
is secreted by the pancreas, contains three ferments called amy- 
lopsin, trypsin, and steapsin. The amylopsin converts starches into 
sugars, the trypsin converts proteids into peptones, and the steap- 
sin acts upon the oils and fats, saponifying them and forming fatty 
acids and glycerine. 
101. W hat is bile? Bile is a golden-brown, viscid fluid which is formed 
and discharged by the liver. It is both a secretion and an excre- 
tion. It helps in the emulsification of fats, it prevents putrefac- 
tive changes in the food, it stimulates the secretion of the intestinal 
glands, stimulates peristalsis and gives color to the stool. 
102. What is peristalsis? Peristalsis is a wave-like movement which 
takes place in the digestive tract and which serves to move its 
contents forward. 
103. What is defecation? Defecation is the voluntary act of extruding 
the feces from the rectum and is accomplished by the relaxation 
of the sphincter ani muscle and the contraction of the muscles of 
the rectum. 
104. Briefly describe the digestive process from the mouth to the anus. 
The food enters the mouth where in an alkaline medium the 
starches are acted upon, the food moistened and formed into a 
bolus and then swallowed. It then passes down the esophagus by 
peristalsis into the stomach where in an acid medium the pro- 50 
QUIZ COMPEND 
teids are converted into peptones and casinogen is converted into 
casein. In a semi-fluid state, called chyme, it then passes through 
the pyloric opening in the stomach into the small intestine. Here 
it is acted upon by the three ferments, in an alkaline medium and 
as peristalsis continues, it passes into the large intestine. This 
organ absorbs the liquid from the digestive material and it be- 
comes more solid. It now takes on the characteristics of feces 
and then passes into the cavity at the lower end of the intestines 
called the rectum. By the act of defecation the feces are extruded 
through the anus. 
The Blood and Blood Circulation 
105. What is blood? Blood is a nutritive fluid containing all of the 
elements necessary for tissue repair: it also contains waste matter 
which it conveys to the organs of excretion. 
106. Describe the composition of the blood. Blood is made up of two 
portions: (1) the fluid portion, called liquor sanguinis or plasma, 
which is clear and colorless and in which floats (2) the cellular 
elements which are called red blood cells or erythrocytes and 
white blood cells or leucocytes. 
107. What is the composition of plasma? Plasma is composed of 
water, albumin, paraglobulin, fibrinogen, mineral salts, etc. Oxy- 
gen, carbonic acid gas, and nitrogen are present in varying pro- 
portions. 
108. Where do the corpuscles originate? The red corpuscles originate 
from colorless, nucleated cells called erythroblasts found in bone 
marrow and are destroyed in the spleen. The white cells originate 
from the lymphocytes of the adenoid tissue. 
109. What is blood coagulation? When the blood is withdrawn from 
the body and allowed to be exposed to the air it becomes thick 
and viscid in about five minutes. This gradually increases until 
it assumes a jelly-like consistency. When this is complete the 
mass contracts and a clear, straw-colored liquid oozes out. This 
is called serum. This continues for about twenty-four hours when 
coagulation is completa 
110. What is the difference between living and coagulated blood? 
The living blood contains the plasma and corpuscles, the plasma 
containing fibrinogen, etc. The dead blood contains the serum 
and the clot which latter contains the corpusules and fibrin. 
111. What retards coagulation? Retention in living vessels, neutral 
salts in excess, inflammatory conditions of the system, exclusion 
from air, all retard coagulation. 
112. What hastens coagulation? A temperature of 100 degrees Fahren- 
heit, contact with the air and rough surfaces, and rest, all hasten 
coagulation. 113. Does the composition of living blood remain constant? No. The 
composition of living blood varies in different parts of the body. 
The arterial blood differs from the venous in that it coagu- 
lates more readily and contains more oxygen and less carbon 
dioxide. So, too, in the portal vein, the composition of the blood 
will change, depending on the stages of the digestive process, etc. 
114. What is the circulatory apparatus? The circulatory apparatus, by 
which the blood is carried to all parts of the body, consists of the 
heart, which is the central organ, and which is connected to a 
system of vessels called arteries, capillaries, and veins. 
115. Describe briefly the course of the blood through the heart. The 
veins terminate at the right auricle and the venous blood then 
passes through that chamber through the tricuspid valve into 
the right ventricle. It then flows into the pulmonary artery and 
is carried to the lungs for aeration. From the lungs it passes 
through the pulmonary veins to the left auricle, then through the 
bicuspid or mitral valve into the left ventricle and then into the 
aorta, which is the beginning of the arterial system. 
116. Describe the flow of the blood through the blood vessels. The 
blood enters the arteries under great pressure, due to the driving 
action of the heart and the resistance offered by the walls of the 
arteries. As the blood enters the capillaries, the velocity is re- 
duced due to the increase in the area of the vessels. When the 
blood again enters the veins, the velocity is increased as the area 
becomes smaller. 
117. What forces keep the blood in circulation? The forces that keep 
the blood in circulation are the action of the heart, the elasticity 
of the arteries, capillary force, contraction of voluntary muscles 
upon the veins and respiratory movements. 
118. What is the pulse? The pulse is the rhythmical dilitation of an 
artery produced by the increased volume of blood thrown into the 
vessel with the contraction of the heart. The pulse can easily 
be felt at any point in the body where an artery is superficial 
enough to convey the sensation. 
PHYSIOLOGY 
51 
Respiration 
119. What is respiration? Respiration is that function by which oxygen 
is taken into the blood and the products of oxidation, namely 
water and carbon dioxide, are given off. 
120. What is the respiratory apparatus? The respiratory apparatus 
consists of the lungs, larynx and trachea. 
121. Where does respiration take place? Respiration takes place in 
the tissues. The actual interchange of gases occurs throughout 
the entire body, the blood and the respiratory apparatus acting 
as media through which actual respiration is accomplished. 52 
QUIZ COMPEND 
122. What is the larynx? The larynx is the upper part of the respira- 
tory tract and is called the organ of voice production. It is a box- 
like structure made up of nine cartilages connected by fibrous 
membranes and the vocal cords. It is so arranged that the air 
can pass in or out, to or from the lungs. 
123. What is the trachea? The trachea is a tube about four or five 
inches long which passes from the larynx downward and divides 
into the right and left bronchi. These in turn re-divide, becoming 
gradually smaller until they join the lungs. 
124. What are the lungs? The lungs are two organs situated in the 
thorax, are conical in shape, pink in color, and of spongy texture. 
The right lung is made up of three lobes and the left lung is made 
up of two lobes. The lobes of the lung are made up of the 
ultimate ramifications of the bronchi within which are found the 
air vesicles or air cells. 
125. How is the venous blood distributed to the lungs for aeration? 
The pulmonary artery passes from the heart to the lungs where 
the branches become a large plexus of capillaries. These capil- 
laries surround the air vesicles and thus the blood and the air 
are brought in close contact, being separated only by a thin wall 
of the air cell and of the capillary. 
126. What is the pleura? The pleura is a serous membrane which sur- 
rounds the lung. 
127. What are the respiratory movements? The respiratory movements 
are two—inspiration and expiration. 
128. What is inspiration? Inspiration is an active process, the result 
of the expansion of the thorax, in which atmospheric air is intro- 
duced into the lungs. 
129. What is expiration? Expiration is a passive process, the result 
of the recoil of the thorax, in which the air in the lungs is ex- 
pelled. 
130. Describe inspiration. In inspiration the chest is enlarged in all 
its diameters. This is brought about by the action of various 
muscles which thrust the sternum, or breast bone, forward and 
raise the ribs. The diaphragm plays an important part in this. 
131. Describe expiration. In expiration all the diamaters of the chest 
are diminished. This is brought about by the relaxation of the 
various muscles which bring about inspiration. 
132. Describe the types of respiration. The three types of respiration 
are: (1) abdominal type, most marked in young children regard- 
less of sex, the respiratory movements being effected by the dia- 
phragm and abdominal muscles; (2) superior costal type, seen 
in the adult female, in which the respiratory movements are more 
marked in the upper part of the chest; (3) inferior costal type, 
seen in the adult male, in which the movements are largely pro- 
produced by the muscles of the lower portions of the chest. PHYSIOLOGY 
53 
133. What is tidal air? Tidal air, or breathing volume of air, is the 
air that passes in and out of the lungs during normal respiration. 
It is estimated at from twenty to thirty cubic inches. 
134. What is complemental air? Complemental air is that amount of 
air that can be taken into the lungs by forced inspiration in addi- 
tion to the normal tidal air and amounts to about 110 cubic 
inches. 
135. Wrhat is reserve air? Reserve air is that which usually remains in 
the lungs after ordinary respiration, but which can be expelled 
by forcible expiration. The volume of reserve air is about 100 
cubic inches. 
136. What is residual air? Residual air is that portion which re- 
mains in the chest and cannot be expelled after the most forcible 
efforts. Its volume is estimated at about 100 cubic inches. 
137. What changes occur in the air during respiration? There is a 
loss of oxygen, about five cubic inches to 100 cubic inches of air. 
There is an increase in water vapor and organic matter. There 
is a gain in carbon dioxide, to the extent of 4.66 cubic inches to 
100 cubic inches of air. There is an elevation in the temperature 
of the air. There is an increase and at times a decrease in the 
amount of nitrogen and a gain of ammonia. 
138. What effect has the organic matter contained in the expired air 
have on the body? When one remains in a room for a long period 
of time in which the ventilation is poor, drowsiness followed by 
headache and nausea is a result. This is due to the organic matter 
that is exhaled and not to the amount of carbon dioxide. 
139. Explain the condition of the gases in the blood. The oxygen is 
absorbed from the lungs and is taken up by the hemoglobin in 
the red cells. It forms a very unstable compound with the hemo- 
globin, and when it is carried to the tissues, the oxygen is readily 
given off. The carbon dioxide is absorbed into the blood from the 
tissues where it goes into solution and is thus carried to the lungs 
by the veins. 
140. Explain the exchange of gases in the air cells of the lungs. The 
oxygen is present in the lungs and the venous blood is present in 
the capillaries. There is a difference in pressure on both sides of 
the thin membrane which separates the two, so that the oxygen 
passes into the capillaries where it is taken up by the hemoglobin, 
while the carbon dioxide passes into the air cells of the lungs. 
141. What is asphyxia? Asphyxia is a condition in which the supply 
of oxygen to the lungs is diminished and the carbon dioxide re- 
tained. This condition soon terminates in death. Drowning, chok- 
ing, etc., are forms of asphyxia. The actual cause of death is 
paralysis of the heart from overdistention of blood. 
142. Discuss animal heat. The activity of the various parts of the 
body is attended by the evolution of heat. Heat is necessary for 54 
QUIZ COMPEND 
the body so that its various organs can properly do their allotted 
work. The body is constantly losing heat by radiation and by 
evaporation, but it is able to renew and maintain a fixed standard 
of heat, regardless of external influences. So, the body in normal 
health, remains at about the same temperature both winter and 
summer. 
143. What is the temperature of the healthy body? The average tem- 
perature is 98.6 degrees Fahrenheit. It varies in different parts of 
the body, being highest where most oxidation takes place, for 
example, in the muscles and liver. 
144. What external influences affect the temperature of the body? 
Exercise will raise the temperature about 1 or 2 degrees; eating a 
hearty meal or the drinking of alcoholic beverage will also cause 
a rise in temperature. External temperature affects the body to 
a slight extent, exposure to cold causing a drop and exposure to 
heat causing a rise in temperature. Disease is a frequent cause 
in variation from normal. Some diseases like typhoid fever and 
pneumonia will cause a rise to 105 to 107 degrees, while cholera 
will cause a drop to as low as 80 degrees. When high temperatures 
persist for a period of time, death ensues. 
145. What is fever? Fever, or pyrexia, is a condition in which the 
body temperature rises above the normal, 98.6 degrees Fahrenheit 
or 37 degrees Centigrade. 
Secretion and Excretion 
146. IF hat is secretion? Secretion consists in the separation of ma- 
terials from the blood, either waste, or to be utilized for some 
function in the body. In the former they are termed excretions 
and in the latter secretions. 
147. Through what medium are secretions made? The secretion is 
made through a special structure called a gland, the material which 
it secretes being previously present in the blood. The gland has 
the power to take from the blood various nutrient materials and 
from them it manufactures the secretion characteristic of the 
gland. Excretions pre-exist as such in the blood. If retained in 
the body, they have a harmful influence on the composition of 
the blood. 
148. Mention some secretions. Some of the common secretions are 
sebum, mucus, saliva, gastric juice, bile, pancreatic juice, etc. 
149. Mention some excretions. Some of the common excretions are 
sweat, urine, and bile. 
150. What are the ductless glands? The ductless or vascular glands are 
structures which have no duct and their secretions are absorbed 
directly into the blood stream. These glands play an important 
part in the maintenance of body health and in the last few years PHYSIOLOGY 
55 
much time has been given to the study of their functions and 
characteristics. Some of the ductless glands are the thyroid, the 
suprarenal, and the pituitary glands. 
151. What is urine? Urine is a clear fluid which is excreted from the 
body by the kidneys. Urine has a characteristic odor, a bitterish 
saline taste, and an acid reaction. It contains urea, uric acid, 
mucus, and organic waste matter. 
152. What is the urinary apparatus? The urinary apparatus consists 
of the kidneys, ureters, and bladder. 
153. What are the kidneys? The kidneys are two bean-shaped organs 
about four or five inches long which have the power of taking 
from the blood stream various waste products in solution. It is 
composed of many small tubules which take the waste from the 
blood and carry it toward the interior portion or pelvis where 
the fluid is passed into the ureters. 
154. What are the ureters? The ureters are two membraneous tubes 
about eighteen inches long which pass, one from each kidney, into 
the bladder, which they enter in an oblique line. 
155. What is the bladder? The bladder is a reservoir for the tem- 
porary reception of the urine before it is expelled from the body. 
It is oval in shape when distended and holds about one pint. 
156. What is urination? Urination, or micturation, is the act of pass- 
ing the urine from the body. When the bladder becomes filled 
there is irritation to the nerves and a reflex causes the relaxation 
of a muscle which is found at the neck of the bladder. When 
this muscle relaxes and the bladder contracts, its contents is forced 
out. Urination is a voluntary act, but if urine is retained for a 
protracted period, the muscle will relax without the aid of the 
will. 
157. What is the liver? The liver is a highly vascular, complex gland 
found attached to the intestines. It is the largest gland in the 
body and weighs about four and one-half pounds. 
158. What is the function of the liver? The liver has a variety of 
functions, chief of which are the secretion of bile, the formation of 
glycogen, and the formation of urea. 
159. What is bile? Bile is a fluid manufactured in the liver and is 
both a secretion and an excretion. It contains substances which 
are used in the process of digestion and also contains certain waste 
materials. The bile is stored in the gall bladder which is found 
on the under surface of the liver. 
160. What are the functions of the skin? The skin acts as a protective 
covering to the body, is a touch organ, is an organ of excretion 
and secretion, is a regulator of body temperature, and also acts as 
an auxiliary organ of respiration. 
161. What are the functions of the hairs? The hairs protect the head 56 
QUIZ COMPEND 
from the heat of the sun and from cold and prevent the entrance 
of foreign bodies into the nose, lungs, ears, etc. 
162. What is the function of the sebaceous glands? The sebaceous 
glands secrete an oily fluid which acts as a lubricant of the skin 
and softens the hairs. 
163. What is the function of the sudoriferous glands? The sudoriferous 
or sweat glands, excrete the sweat, which function is going on 
continuously and helps in maintaining an even body temperature. 
164. What is insensible perspiration? Insensible perspiration is that 
perspiration which is formed so gradually that it evaporates as 
soon as it reaches the surface and passes off without being noticed. 
165. What is sensible perspiration? Sensible perspiration is that per- 
spiration which forms so rapidly that evaporation is not sufficiently 
rapid and the fluid forms in beads upon the skin. This occurs 
when the body is subjected to great heat and exercise. CHAPTER IV. 
BACTERIOLOGY 
1. Define bacteriology. Bacteriology may be defined as that branch 
of science which has for its consideration the life history of bac- 
teria. 
2. What are bacteria? Bacteria are microscopic unicellular organ- 
isms belonging to the plant group. 
3. Describe the cell substance of bacteria. The cell substance of 
bacteria is like cytoplasm in character and is surrounded by a 
more or less distinct cell wall. In some bacteria this cell wall de- 
velops into a distinct capsule which appears as a distended or 
swollen cell wall or cell membrane. 
4. What is the size of bacteria? The size of bacteria vary greatly. 
Some forms are so small that they require specially made micro- 
scopes to be seen, yet some other types may be quite large. 
5. How are bacteria classified? Bacteria are classified in many ways, 
but the commoner bacteria are classified according to their shape 
(morphologic classification) into three groups: (a) cocci, (b) 
bacilli, (c) spirilla. 
6. What are cocci? Cocci are round or spherical bacteria. 
7. What are bacilli? Bacilli are rod-shaped bacteria. 
8. What are spirilla? Spirilla are spiral-shaped bacteria. 
9. How are cocci subdivided? The cocci are subdivided into a 
classification according to their grouping or arrangement as fol- 
lows: (a) micrococci, (6) diplococci, (c) tetracocci, id) strepto- 
cocci, (e) staphlococci. 
10. What are micrococci? Micrococci are those cocci which occur 
singly. 
11. What are diplococci? Diplococci are those cocci which occur in 
pairs. 
12. What are tetracocci? Tetracocci are those cocci which occur in 
groups of four. 
13. What are streptococci? Streptococci are those cocci which occur 
in chains. 58 
QL1Z COMPEND 
14. What are staphlococci? Staphlococci are those cocci which occur 
in clusters resembling in arrangement a bunch of grapes. 
15. Which of these subdivisions of cocci are most important? The 
most important are the diplococci, the streptococci, and the staphlo- 
cocci. 
16. What are flagella? Flagella are delicate hair-like projections of 
the cytoplasm of bacteria by which these organisms are enabled to 
move about. Some bacteria have but one flagellum while others 
by the development of a round or oval body, which is highly re- 
have two or more such processes. All bacteria do not have the 
power of movement. 
17. How do bacteria reproduce? Bacteria reproduce in one of two 
ways: (a) by simple fission, (b) by spore formation. 
18. Describe simple fission. This method of reproduction is most 
common and consists of a constriction in the center of the full- 
grown organism, two cells resulting from the single mother cell. 
19. Describe spore formation. Spore formation is the rarer form of 
bacterial reproduction and occurs in two ways: (a) endogenous, 
(b) arthrogenous. 
20. What is endogenous spore formation? This form of spore forma- 
tion is evidenced by a granular change in the cell contents followed 
fractile and which is surrounded by a tough resisting membrane. 
This increases in size, breaks its membrane, and becomes a mature 
bacterium. 
21. Describe bacterial nutrition. Bacteria, unlike other plants, do not 
get carbon dioxide directly from the air and depend upon the 
more complex compounds for carbon and nitrogen necessary for 
their nourishment. 
22. What are aerobic bacteria? Aerobic bacteria, or aerobes, are those 
bacteria which thrive best on free oxygen. 
23. What are anaerobic bacteria? Anaerobic bacteria, or anaerobes, 
are those bacteria which thrive best without oxygen. 
24. What influence has moisture on bacterial growth? Moisture is 
necessary for bacterial growth, although some species show de- 
cided resistance to dryness. 
25. How does variation in temperature influence bacteria? Bacteria 
grow best when the temperature is suitable for them and marked 
variations in temperature which does not cause their death will 
stop their reproduction and other of the vital manifestations. 
There are some bacteria which will live in temperatures as low 
as 0 degrees C. and others as high as 70 degrees C., but the average 
range is between 12 and 42 degrees C. Bacteria resist cold better 
than heat and will live for weeks in a dormant state when sub- 
jected to cold. 
26. What is the thermal death point”? The thermal death point is BACTERIOLOGY 
59 
the point of elevation to which the temperature must go before the 
bacteria are destroyed within ten minutes. Spores require more 
heat to kill them than do mature bacteria. 
27. How is heat used as a germicide? Heat is used in two ways as 
a germicide; the so-called moist heat and dry heat methods. Moist 
heat is much more efficient than dry heat, and for most practical 
purposes steam under pressure is used to destroy bacteria. 
28. What are ptomaines? Ptomaines are substances produced by bac- 
teria which cause the decomposition of proteins. These substances 
are alkaloids. Some of these are harmless while others are very 
poisonous. The latter are responsible for that condition of the 
digestive tract which is called ptomaine poisoning. 
29. What are toxins? Toxins are substances which are thrown off by 
bacteria during their metabolic activity. They are not the result 
of decomposition like ptomaines. 
30. What are endotoxins? Endotoxins are toxins which remain within 
the bacteria. 
31. What are exotoxins? Exotoxins are toxins which are thrown out 
and absorbed by the surrounding tissues. 
32. What is meant by the term “pathogenic bacteria”? Strictly, the 
term pathogenic bacteria refers to those microorganisms which 
cause disease, but inasmuch as it is difficult to draw the line be- 
tween those that do and those that do not, the term pathogenic 
as it relates to bacteria, is used to indicate those which live on 
living substances. Those that live on dead material are called non- 
pathogenic bacteria. 
33. How can bacteria be classified as causing a disease? Before any 
organism can be credited with causing a specific disease it must 
comply with a group of requirements set forth by Koch and 
called after him, “Koch’s Postulates.” 
34. What are Koch’s postulates? Koch’s postulates are as follows: 
(1) the organism must be present in the tissues or excreta of 
the animal afflicted with the disease in question; (2) the organism 
must be isolated and cultivated outside the body on suitable media 
for several successive generations; (3) the isolated and cultivated 
organism, when introduced into a suitable animal, must produce 
symptoms similar to those of the disease; (4) the organisms must 
be found in the tissues or excreta of the inoculated animal. 
35. What are media? Media are food materials suitable for the growth 
of bacteria and include agar agar, blood, milk, egg, potato, etc. 
36. What are infective diseases? Infective diseases are those diseases 
which are caused by microorganisms and are spoken of as infec- 
tions. 
37. What are the principal sources of infection? The principal sources 
of infection are: (a) inspiration, (6) entrance through the gas- 60 
QUIZ COMPEND 
trointestinal tract, (c) into the circulation through abrasions in 
the mucous membrane or skin (d) by insect bites. 
38. What is a local infection? A local infection is one in which the 
effect of the entrance of bacteria has been confined to a localized 
area. 
39. What is a general infection? A general infection is one which 
affects the entire system. 
40. What terms are used in connection with general infection? There 
are three terms used in connection with general infection: (1) 
septicemia, (2) sapremia, (3) pyemia. 
41. What is septicemia? Septicemia is a condition in which the or- 
ganisms enter the blood stream, thrive in that medium, and are 
distributed throughout the body. 
42. What is sapremia? Sapremia is a condition in which the bacteria 
remain localized, but the toxins are taken up by the blood and 
lymph streams. 
43. What is pyemia? Pyemia is a condition in which the localized 
process has advanced to the necrotic stage and parts of the 
necrotic material are taken up by the circulation and deposited at 
some other point. This gives rise to metastatic abscesses. 
44. What is resistance? Resistance is the power of the body to pre- 
vent the successful growth and multiplication of bacteria in the 
body. 
45. What factors lower the resistance of the body to infection? The 
resistance of the body is lowered by the use of alcoholics, hard 
work, exposure to the extremes of temperature, starvation, consti- 
tutional diseases such as diabetes, nephritis, etc., previous forms of 
infection, etc. 
46. What is meant by the term “immunity”? By immunity is meant 
the inherent power of a living body to successfully withstand the 
invasion of bacteria, toxins, and drugs. 
47. How is immunity classified? Immunity is classified into: (a) 
natural immunity and (b) acquired immunity. 
48. Describe natural immunity. Natural immunity is an immunity 
which certain individuals possess by reason of race, age, or other 
general characteristics. It is divided into racial immunity and in- 
herited immunity. 
49. Describe acquired immunity. Acquired immunity is divided into 
active and passive immunity. Active acquired immunity is ob- 
tained as a result of having had an attack of a pathogenic organ- 
ism and having overcome it. Thus, one attack of yellow fever 
immunizes the individual against another attack. Vaccination 
actively immunizes against smallpox. Passive acquired immunity 
is obtained by injecting protective substances (anti-toxins) into BACTERIOLOGY 
61 
the blood. Thus, anti-toxin is given in diphtheria because it con- 
tains substances which neutralize the toxins of the disease. 
50. What theories have been advanced to account for the various phe- 
nomena of immunity? There have been two theories advanced to 
account for the phenomena of immunity: {a) the theory of phago- 
cytosis of Metchnikoff; (b) the side-chain or chemical theory of 
Ehrlich. Both these theories explain satisfactorily why certain 
bacteria are unable to infect the body and why the body, once in- 
fected, cannot, in many diseases, be again infected. 
51. What apparatus is essential for the study of bacteriology? The 
essential bacteriologic apparatus is the microscope, a sterilizer, an 
incubator, glassware, and chemicals including stains. 
52. Briefly describe the microscope. The microscope is an instrument 
which enables us to greatly magnify objects, thus making visible 
minute substances. It consists of an eye-piece, several objectives, 
a stage, a condenser, and an iris diaphragm to control the light, 
and suitable mechanical devices to permit of proper adjustments 
and focusing. The objectives are usually three in number and 
are low power, high power, and oil immersion, the latter having 
the largest magnification and being essential to bacteriologic work. 
53. Describe an incubator. An incubator is an apparatus which keeps 
bacteria at the temperature of the body so that they will grow suc- 
cessfully. It consists of a double-wall chamber and between the 
walls, the space is filled with water. A gas flame or electricity 
is used as a heating medium and the apparatus is usually equipped 
with a thermostat which automatically regulates the temperature. 
54. Describe the glassware used in bacteriology. The glassware in- 
cludes glass slides, coverslips, test tubes, flasks, beakers, pipettes, 
and Petri dishes. The latter are shallow, round dishes with 
covers, used for growing cultures. 
55. What are cultures? A culture is a growth of bacteria upon or 
in some suitable medium such as agar agar, etc. 
56. How are cultures prepared? Cultures are prepared by placing the 
available bacteria upon or into a medium which will best suit. 
The selection of the medium and its preparation depends greatly 
upon the character of the bacterium which is to be grown. The 
vessel containing the medium is placed into an incubator which 
is kept at a temperature of 37 degrees Centigrade. It is necessary 
to exercise great care in preparing cultures so that they do not 
become contaminated with bacteria in the air or on the materials 
used. After the culture has been in the incubator for a short time 
small colonies will appear on the surface of the medium or 
within it. 
57. What is a pure culture? A pure culture is one that contains only 
one species of microorganism. 
58. What is a stab culture? A stab culture is one that is inoculated 62 
QUIZ COMPEND 
by passing a needle containing the bacteria to be grown deep 
into the medium which is usually solid gelatine. 
59. What is a streak culture? A streak culture is one in which the 
solid medium is streaked across the surface with a wire dipped 
into the material to be cultivated. 
60. How are bacteria examined under the microscope? Bacteria are 
examined either alive or dead. In examining live bacteria, the 
hanging drop method is used. Dead bacteria are fixed and 
stained before being examined. 
61. Describe the hanging drop. The hanging drop consists of a glass 
slide which has one surface so ground that a small receptacle is 
formed. A ring of vaseline is placed around the excavated por- 
tion. A clean cover glass is selected and a drop of the material 
to be examined is placed in the center. The glass slide is then 
carefully lowered upon the cover glass and the vaseline ring will 
cause the cover glass to adhere to the slide, acting like a seal. 
The slide is then turned carefully over and the drop of material 
is now suspended on the under surface of the cover glass. 
62. Describe the examination of dead bacteria. A thin film of the 
material is placed upon a glass slide and is allowed to dry. The 
slide is then passed rapidly through a flame three or four times, 
smear side up, which fixes the material to the glass and prevents 
washing off during staining. The slide is then stained with the 
proper stains and when dry is ready for the microscope. A cover 
glass is sealed over the specimen with Canada balsam and when 
dry can be used by placing the immersion oil upon the upper sur- 
face of the coverslip. 
63. What are stains? Stains are substances, usually the basic aniline 
dyes, which are used for coloring bacteria. Certain bacteria show a 
peculiar selective power for certain dyes, so that various combi- 
nations of stains are used to assist in the identification of certain 
bacteria. 
64. Mention some of the special stains used in bacteriology. The two 
special stains used commonly in staining bacteria are the Gram 
stain and the Ziehl-Neelson stain. 
65. Describe the Gram stain. This stain is used as follows: the 
smear is treated with aniline gentian violet, which is poured on 
and allowed to remain for three minutes. It is then poured off 
and the slide treated with a solution of iodine, potassium iodide, and 
water for two minutes. This changes the purple color to a grayish 
shade. Alcohol is then poured upon the slide and this is con- 
tinued until no more color comes off. Bismarck brown is now 
used as a counter-stain and the slide is washed in water and dried. 
If the bacteria on examination remain a dark violet-blue, they are 
said to be Gram-positive. If they are decolorized, they take the 
counter-stain and are said to be Gram-negative. Many bacteria 
stain this way and many do not so that often important bacteria 
may be differentiated in this manner. BACTERIOLOGY 
63 
66. Describe the Ziehl-Neelson stain. The Ziehl-Neelson stain is used 
to bring out the “acid-fast” characteristics of certain bacteria, par- 
ticularly the bacillus tuberculosis. This means that the bacteria 
have such a strong affinity for carbol-fuchsin, that they will not 
be decolorized after having been stained with it, even on the ap- 
plication of acid. The technic follows: the smear is covered with 
a filtered solution of carbol-fuchsin and held over a flame so 
that the liquid will steam but not boil. This is done for five or 
ten minutes, replacing the stain lost by evaporation, drop by drop. 
The slide is then alternately immersed in 25 per cent, sulphuric 
acid and water, until no more color appears after the last washing 
in the water. It is then counter-stained with Loeffler’s methylene 
blue for one or two minutes and again washed in water and dried. 
Upon examination, the bacteria will appear red and the surround- 
ing material will be blue. 
67. Mention the commoner pus-producing bacteria. The commoner 
pyogenic or pus-producing bacteria are: (a) staphylococcus pyo- 
genes aureus, (6) staphylococcus pyogenes albus, (c) staphylococ- 
cus pyogenes citreus, (d) streptococcus pyogenes, (e) gonococcus. 
68. Describe the staphylococci pyogenes. The staphylococci pyo- 
genes aureus, albus, and citreus are alike except that they produce 
different colors of pus. Collectively they are called the staphylo- 
cocci, or grape cocci. They are round and grow in bunches like 
grapes. They are non-motile and have no flagella or spores. They 
grow well in oxygen and poorly without it, and thrive best at body 
temperature. 
69. What is the habitat of the staphylococci pyogenes? They are 
widely distributed, found in dirty water, sewage, air, dust of streets 
and houses, and on the skin. They are normally present in the 
mouth, nose, rectum, external ear, etc. 
70. What is meant by the term “pathogenesis”? By the term patho- 
genesis is meant the various diseases that result from a micro- 
organism. 
71. What is the pathogenesis of the staphylococci pyogenes? They 
cause carbuncles, boils, acne, abscesses, osteomyelitis, septicemia, 
and any inflammation of the serous membrane. Endocarditis is one 
of the grave affections caused by these bacteria. They also play an 
important part in secondary infection, causing necrosis of previously 
infected tissues. 
72. Describe the streptococcus pyogenes. The streptococcus pyogenes 
grows in chains, 4 to 40 individual cocci in a chain. The cocci 
are not motile and do not have spores. They are Gram positive. 
They grow either in oxygen or in its absence and are classified 
as facultative aerobes. They develop best at body temperature. 
73. What is the habitat of streptococcus pyogenes? They' are found 
in sewage, dwellings, dust, on the healthy human body, and in 
the cavities of the respiratory tract, rectum, etc. 64 
QUIZ COMPEND 
74. What is the pathogenesis of streptococcus pyogenes? This bac- 
terium causes many diseases such as erysipelas, puerperal fever, 
meningitis, pneumonia, endocarditis, peritonitis, tonsilitis, osteo- 
myelitis, and the diarrhea of children. In general septicemia it 
is found in the blood and plays an important part in secondary 
infection, aggravating the original infection and aften causing 
death. Thus, in scarlatina, smallpox, and diphtheria it is often 
the cause of death. 
75. Describe the gonococcus. The gonococcus is always found in 
pairs, and resemble two coffee beans facing each other, and are 
cemented by an invisible substance. It is non-motile, has no 
flagella or spores, and stains readily with Loeffler’s methylene blue. 
It is Gram negative. It is facultative anaerobe and grows best at 
body temperature. 
76. What is the habitat of the gonococcus? The gonococcus is a 
strict parasite and is never found outside the human organism 
except on linen, towels, instruments, etc. 
77. What is the pathogenesis of the gonococcus? The gonococcus 
produces a distressing disease called gonorrhea which may become 
so severe as to cause death. It frequently affects the conjunctiva 
of the eye and sometimes causes a pan-ophthalmia, which destroys 
the sight. It may cause arthritis, gonorrheal rheumatism, endo- 
carditis, etc. Any serous membrane may be infected and serious 
results follow. 
78. Do all bacteria produce disease? No. Those that produce dis- 
ease are called pathogenic and those that do not produce disease 
are called non-pathogenic. 
79. Do all pathogenic bacteria cause pus formation? No. Those that 
cause the formation of pus are called pyogenic bacteria, while 
those that do not form pus are called non-pyogenic bacteria. 
80. Mention some of the non-pyogenic bacteria. Some of the non- 
pyogenic bacteria that cause disease are the tubercle bacillus, the 
anthrax bacillus, and the typhoid bacillus. 
81. Describe the tubercle bacillus. The tubercle bacillus appears as 
a slender rod, without spores and flagella. It is a difficult bac- 
terium to stain and requires the Ziehl-Neelson stain. It thrives 
best at body temperature, grows slowly, and is an obligate aerobe. 
It dies quickly in sunlight, but in sputum it resists drying and 
light for months. It is killed quickly by formalin and bichloride 
of mercury, but resists a 3 per cent, solution of phenol for hours. 
82. What is the habitat of the tubercle bacillus? The tubercle ba- 
cillus is a strict parasite and never lives on dead material. It is 
widely distributed, being found in all human communities, espe- 
cially where quarters are crowded. It is found in the dust of 
rooms, vehicles, and streets and often in milk and butter. 
83. What is the pathogenesis of the tubercle bacillus? The tubercle BACTERIOLOGY 
65 
bacillus causes in man and cattle the disease called tuberculosis 
or consumption. The disease is widespread, but is most common 
where human beings are huddled together in dark, poorly ventilated 
shops and rooms. All the tissues of the body may become in- 
fected, particularly the lungs, intestines, larynx, spleen, and bones. 
If the bacilli reach the blood stream they usually produce the 
acute miliary type of tuberculosis. The lesion of tuberculosis is 
the tubercle which is a globular mass about the size of a small 
shot. 
84. Describe the anthrax bacillus. The anthrax bacillus appears as 
a large rod often seen in chains or pairs. They have no flagella 
and are not motile, but they form spores. It is Gram positive. 
It is a facultative anerobe, but grows much better in oxygen. It 
grows best at body temperature and the spores withstand great 
heat for a long period of time. 
85. What is the habitat of the anthrax bacillus? The anthrax bacillus 
is found only where infected animals, hides, and hair have been. 
Hay, bristles, hides, manure, etc., contain the bacilli. Meadows 
and fields may be contaminated for years. Drinking water may 
be polluted by tanneries and the bodies of dead animals. 
86. What is the pathogenesis of anthrax bacillus? It is a very virulent 
bacterium and grows so rapidly and luxuriantly that it is supposed 
to cause death by merely mechanically overwhelming the body. 
The disease is called by different names such as anthrax, splenic 
fever, woolsorter’s disease, malignant pustule, and charbon. The 
disease has been contracted from shaving brushes in which the 
bristles were not sufficiently sterilized. In man it is generally 
fatal, appearing first as a small carbuncle or pustule and soon 
becoming a general infection. 
87. Describe the typhoid bacillus. The typhoid bacillus appears as a 
short plump rod which has flagella and is actively motile, but does 
not form spores. It stains with all of the common dyes and is 
Gram negative. It remains alive in ice for months, but grows 
best at body temperature. 
88. What is the habitat of the typhoid bacillus? The typhoid ba- 
cillus never exists in nature, except where water or soil has been 
contaminated by feces or urine. It may multiply in potable waters, 
in milk, and in the juice of oysters. It enters the body through 
the alimentary tract in food and water. Personal contact is also 
a method of transmission. 
89. What is the pathogenesis of the typhoid bacillus? The typhoid ba- 
cillus is the cause of typhoid fever. During the attack the germs 
are found circulating in the blood stream. They are found in the 
feces even after clinical recovery and are often found in the 
urine. Typhoid fever is not merely a localized infection, but is a 
bacteriemia. In some cases there is a mixed infection in which 
the streptococcus pyogenes plays an important role. 66 
QUIZ COMPEND 
90. What microorganism causes syphilis? The organism that causes 
syphilis is called the treponema pallidum of Schaudinn, or the 
spirochaeta pallida. 
'91. Describe the spirochaeta pallida. The spirochaeta pallida is a 
delicate structure which is classified variously, but usually with 
the spirilla. It has from 3 to 12 turns or bends and its ends are 
delicately pointed. It is stained with difficulty, the Giemsa stain 
being best. 
92. What is the habitat of the spirochaeta pallida? The spirochaeta 
pallida is a strict parasite and is found only in the tissues of 
those suffering with syphilis. It is not found in the tissues of 
normal persons or of those suffering with other diseases such as 
tuberculosis, carcinoma, etc. 
93. What is the pathogenesis of the spirochaeta pallida? This or- 
ganism, as before stated, is the cause of syphilis, and is found in 
chancre and mucous patches in the early stages of syphilis. It is 
also found in the blood, bone marrow, liver, etc., and in the 
brain and spinal cord of those suffering with tabes dorsalis or 
locomotor ataxia. 
94. What is the Wasserman test? The Wasserman test, or the Was- 
serman reaction, is a test to determine the presence of the syphi- 
litic anti-body in the blood serum of syphilitics. 
95. Briefly describe the Wasserman reaction. The Wasserman reaction 
is a very complicated test, the basis of which is the determination 
of syphilitic anti-bodies in the blood serum of a suspected syphi- 
litic. The test hinges on the hemolysis or solution of the red 
blood cells of the sheep due to certain changes which have taken 
place in the serum of the suspect. When hemolysis occurs, the 
reaction is said to be negative; when it does not occur, the re- 
action is said to be positive. 
96. Of what value is the Wasserman reaction in the diagnosis of 
syphilis? When a positive Wasserman is obtained and the test 
is known to have been made accurately, it is an absolute sign of 
syphilis. When the reaction is negative, it does not necessarily 
preclude syphilis. 
97. Why is knowledge of bacteriology essential to the practice of chi- 
ropody? The practice of chiropody includes the treatment of 
various infections, and the characteristics of the bacteria causing 
them should be understood. Further, there are many foot con- 
ditions which are merely signs of an infection in some part of the 
body far remote from the foot, and a knowledge of this subject 
is necessary to comprehend these infections. CHAPTER V. 
PATHOLOGY 
1. Define pathology. Pathology is that branch of science which deals 
with diseases in all its relations, especially with its nature and the 
functional and material changes caused by it. The study of pa- 
thology is divided into (a) physiologic pathology, (b) morpho- 
logic pathology. 
2. Define physiologic pathology. Physiologic pathology is that branch 
of pathology that deals with the changes in function of a part in 
disease. 
3. Define morphologic pathology. Morphologic pathology is that 
branch of pathology that deals with the changes in structure of a 
part in disease. 
4. What unit is used for pathologic study? The cell is the unit that 
is generally used for pathologic study. 
5. What is a typical cell? A typical cell is an imaginary structure 
used to simplify study and has all of the characteristics of the 
various cells in the body. 
6. How do cells functionate? Cells functionate by vibration within 
the cells which causes heat and energy. 
7. How are cells destroyed? Cells are destroyed by infiltration or 
by degeneration. 
8. What is meant by infiltration? Infiltration means the entrance of 
a foreign substance into the cell causing its destruction and is a 
physical change. 
9. Mention some substances which enter a cell by infiltration. Some 
of the substances which enter cells by infiltration are fat, urine, 
bile, glycogen, the blood plasma, calcium salts, etc. 
10. What is meant by degeneration? Degeneration is a retrogressive 
change within the cell in which the living material is converted 
into inert matter and is a chemical change. 
11. Mention several types of degeneration. Some of the types of de- 
generation are fatty, mucoid, colloid, amyloid, cloudy swelling, etc. 
12. Mention one of the common causes of degeneration. One of the 
common causes of degeneration is the presence of toxins. 68 
QUIZ COMPEND 
13. What are toxins? Toxins are the poisonous products produced by 
bacteria. 
14. How are toxins classified? Toxins are classified as (a) endo* 
toxins, (b) exotoxins. 
15. What are endotoxins? Endotoxins are poisonous substances liber- 
ated from the bacterium after its destruction. 
16. What are exotoxins? Exotoxins are poisonous substances which 
are set free by living bacteria. 
17. What is atrophy? The term atrophy is used to designate a de- 
crease from the normal size of a cell. It is classified as single 
atrophy or as numeral atrophy. 
18. What is single atrophy? Single atrophy is a decrease in the size 
of the cells of a tissue. 
19. What is numeral atrophy? Numeral atrophy is a decrease in the 
size and reduction of the number of cells of a tissue. This is 
also called hypoplasia. 
20. What is hypertrophy? The term hypertrophy is used to designate 
an abnormal increase in the size or the number of cells of a part. 
21. What is hyperplasia? The term hyperplasia is used to designate 
an abnormal increase in the number of cells in a part. 
22. What is pigmentation? Pigmentation is the accumulation of color- 
ing matter in the tissues between the cells. 
23. What elements are usually found in pigment? The elements 
usually found in pigment are carbon, hydrogen, nitrogen, sulphur, 
and occasionally iron. 
24. Mention two normal pigments found in the body. The normal 
pigment of the skin is called melanin and the normal pigment 
of the blood is called hemotin. 
25. What is the origin of pigment? The origin of pigment is (a) ex- 
ternal, such as tatooing with aniline dyes; (b) internal, due to 
disintegration of red blood cells. 
26. What is meant by the term “hematogenous pigmentation”? Hema- 
togenous pigmentation is that which is due to the setting free of 
pigment by the blood, due to abnormal conditions. 
27. What pigments are released by hematogenous pigmentation? The 
two pigments released by hematogenous pigmentation are hemo- 
siderin and hemotoidin. 
28. What is hepatogenous pigmentation? Hepatogenous pigmentation 
is the discoloration of the tissues due to the liberation of bile from 
the liver. 
29. Mention the elements of bile pigment? The elements of bile pig- 
ment are bilirubin or red bile and biliverdin or green bile. PATHOLOGY 
69 
30. IF hat is lymph? Lymph is a fluid found in the lymph spaces and 
lymph vessels and is diluted plasma. 
31. What is an exudate? An exudate consists of lymph which has 
passed through the walls of a blood vessel as a result of an in- 
flammatory condition. 
32. What is a transudate? A transudate consists of lymph which has 
passed through the walls of a blood vessel as a result of other 
than inflammatory conditions. 
33. What is the composition of blood? Blood is composed of plasma, 
red and white cells, and blood platelets. 
34. What disease-resisting ferment is found in blood plasma? A sub- 
stance called hormones is found in the blood which resists disease. 
35. What is plasma? Plasma is a clear, straw-colored, transparent 
fluid of alkaline reaction containing several proteins, the most 
important of which is fibrinogen. Its specific gravity is 1.025 
and is 90 per cent, water. 
36. What is a red blood corpuscle? A red blood corpuscle or an 
erythrocyte is a small, circular, non-nucleated, bi-concave disk 
which appears straw-colored singly and red in masses. There are 
5,000,000 red blood cells to the cubic millimeter of blood in the 
male. The red blood cells originate in the red marrow of long 
bones. 
37. What is a white corpuscle? A white corpuscle or leukocyte is a 
round or globular, grayish cell presenting a more or less irregu- 
lar surface. There are several varieties of white blood cells found 
in the blood, which are called large mononuclear, small mononu- 
clear, polymorphonuclear. There are also a small percentage of 
miscellaneous white cells known as eosinophiles, basophiles, neu- 
trophiles, and mast cells. There are about 7,500 leukocytes to the 
cubic millimeter of blood. They originate in the lymph glands and 
also in the bone marrow. 
38. What are blood platelets? Blood platelets, or thrombocytes, are 
small, circular, shiny disks which are granular and non-nucleated. 
They are not easily seen under the microscope unless the speci- 
men is specially stained. They are supposed to be the fragments 
of the cytoplasm of giant cells found in the marrow of bones. 
They number between 250,000 and 300,000 per cubic millimeter 
of blood. 
39. What is phagocytosis? Phagocytosis is a phenomenon by which 
the white blood cells or leukocytes ingest or digest bacteria or other 
foreign substances. 
40. What is inflammation? Inflammation is a succession of changes 
that occur in a living tissue while it is impaired, provided that 
the injury is not sufficiently severe to destroy at once the struc- 
ture and vitality of the tissue. It is a resisting and a defensive 
process. 70 
QUIZ COMPEND 
41. What are the causes of inflammation? The causes of inflamma- 
tion are: (a) physical, caused by violence; (b) chemical, caused 
by acids, etc.; (c) thermal, caused by heat and cold; (d) elec- 
trical, caused by electricity; (e) bacterial, caused by bacteria or 
their toxins. 
42. What are the phenomena of inflammation? During the course of 
an inflammatory reaction, the phenomena in order are: (1) dili- 
tation of the blood vessels, generally preceded by an initial shock 
or contraction of the arterioles and an acceleration of the blood 
stream; this causes a local hyperemia or redness; (2) retardation, 
a period in which the blood stream slows up and the part has 
become hot; (3) active migration of leukocytes into the surround- 
ing tissues, called chemotaxis, and is the essential feature of in- 
flammation; (4) synchronous with the emigration of the leuko- 
cytes, there is an exudation of lymph, known as the inflammatory 
exudate, which passes into the surrounding tissues in large quan- 
tities; (5) the red blood cells are squeezed through the vessel walls 
involuntarily, this is called diapedesis; (6) a point of stasis or 
stagnation is now reached in which the part is red, swollen, hot, 
painful, and has lost or impaired function. 
43. What occurs in the tissues that surround an inflamed area? The 
connective tissue cells immediately surrounding an inflammatory 
area proliferate or increase in number. 
44. What occurs in an inflamed area after infiltration has taken place? 
After infiltration of the inflamed part there is a degeneration. 
45. What are the terminations of inflammation? The terminations of 
inflammation are: (1) resolution, (2) organization, (3) suppura- 
tion, (4) ulceration, (5) gangrene, (6) chronicity. 
46. What is resolution? Resolution is that termination of inflamma- 
tion in which the condition reaches the point of almost complete 
stasis; the point at which the red blood cells are about to leave 
the vessel wall (diapedesis), when there is a gradual return to 
normal. 
47. What is organization? Organization is that termination of inflam- 
mation which reaches a stage of stasis, more tissue being affected, 
phagocytosis existing together with a proliferation of cells which 
results in organized scar tissue. 
48. What is suppuration? Suppuration is that termination of inflam- 
mation in which part of the affected tissue has been destroyed, pus 
being formed. 
49. What is ulceration? Ulceration is the progressive loss of tissues 
microscopically, in skin or mucous membrane, which previously 
has been the seat of an inflammatory process. 
50. What is gangrene? Gangrene is the terminal stage of inflamma- 
tion in which there is a death of tissues in large masses. 
51. What is meant by chronic inflammation? Chronic inflammation PATHOLOGY 
71 
means a long continuance of some or all of the changes seen in 
acute inflammation, but less in intensity. There is an abnormal 
tendency to the production of new tissue in chronic inflammation. 
52. What are the cardinal symptoms of inflammation? The cardinal 
symptoms of inflammation are pain, heat, redness, swelling, and 
impaired function. 
53. What are the types of exudates? The types of exudates are as 
follows: (a) serous, (b) sero-fibrous, (c) fibrinous, (d) hemor- 
rhagic, (e) purulent or suppurative. 
54. What happens to the exudate in an inflamed area? The exudhte' 
present in an inflamed area is encapsulated by body resistance, 
thus localizing the process. 
55. What happens if body resistance is below normal and the exudate 
cannot be encapsulated? If body resistance is below normal, the 
inflammation might terminate in a general septicemia or in the 
formation of metastatic abscesses; this provided there is no en- 
capsulation. 
56. Explain the formation of a capsule in an inflamed area. Assum- 
ing the irritant to be bacteria which have entered the tissues and 
released their toxins, the following phenomena occur: the initial 
contraction of the arterioles is followed by an acceleration of the 
blood stream with consequent enlargement of the blood vessels. 
The endothelial cells, which line these blood vessels, enlarge andl 
form sister cells or fibroblasts which are released as phagocytic 
agents. The spaces between the cells of the blood vessels called 
stomata, having become sufficiently large, permit the exit of leuko- 
cytes, fibroblasts, lymph, and red cells into the surrounding tissue. 
The bacteria, surrounded by their toxins, are now encircled by 
the leukocytes, lymph, and red cells in the order named, with an 
occasional fibroblast interspersed among them. The leukocytes 
are partially destroyed by the toxins, but a liquefaction of dead 
tissue and a dilution of toxins takes place as a result. The lymph 
neutralizes and dilutes the toxins while the fibroblasts act as phag- 
ocytes, thus completing the work of the leukocytes. The entire 
infected area undergoes a necrosis. The arrangement of the blood 
contents around the bacteria, together with the adjacent white 
fibrous tissue, assumes the formation of organized white fibrous 
tissue, encapsulating the necrosed tissue, which is now called pus, 
forming an abscess. 
57. What is the classification of ulcers? Ulcers are classified as (a) 
specific, (b) malignant. 
58. What is a specific ulcer? A specific ulcer is one that is caused 
by a specific microorganism and is inflammatory in origin. 
59. What is a malignant ulcer? A malignant ulcer is one that is not 
primarily of inflammatory origin and which is necrotic in nature. 
An example is perforating ulcer of the foot in tabes dorsalis 
which is primarily necrotic. The necrotic tissues act as irritants 
and cause true inflammatory ulceration secondarily. 72 
QUIZ COMPEND 
60. Mention three chronic ulcers. Three chronic ulcers often seen 
by the chiropodist are (a) irritable, (b) varicose, (c) callous 
or indolent. 
61. What is necrosis? Necrosis is the death of more or less ex- 
tensive groups of cells with degenerative changes in the inter- 
cellular substance. It is a term often applied to bone, when this 
tissue dies en masse without loss of structure. 
62. What is caries? Caries is the molecular disintegration or ulcera- 
tion of bone. 
63. Give the clinical classification of gangrene. The clinical classifica- 
tion of gangrene is (1) dry, (2) moist. 
64. Give the etiologic classification of gangrene. The etiologic classi- 
fication of gangrene is (1) direct, (2) indirect, (3) specific. 
65. How does dry gangrene occur? Dry gangrene occurs as a result 
of a gradual cutting off of the arterial supply to a part, the fluids 
in the tissues being drained off by the veins. 
66. How does moist gangrene occur? Moist gangrene occurs when 
the venous return is suddenly and completely cut off and the fluids 
in the tissues remain. All gangrene caused by severe inflammations 
is of the moist variety. 
67. What is the appearance of a part when it becomes gangrenous? 
A gangrenous area suffers a loss of motion, heat, color, and sen- 
sation. There is no pulsation. In moist gangrene the part ap- 
pears purplish and in dry gangrene it appears waxy. 
68. Which form of gangrene is more likely to be septic. The moist 
form of gangrene is more likely to be septic. This is due to the 
presence of fluids in the tissues in this form. 
69. What objective symptom readily distinguishes moist gangrene 
from dry gangrene? Moist gangrene has a very offensive odor. 
Dry gangrene causes the affected parts to assume a shriveled, 
parchment-like appearance. 
70. What is a slough? A slough is necrosed or dead tissue which is 
separated from the living tissue by a process of inflammation, the 
dead material being forced off by the formation of granulations 
beneath. 
71. What is the line of demarcation? The line of demarcation is an 
inflammatory line which distinctly separates living from dead tissue 
and precedes the formation of a line of separation. 
72. What is the line of separation? The line of separation is a more 
or less indistinct, irregular line which separates living from dead 
tissue, and is caused by the formation of granulation tissue. 
73. What is the difference in the lines of demarcation and separation 
in dry and moist gangrene? In moist gangrene, the lines are well 
developed whereas in dry gangrene they are usually imperfectly 
developed. PATHOLOGY 
73 
74. How is the dead tissue cast off? The dead tissue is cast off by a 
process known as ulcerative inflammation, in which the granula- 
tions that form in the living tissue lift off the slough. A cer- 
tain amount of pus is formed by the granulations at the line of 
demarcation. 
75. What is a tumor? The term tumor is used to indicate any swell- 
ing, but in a restricted sense, it is applied to designate a new 
growth or neoplasm. 
76. How are tumors classified? Tumors are classified as to their 
character as (a) benign, (b) malignant. They are also classified 
according to their consistency as (a) solid, (b) cystic. 
77. What are benign tumors? Benign, or innocent tumors, are those 
growths which do not cause death directly, and which when re- 
moved do not recur. Examples are fibroma, osteoma, etc. 
78. What are malignant tumors? Malignant tumors, or cancers, are 
those growths which cause death and which will recur when re- 
moved. Examples are epithelioma, sarcoma, etc. 
79. What are solid tumors? Solid tumors are those which are made 
up of solid tissue such as muscle (myoma), bone (osteoma), etc. 
80. What are cystic tumors? Cystic tumors are those which are made 
up of a more or less defined wall and containing a liquid or semi- 
liquid substance. Examples are sebaceous cyst, retention cyst, etc. 
81. Mention some of the characteristic differences between innocent 
and malignant tumors. The innocent tumors are growths of normal 
tissue and are composed of the tissues in which they are found. 
Malignant tumors are growths of perverted tissue and are not 
made up of the tissues in which they are found. The innocent tumors 
do not cause death, except indirectly, while the malignant tumors 
do cause death. The innocent tumors are encapsulated while the 
malignant growths are not and spread into the surrounding tissues. 
An innocent tumor, when excised, does not recur. A malignant 
tumor will recur after excision unless the operation is very ex- 
tensive and is done early in the development of the growth. CHAPTER VI. 
PHYSICAL DIAGNOSIS 
1. What is the study of physical diagnosis? Physical diagnosis is 
that branch of medicine which aims to aid in making a diagnosis 
by objective, subjective, mechanical, or physical means. 
2. What comprises physical diagnosis? Physical diagnosis comprises 
the use of the clinical thermometer, subjective and objective exam- 
ination, history taking, palpation, percussion, auscultation, and 
mensuration. 
3. What is the function of the clinical thermometer? The clinical 
thermometer is used to measure the temperature of the body, 
either subnormal, normal, or abnormal. 
4. What is the normal temperature of the body? The normal tem- 
perature of the body at the surface is 98.6 degrees Fahrenheit, or 
37 degrees Centigrade. 
5. What does a subnormal temperature indicate? A subnormal tem- 
perature usually signifies a lowered degree of health and vitality 
and indicates an apathetic state. When it occurs suddenly it indi- 
cates hemorrhage or shock. 
6. What does an abnormal temperature indicate? An abnormal tem- 
perature usually indicates infection and inflammation. 
7. What is subjective examination? Subjective examination is the 
information elicited from the patient by means of questions and 
answers. 
8. What is objective examination? Objective examination is what 
we can see, particularly that which pertains to the departure from 
the normal. 
9. Of what importance is history taking? History taking is of value 
for future reference and facilitates remembering all symptoms, 
diagnoses, and treatment of a particular case. 
10. What is palpation? Palpation is the use of the sense of touch 
in examining the body and is used for feeling abnormalities, etc. 
11. What is percussion? Percussion is the eliciting of sounds by tap- 
ping with the fingers, noting any departure from the normal sound. 
12. What is auscultation? Auscultation is listening with the ear di- rectly to the part ((immediate method) or through the medium of 
an instrument called the stethoscope (mediate method). 
13. What is mensuration? Mensuration is measuring parts of the 
body and is useful in making comparisons. 
14. What are the cardinal symptoms of infection and inflammation? 
The cardinal symptoms of infection and inflammation are pain, 
heat, redness, swelling, and partial loss of function. 
15. Mention three infections met occasionally in chiropody. Three 
such infections are staphlococcic infection, streptococcic infection, 
and erysipelas. 
16. Does the temperature of the body rise with these infections? 
The temperature seldom rises in staphlococcic infection and prac- 
tically always in streptococcic infection and erysipelas. 
17. Differentiate chilliness and chill. Chilliness is simply a feeling 
of localized cold, such as chilliness down the spine. True chill 
is characterized by shaking of the body and chattering of the 
teeth and an intense feeling of cold over the entire body. 
18. What is the significance of a chiU? A- chill signifies a rapid rise 
in body temperature due to infection and absorption of toxins. 
19. What is the significance of night sweats? Night sweats usually 
signify a vitality of the system below normal, usually due to in- 
fection as tuberculosis, pneumonia, and anemia. 
20. What should be suspected if a patient complains of gaining a 
pound a day? General oedema, or excessive fluid in the tissues, 
should be suspected. 
21. What are the causes of general oedema? The causes of oedema 
are nephritis and heart decompensation (weak heart muscle). 
22. How can these two causes of oedema be differentiated? The 
oedema of nephritis is usually all over the body. The oedema of 
cardiac decompensation usually begins in the feet and legs and 
extends upward. 
23. How can oedema be diagnosed? Oedema can be diagnosed by 
pressing directly over a bone as the tibia or forehead. This pres- 
sure will produce pitting, showing the presence of fluid in the 
tissues. » 
24. Of what significance is the recognition of oedema to the chiropo- 
dist? In oedema all operative treatment is contraindicated on 
account of the risk of infection, tissue resistance being below 
normal, making healing slow or doubtful, with the possibility of 
sloughing. 
25. What does cyanosis (blueness) of the lips, ears, cheeks, nose, and 
finger nails indicate? This symptom appears in any condition in 
which the blood is not properly oxygenated such as pneumonia, 
asthma, cardiac disease, and poisoning by coal-tar derivatives such 
as headache powders, aspirin, etc. 
PHYSICAL DIAGNOSIS 
75 QUIZ COMREND 
76 
26. What is the signficance of cyanosis to the chiropodist? The feet 
will be affected as well as the other parts of the body and will 
feel cold to the touch. In such cases operative procedures are 
contra-indicated. 
27. What subjective symptom would lead one to suspect myocarditis 
(degeneration of the heart muscle or weak heart) ? The charac- 
teristic symptom of myocarditis is dyspnea (shortness of breath) 
on exertion or walking up hill, up stairs, dancing, running, etc. 
28. What objective symptom would lead one to suspect myocarditis? 
The characteristic symptom is oedema of the feet and legs with 
pitting on pressure as at the shoe tops. 
29. What other constitutional or systemic conditions cause pitting? 
Kidney disease, varicose veins, tight garters, increased abdominal 
pressure on return veins as in pregnancy, tumors, cirrhosis (hard- 
ening of the liver) will cause pitting. 
30. How can such conditions be differentiated? In heart conditions 
the oedema is limited to the feet and legs only or it is worse 
in these regions than elsewhere and there is dyspnea on exertion. 
In kidney conditions the oedema is general and is found in the 
face, arms, chest, abdomen, and lower extremities. Examination 
of the urine also determines kidney disease. Varicose veins can 
be seen upon examination as enlarged, superficial, tortuous veins. 
The other factors in oedema can be determined by a history of 
the case. 
31. What is angina pectoris? Angina pectoris is a spasm of the 
coronary arteries of the heart causing a cramp of the myocardium. 
32. What are the symptoms of angina pectoris? The symptoms are 
a sudden knife-like pain over the region of the heart, usually re- 
flecting down the left arm. The pain is of sudden onset and 
usualy attacks those with high blood pressure and arterioscle- 
rosis. 
33. Of what interest is angina pectoris to the chiropodist? This con- 
dition may result from the use of cocaine or adrenalin in local 
anesthesia in an operation. 
34. What is the danger of angina pectoris? The danger is sudden 
death following the pain. 
35. What is the treatment to be given during such an attack? Nitro- 
glycerin tablets, 1/100 of a grain placed under the tongue and 
repeated every ten minutes until relieved. 
36. What would lead one to suspect high blood pressure? High blood 
pressure should be suspected in individuals who have tortuous 
temporal vessels, arcus senilis (a grayish ring at the edge of the 
cornea of the eye), vertigo (dizziness), throbbing in the ears, and 
insomnia. 
37. How can a positive diagnosis of high blood pressure be made? 
A positive diagnosis of high blood pressure can be made by the PHYSICAL DIAGNOSIS 
77 
sphygmomanometer or blood-pressure apparatus. 
38. Of what interest is the diagnosis of high blood pressure to the 
chiropodist? In hypertension, tissue resistance is below par. 
Operations are a greater risk than in normal persons. Antisepsis 
should be more complete. In middle-age persons, syphilis or ne- 
phritis should be suspected. 
39. What is the pulse? The pulse is a rhythmically recurring im- 
pulse arising in the systole (contraction) of the left ventricle of 
the heart and palpable throughout the arterial system. 
40. Where can the pulse best be felt? The pulse can be best felt at 
the wrist above the base of the thumb (radial artery), in front 
of the ear (temporal artery), about an inch forward from the angle 
of the jaw (facial artery), on the dorsum of the foot immediately 
to the outside of the tendon of the extensor longus hallucis (dor- 
salis pedis artery), on the inner side of the foot behind and a 
little below the inner malleolus (posterior tibial artery). 
41. What is the rate of the normal heart beat? The normal heart 
beats 70 to 75 per minute in the male and 75 to 80 per minute 
in the female in a standing position; this is 5 to 10 beats per 
minute less lying down. 
42. Mention three causes of increased heart rate. Three causes for 
increased heart rate are fever, goiter, and excitement. 
43. What is meant by blood pressure? Blood pressure is the lateral 
tension on the vessel wall exerted by the blood while flowing 
through the arteries. 
44. What is hypertension? Hypertension is increased blood pressure. 
45. Mention six causes of hypertension. Six causes of hypertension 
are worry, anxiety, overwork, lack of sleep, nephritis, and syphilis. 
46. What constitutional condition does high blood pressure cause? 
High blood pressure causes premature senility. 
47. How does high blood pressure interest the chiropodist? It must 
be remembered that the feet share in the aging process taking place 
in the body and that their vitality and tone are lowered in pro- 
portion. 
48. What is the danger of high blood pressure? High blood pressure 
may bring about cerebral hemorrhage, or apoplexy, causing paraly- 
sis or death. 
49. What is a constitutional disease? A constitutional disease is a 
chronic ailment affecting the entire body, lowering its resistance, 
and reducing vitality. 
50. Mention two constitutional diseases. Two constitutional diseases 
are syphilis and diabetes. 
51. What is the etiology of syphilis? Syphilis is caused by a micro- 
organism called the spirochaeta pallida. 78 
QUIZ COMPEND 
52. Describe the usual clinical course and symptoms of syphilis. 
(Primary stage) : The chancre or initial lesion occurs at the site 
of infection, the average incubation time being about twenty-one 
days. (Secondary stage) : There is a generalized eruption of a 
copper-colored skin rash which does not itch, sore throat, tem- 
porary falling of the hair, fever, and general malaise. It appears 
from one to three months after tbe primary sore. (Tertiary stage) : 
A gumma (syphilitic tumor) may appear in any part of the body, 
attacking any tissue, and manifests itself any time after one 
year after infection. Syphilis in its tertiary stage may simulate 
almost any disease, and particularly affects the nervous system. 
It is contagious throughout its entire course by contact or 
through secretions, discharges, or blood. 
53. What are the essentials to be remembered in operating on a 
patient having syphilis? There is a grave danger of infecting 
the operator and also of infecting other patients if instruments 
are not properly sterilized. In the tertiary stage, tissue resistance 
is below normal, healing is poor, and operative infection is more 
liable to occur. 
54. Give the usual symptoms of diabetes? The three cardinal symp- 
toms of diabetes are polydipsia (increased thirst), polyphagia 
(increased appetite), and polyuria (increased amount of urine). 
There are two kinds of diabetes: (1) True diabetes, or diabetes 
mellitus, in which the urine contains sugar and is of high spe- 
cific gravity; (2) diabetes insipidus, in which the urine does 
not contain sugar and is of low specific gravity. The first form 
only affects the general health. 
55. What condition might follow a slight operation especially upon the 
feet of diabetic patients? Slight operations upon the feet of dia- 
betics may terminate in gangrene with loss of the toe or the foot. 
56. How does tuberculosis affect the feet? Tuberculosis may cause 
tubercular necrosis or arthritis of the bones. 
57. What might be suspected in an individual who gradually lost 
weight without obvious reason? Pulmonary tuberculosis might be 
suspected. 
58. What are the symptoms of pulmonary tuberculosis? The symp- 
toms of pulmonary tuberculosis are gradual loss of weight, a 
rise in body temperature in the evening, cough, ease of fatigue, 
and night sweats. 
59. What peculiar abnormality of the head might lead one to suspect 
syphilis? Syphilis might be suspected in individuals who have 
an unusually large head (macrocephalus) or an unusually small 
head (microcephalus). 
60. What two characteristic conditions of the hair would lead one to 
suspect syphilis? Syphilis might be suspected where the hair PHYSICAL DIAGNOSIS 
79 
falls out rapidly and is replaced after a short duration, or where 
the hair falls out in circumscribed areas causing complete baldness 
in these areas. The latter condition is called alopecia areata. 
61. What diagnosis would be made if a patient fell in the office in 
convulsions (jerking of the upper and lower extremities and jaw) ? 
Such a condition would be diagnosed as epilepsy. 
62. What is meant by the Argyll-Robertson pupil? If the eyelids 
are closed and then are quickly opened by the examiner, the 
pupils contract sluggishly or not at all when exposed to the light. 
63. What is the significance of the Argyll-Robertson pupil? Such 
a pupil indicates tertiary syphilis and beginning tabes. 
64. What is tabes? Tabes or tabes dorsalis (locomotor ataxia) is a 
degenerative condition of the posterior columns of the spinal 
cord due to syphilis. 
65. Why should the chiropodist be able to recognize tabes? Such 
patients often come to the chiropodist complaining of a sore on the 
plantar surface of the foot called perforating ulcer, with a com- 
plaint of weakness, numbness of feet, and pains in the legs. 
66. Describe arcus senilis. Arcus senilis is a fatty, grayish ring found 
in the cornea at the periphery of the iris, often noticed in elderly 
people, and is due to a degeneration and fatty deposits. 
67. What is the significance of arcus senilis? Its significance is 
arteriosclerosis, usually with high blood pressure. When seen 
in middle-aged people it suggests premature aging of the patient. 
68. What is the significance of arcus senilis to the chiropodist? In 
such cases the general health is below normal and the feet are 
also below normal. 
69. What condition is suggested by spontaneous recurrent nose bleed 
in an elderly person? Such a condition would suggest hyper- 
tension, or arteriosclerosis. 
70. Should such a nose bleed be stopped? No, as the loss of blood 
reduces blood pressure and prevents cerebral hemorrhage. 
71. What is meant by hemophilia? Hemophilia is the inability of the 
blood to coagulate to a greater or lesser extent. 
72. What are the dangers of hemophilia? Persons suffering with this 
condition can have serious hemorrhages from the slightest cut 
or wound. 
73. What condition would a chronic, raised, crusty sore or ulcer of 
years’ duration at the nasal side of the orbit suggest? Such a 
lesion would suggest cancer (epithelioma) of the skin. 
74. Mention the five most prominent signs or stigmata of degeneracy. 
The five most prominent signs of degeneracy are abnormally tall 
or short stature, abnormally large or small head, absence of the 
lobe of the ear (the lower part of the ear is attached directly to 80 
QUIZ COMPEND 
the head), high arched palate, and an unusually small palpebral 
fissure (the opening between the margins of the eyelids). 
75. Mention and describe three kinds of degenerates. (1) Superior 
degenerates are those who have unusual mental endowments and are 
usually very artistic. (2) Inferior degenerates are those who 
show signs of degeneracy, their mentality is below normal, they 
are erratic, morbid, eccentric, criminal, or insane. (3) Debile are 
weak minded, imbecile, and idiotic. Those of class 1 aggravate 
their symptoms and are very sensitive to pain. Those of class 2 
minimize their symptoms and endure pain well. Those of class 3 
have the mentality of a child and diagnosis must be made by 
physical examination. 
76. What condition is suggested by paleness of the lips and of the 
inner surface of the lower eyelids? Such a state should suggest 
anemia. 
77. Mention two important lesions of the lips. Two important lesions 
of the lips are epithelioma (cancer) and chancre. 
78. How are these lesions differentiated? Cancer is usually of months 
or years duration; an increased amount of tissue is often present; 
there is a glandular enlargement at the side of the neck which 
comes late; there are no constitutional symptoms until late in the 
disease; the Wasserman test is negative; no spirochaeta show on 
the microscopic slide; there is no fever. In chancre there is a 
history of exposure to syphilis and the ulcer appears about three 
weeks after such exposure and passes away after four or five 
weeks; the glands are involved early; there is no increase in 
tissue; an ulcer appears with a loss of tissue; there are early con- 
stitutional symptoms such as headache; fever is present; there 
is a generalized skin rash which appears about from one to three 
months after and does not itch; the Wasserman test is usually 
positive and spirochaeta are found under the microscope. 
79. What two diseases can be strongly suspected from the odor of 
the breath? Diabetes with complication and severe kidney dis- 
ease are often detected by the odor of the breath. 
80. Describe the odor from such a breath. In diabetes with acidosis 
the breath has an acetone odor (odor of violets). In severe kidney 
disease there is an uraemic odor, the breath smelling of urine. 
There is suppression of urine. 
81. Of what value is this knowledge of the odor of the breath to a 
chiropodist? Any operative work in such cases is contraindicated, 
as tissue resistance and vitality is below normal. Infection and 
sloughing are liable to occur with grave results. 
82. How does syphilis sometimes manifest itself on the tongue? There 
may be a chancre (primary stage) or mucous patches (secondary 
stage), or there may be a gumma; enlargement of the tongue with 
deep fissures and indentations of the teeth on borders (tertiary 
stage). PHYSICAL DIAGNOSIS 
81 
83. Does active syphilis contraindicate surgery? Yes, on account of 
the resistance being below normal. 
84. Of what use is the study of physical diagnosis to the chiropodist? 
As will be noted by the foregoing questions and answers, anyone 
having to do with any part of the human anatomy, or treating 
pathologic conditions thereof, should remember that no one part is, 
entirely independent of the balance, and that by encouraging our 
use of signs and symptoms nature offers us we will make fewer 
mistakes, in unusual cases, attain better results, and receive fewer.- 
criticisms. CHAPTER VII. 
DERMATOLOGY AND SYPHILOLOGY 
1. What is dermatology? Dermatology is that branch of medicine 
which deals with the diagnosis and treatment of diseases of the 
skin. 
2. What is syphilology? Syphilology is that branch of medicine 
which has to do with syphilis and all its relations. 
3. How are lesions on the skin classified? Lesions on the skin are 
elassfid as primary and secondary. 
4. What are primary lesions? The primary lesions are those which 
constitute the initial manifestations upon the skin. 
5. What are secondary lesions? Secondary lesions result from the 
natural or accidental modification of the primary lesions. 
6. Mention the primary lesions. The primary lesions are macules, 
papules, vesicles, blebs, pustules, tubercles, wheals, and tumors. 
7. What is a macule? A macule is a circumscribed discolored (in- 
crease or decrease of pigment) patch of skin of variable size and 
shape, without elevation or depression. 
8. What is a papule? A papule is a circumscribed solid elevation 
of the skin varying in size from a pin head to a pea. It may be 
rounded, pointed, or flat and variously colored. 
9. What is a vesicle? A vesicle is a pin-head to pea-size circum- 
scribed elevation of the epidermis containing clear or opaque fluid. 
10. What is a bulla? A bulla is a round or irregularly shaped pea 
to egg sized elevation of the epidermis containing clear or opaque 
fluid. 
11. What is a pustule? A pustule is a circumscribed flat or acuminate 
elevation of the epidermis containing pus. 
12. What is a wheal? A wheal is an edematous circumscribed irregu- 
lar pinkish elevation of the skin, transitory in character. 
13. What is a tubercle? A tubercle is a circumscribed, solid, deep- 
seated elevation of the skin attaining or surpassing the size of a 
pea. DERMATOLOGY AND SYPHILOLOGY 
83 
14. What is a tumor? A tumor is a variously sized and shaped promi- 
nence having its seat in the corium or subcutaneous tissue. 
15. Mention the secondary lesions? The secondary lesions are scales, 
crusts, excoriations, fissures, ulcers, scars, and stains. 
16. What are scales? Scales are dry epidermal exfoliations shed from 
the surface of the skin. 
17. What are crusts? Crusts are brownish or yellowish masses of 
dried exudation. 
18. What are excoriations? Excoriations are epidermal denudations, 
usually the result of local traumatism. 
19. What are fissures? Fissures are linear cracks or wounds in the 
epidermis or corium due to disease or injury. 
20. What are ulcers? Ulcers are round or irregular losses of tissue 
involving the skin and subcutaneous tissue. 
21. What are scars? Scars are connective tissue new formations oc- 
cupying the region of former losses of tissue. 
22. What are stains? Stains are discolorations of the skin left after 
the disappearance of cutaneous lesions. 
23. Mention the subjective symptoms occuring in skin diseases? The 
various subjective phenomena occuring in skin diseases are the 
sense of heat, burning, itching, smarting, tingling, and pain. These 
are present in varying degrees of intensity in different diseases. 
24. Describe the embryonic origin of the skin. The epidermis of the 
skin is derived from the ectoderm. The derma or corium is de- 
rived from the mesoderm. 
25. How are the layers of the skin divided? The layers of the skin 
are divided into three distinct sections; the epidermis, the corium 
and the subcutaneous tissue. 
26. How is the epidermis divided? The epidermis, cuticle, or scarf 
skin is divided into four layers: (a) stratum corneum, (b) 
stratum lucidum, (c) stratum granulosum, (d) stratum mucosum. 
27. Describe the stratum corneum. The stratum corneum, or horny 
layer of the epidermis is made up of many layers of non-nucleated, 
scaly cells which act as a protection to the softer structures below. 
28. Describe the stratum lucidum. The stratum lucidum, or clear 
layer is made up of from two to four layers of bright elongated 
cells which appear clear under the microscope. 
29. Describe the stratum granulosum. The stratum granulosum or 
granular layer is made up of several layers of flattened granular 
cells. The granules contain a chemical substance callecT kerato- 
hyalin and an allied substance called eleidin. These substances 
piay a part in the changes that take place in the character of the 
skin in the outer layers. 84 
QUIZ COMPEND 
30. Describe the stratum mucosum. The stratum mucosum, the mu- 
cous layer or rete Malpighii, is the deepest and most important 
layer of the epidermis. The basal layer rests upon the basement 
membrane or membrana propia and is made of columnar epi- 
thelium. These cells have the power of reproduction and also 
contain the pigment of the skin. Above the basal layer are several 
layers of cells which contain nuclei and which have serrated bor- 
ders. These are called prickle cells. 
31. How is the epidermis nourished? The epidermis has no blood 
vessels, but receives nourishment by osmosis from the derma, the 
nutrient fluid being found in the intercellular spaces in the lower 
layers. 
32. How is the derma divided? The derma, corium, or cutis vera is 
divided into two layers: (a) the papillary layer, (6) the reticular 
layer. 
33. Describe the papillary layer of the corium. The papillary layer of 
the corium or the Pars Papillaris, is made up of bundles of con- 
nective tissue fibers in which are found connective tissue cells. 
The papillae are small conical elevations which dovetail with the 
rete above. These papillae contain blood vessels, nerves, lym- 
phatics, and nerve corpuscles. 
34. Describe the reticular layer of the corium. The reticular layer 
of the corium, or the Pars Reticularis, is made up of loosely ar- 
ranged bundles of connective tissue fibers. This layer blends 
with the papillary layer without a line of demarcation. The blood 
vessel and lymphatic plexuses are found in this structure as well 
as the hair follicles, sweat glands, and sebaceous glands. 
35. Describe the subcutaneous tissue. The subcutaneous tissue, stratum 
subcutaneum or tela subcutanea, is made up of loose connective 
tissue in the meshes of which are contained the fat globules. The 
deeper hair follicles and sweat glands are also found here. 
36. Describe the arrangement of the blood vessels in the derma. The 
blood vessels are arranged in two plexuses, the superficial, found 
in the papillary layer and from which the capillary loops enter 
the papillae, and the deep plexus, which is found in the reticular 
layer. The deep plexus sends branches to the sweat and sebaceous 
glands and to the hair follicles. 
37. Describe the arrangement of the lymph vessels in the derma. The 
lymph vessels follow the blood vessels in a general way, there 
being a superficial and a deep lymph-plexus. 
38. Describe the nerve supply to the skin. The nerves terminate 
mostly in the derma, the medullated fibers terminating in the papil- 
lae as tactile corpuscles and in the subcutaneous tissue as Pacinian 
corpuscles. The non-medullated fibers penetrate the derma and 
are lost in the rete of the epidermis. The skin also contains mo- 
tor and vaso-motor nerves. 39. How are skin diseases classified? Skin diseases are classified ac- 
cording to their general characteristics into various groups such 
as anemias, hyperemias or congestions, inflammations, hypertro- 
phies, atrophies, neoplasms or new growths, etc. 
40. What common skin diseases appear on the foot and leg? The 
commoner skin diseases that appear on the foot and leg are ery- 
thema nodosum, eczema, impetigo, pompholyx, lichen planus, 
psoriasis, the various forms of dermatitis, tinea trichophytina, 
pediculosis, scabies, ichthyosis, elephantiasis, tuberculosis, and 
syphilis. 
41. What is erythema nodosum? Erythema nodosum, or dermatitis 
contusiformis, is an acute inflammatory disease of the skin in which 
are found round or oval node-like swellings. 
42. What are the symptoms of erythema nodosum? The symptoms are 
as follows: fever, articular pains, coated tongue, and general 
malaise. The round or oval swellings, varying in size from a 
hazel nut to an egg, appear on the tibia. Sometimes the forearms, 
face, and trunk are also involved. The nodes are red, tense, and 
shining and tender to the touch. They are hard at first but soon 
soften. They never suppurate. It appears in early life, being rare 
after the age of thirty. Males are affected much oftener than 
females. 
43. What is the treatment for this condition? The treatment consists 
of regulation of the bowels and other internal treatment. Externally 
hot lead and opium wash and elevation of the legs. Recovery is 
complete in two to six weeks. 
44. What is eczema? Eczema, tetter, salt rheum, etc., is an acute, 
subacute, or chronic, non-contagious disease of the skin charac- 
terized primarily by erythema, vesicles, papules, or pustules, and 
secondarily by scales and crusts and accompanied by itching and 
burning; a catarrhal dermatitis. This disease constitutes about 
30 per cent, of all skin diseases and affects persons at all ages 
and in all conditions of life. It is the most important of all skin 
lesions. 
45. How many types of eczema are recognized? There are four ele- 
mentary types of eczema: Eczema erythematosum, eczema papu- 
losum, eczema vesiculosum, and eczema pustulosum. These may 
terminate in the more chronic forms, eczema rubrum or eczema 
squamosum. 
46. What forms of eczema are usually found on the feet? The forms 
of eczema usually found on the feet are eczema vesiculosum, 
eczema rubrum, eczema squamosum, and qczema fissum. 
47. How else is eczema classified? Eczema is also classified as acute 
and chronic. This classification applies not only to the duration 
but also to the intensity of the inflammatory process. 
48. How are these two stages differentiated? The acute type of 
DERMATOLOGY AND SYPHILOLOGY 
85 86 
QUIZ COMPEND 
eczema is always accompanied by surface exudation, while the 
chief characteristic of chronic eczema is infiltration. 
49. What is the etiology of eczema? The actual cause is unknown. 
The contributing causes of eczema are both internal and external. 
The internal causes include disorders of the alimentary tract such 
as constipation, dyspepsia, etc., functional and organic nerve dis- 
eases, general debility, rheumatism, diabetes, Bright’s disease, etc. 
The external causes are many and include chemical irritants, such 
as acids, strong soaps, etc.; thermal irritants, such as solar or 
artificial heat, cold when associated with wet; mechanical irritants, 
such as friction, scratching, etc. 
50. What is the diagnosis of eczema? The diagnosis of eczema is. 
usually simple, but occasionally becomes difficult. Its cardinal 
characteristics are redness, vesicles, pustules, and discharge; crust- 
ing and scaling; infiltration and thickening; itching and burning. 
51. What is the prognosis of eczema? Eczema very often runs a 
long chronic course and if untreated will continue indefinitely. 
Proper treatment, continued sufficiently, will usually bring good 
results. 
52. What is the treatment for eczema? The treatment for eczema is 
both internal and external. The internal treatment consists of diet, 
laxatives, digestives, alteratives, etc. 
53. What is the external treatment for eczema? The local treatment 
of the lesions is most important and requires a very careful se- 
lection of drugs. The type of drug to be used is governed entirely 
by the degree of inflammatory reaction present. In acute eczema 
the treatment must be soothing, even water being an irritant to 
this type. In chronic eczema soaps and water are of value. The 
basic principle upon which treatment is given is soothing agents 
for acute cases and stimulants for chronic cases. 
54. What drugs are used in the treatment of acute eczema? The 
soothing agents most commonly used in acute eczema are zinc 
oxide, corn starch, rice flour, bismuth subnitrate, boric acid, kaolin, 
etc. Olive oil is used to cleanse the skin. Lotions are used in 
moist eczema, and these may contain zinc oxide, calamine, phenol, 
boric acid, lime water, glycerine, etc. 
55. What drugs are used in chronic eczema? The stimulant group of 
drugs are used in chronic eczema and include tar, white precipi- 
tate, sulphur, salycilic acid, etc. 
56. What other local measures are used in the treatment of eczema? 
Other measures than drugs include baths, containing starch or 
borax, and the Z-ray. 
57. Describe impetigo. Impetigo, or impetigo contagiosa, is an acute 
inflammatory disease of the skin which is contagious. It is char- 
acterized by the appearance of vesicles or blebs which become 
pustular and dry upon the skin as thin crusts. There is a form of 
impetigo called impetigo simplex which is non-contagious. This DERMATOLOGY AND SYPHILOLOGY 
87 
latter form is often seen upon the foot and is caused by the 
scratching of other itchy skin lesions such as eczema or lichen 
planus. 
58. What is the treatment for impetigo? The treatment for impetigo 
consists of the use of mercurial ointments which are strong anti- 
septics. The crusts should be removed with soap and water and 
white precipitate, about 2 per cent., in zinc ointment should be 
applied. The local remedy should not be irritant as this tends 
to aggravate the condition. 
59. What is pompholyx? Pompholyx is an acute inflammatory disease 
of the skin in which hard, deep-seated vesicles appear upon the 
hands and feet. Many cases formerly diagnosed as pompholyx 
have been found to be due to some form of tinea. 
60. What are the symptoms of pompholyx? The patient complains 
of a feeling of heat, burning, tingling, or itching. The vesicles 
may remain separate or they may coalesce to form bullae. The 
fluid is often absorbed and the eruption will disappear within a 
few days. Hyperidrosis often accompanies an attack and recur- 
rences are frequent. 
61. What is the cause of pompholyx? The etiology of pompholyx is 
given as occurring in those whose nervous tone is below normal. 
It is commonly associated with increased sweating and is more 
frequent in women than in men. It is seen mostly in adult life. 
62. What is the treatment of pompholyx? The treatment of pompho- 
lyx is both internal and external. The internal treatment consists 
of the use of tonics. Locally salicylic acid, boric acid, diachylon 
ointment, and X-rays are used. 
63. What is lichen planus? Lichen planus is an inflammatory disease 
of the skin characterized by the appearance of small, flat, angular, 
shining, bluish-red papules associated with pronounced itching. 
64. What is the cause of lichen planus? The cause of lichen planus 
is probably of neurotic origin. Nervous exhaustion resulting from 
grief, worry, overwork, etc., is the most common cause. Digestive 
disturbances are also etiologic factors. 
65. What is the treatment of lichen planus? The treatment is both 
general and local. Hygiene and diet must be regulated and 
arsenic or mercury are given internally. When the intestinal tract 
is at fault, correction of the trouble will clear up the skin lesion 
Locally tar, phenol, salicylic acid, mercury, etc., are used. 
66. What is psoriasis? Psoriasis is a chronic inflammatory skin dis- 
ease which is characterized by variously sized, reddish, dry, rounded 
patches covered with abundant silvery scales. 
67. What are the symptoms of psoriasis? The disease may attack 
any one at any age, but adolescents and young adults are the 
ones usually afflicted. It begins as small reddish papules covered 
with small scales. These spread at the periphery until they attain 88 
QUIZ COMPEND 
the size of a dollar. The scales look like mother-of-pearl and are 
superimposed upon each other in an imbricated manner. The 
lesion is always dry, and appears most often on the extensor sur- 
faces of the elbows and knees. Itching is usually slight. 
68. What is the etiology of psoriasis? The cause of this disease is 
obscure. Gout and rheumatism are often associated with psoriasis 
and are considered by some as etiologic. There are three etiologic 
views which are metabolic, nervous, and microbic. The first seems 
to be the most likely. 
69. What is the treatment for psoriasis? Both internal and external 
treatment is used. Internally arsenic is used most. Externally the 
treatment consists of first removing the scales by washing with 
soap and water. The drugs used are chrysarobin, tar, white pre- 
cipitate, salicylic acid, etc. The disease is liable to relapses, espe- 
cially in cold weather. 
70. What is meant by the term “dermatitis”? Dermatitis, or inflam- 
mation of the skin, is a disorder characterized by pain, heat, red 
ness, and swelling. The term is restricted to acute inflammations 
which result from known irritants. 
71. How is dermatitis classified? Dermatitis is classified as: (a) der- 
matitis traumatica, (b) dermatitis calorica, (c) dermatitis vene- 
nata, (d) dermatitis medicamentosa, (e) dermatitis gangrenosa. 
72. What is dermatitis traumatica? Dermatitis traumatica is an in- 
flammation of the skin due to all forms of external violence such 
as contusions, lacerations, and excoriations (due to friction, scratch- 
ing, etc.). The dermatitis caused by scratching is of importance, 
as it often is the means of complicating other skin diseases. 
73. What is dermatitis calorica? Under this head are included the 
inflammations caused by heat (dermatitis ambustionis), and by 
cold (dermatitis congelationis). In both these forms of derma- 
titis calorica there is erythema, vesication, or gangrene, accom- 
panied by severe pain. 
74. What is dermatitis venenata? Dermatitis venenata is due to con- 
tact with harmful animal and vegetable substances. Under this 
may be mentioned the acids and alkalies, croton oil, mustard, can- 
tharides, anilin dyes, etc. The most important etiologic factor in 
dermatitis venenata is poison ivy, or poison oak, and poison 
sumach or dogwood. 
75. What are the symptoms of dermatitis venenata? After exposure 
to the poison of the plant, in from a few hours to a few days, the 
hands and face become the seat of a large number of vesicles 
and blebs. The rest of the body often becomes involved by auto- 
inoculation. The eruption lasts from one to four weeks. Some 
persons are very susceptible to this poisoning so that close prox- 
imity without actual contact will bring about an attack. Others, 
again, manifest no bad effects even after contact with the poison. DERMATOLOGY AND SYPHILOLOGY 
89 
76. What is the treatment of dermatitis venenata? The treatment of 
this lesion consists of the use of local applications, the best of 
which are alcohol and lead water. Ointments containing phenol 
and sodium bicarbonate are also used. 
77. Describe dermatitis medicamentosa. This class of dermatitis (drug 
eruptions) includes eruptions caused by the ingestion or absorp- 
tion of certain medications. 
78. What factors favor the appearance of drug eruptions? The fac- 
tors that favor the appearance of drug eruptions are idiosyncrasy, 
excessive cutaneous elimination, imperfect renal or intestinal elimi- 
nation, large doses, long continued use of the drug. Individual 
susceptibility is the most important factor. 
79. How does the eruption appear? The eruption may appear as 
macular, papular, vesicular, bullous, or hemorrhagic. 
80. Which drugs are most likely to cause dermatitis medicamentosa? 
The drugs most likely to cause this disease are antipyrin, arsenic, 
belladonna, bromides, chloral, copaiba, cubebs, digitalis, iodides, 
mercury, opium, quinine, salicylic acid, etc. 
81. Which of these drugs is liable to produce an eruption which might 
be brought to the attention of the chiropodist? The drugs are 
bromides and iodides. 
82. What is dermatitis gangrenosa? Dermatitis gangrenosa is an in- 
flammation of the skin which results in death of the tissues in 
mass. Any local or systemic condition which may terminate in 
death of the skin should be classified as dermatitis gangrenosa. 
Thus, burns or frostbite, which are classified as dermatitis calorica, 
become dermatitis gangrenosa when there is a death of tissue. 
So, too, infections like trench foot are thus classified. Systemic 
disease, such as Raynaud’s disease and diabetes, may also cause 
dermatitis gangrenosa. 
83. What is the treatment of dermatitis gangrenosa? There are two 
ways of treating this condition—one active and the other passive. 
The first consists of excision above the dead tissue and the second 
of waiting until a line of demarcation has formed and the dead 
area cast off by a slough. 
84. What is tinea? Tinea is a parasitic organism of the fungus 
variety which attacks the skin of man. There are many forms of 
this parasite, but the two most common and of most interest to the 
chiropodist are the tinea trichophytin and the tinea epidermiphytin. 
The disease is called ringworm. 
85. What are the symptoms of ringworm? The eruption usually af- 
fects the skin on the plantar surface of the toe webs, and at first 
is apt to be mistaken for eczema. It may occur at any age, but 
very old people are rarely affected. It appears more often in warm 
weather in which it differs from eczema. The fungi penetrate 
deeply into the epidermis and undergo periods of dormancy and 90 
QUIZ COMPEND 
growth, alternately. In cold weather the disease is dormant, while 
in warm weather it becomes active. When the attack recurs the 
lesions are found in the same place as they occupied formerly. 
86. How many varieties of tinea or ringworm are there? There are 
three varieties described. In the first variety there is an over- 
production of callous with more or less scaling and Assuring. In 
the second class there is maceration between the toes, especially 
the fourth interspace. The eruption spreads along the toes toward 
their ends, to the dorsal surface or backward on the sole with a 
spreading vesicular margin. This variety may be so slight as 
to be scarcely noticeable, with white friable scales, or it may be 
so severe that it will undermine thick layers of epidermis. When 
the lesion is so severe it is called “eczematoid ringworm.” The 
third variety is characterized by an eruption on the sole, the side 
of the foot, and especially on the hollow of the instep. It is made 
up of deep-seated vesicles which appear singly or grouped. Some 
of these rupture, discharging serum; others dry up, leaving small 
brownish dots. In either case, dry scaly patches are produced. 
87. How can the type of ringworm fungus be determined? There is no 
diagnostic clinical characteristic for each type. They can be dis- 
tinguished only by culture and by the microscope. 
88. What is the etiology of ringworm? The mycelia and spores of 
various fungi have been isolated. The trichophyton and the epi- 
dermophyton are the most common. Warm, moist weather favors 
their growth. The fungus is carried from one person to another by 
public baths, launderies, and by footgear. The fungi are very 
viable. Ordinary laundering does not destroy them. Infected 
socks should be boiled at least fifteen minutes to insure destruc- 
tion. Hyperidrosis is a factor in their growth. 
89. What is the treatment for ringworm? The best treatment consists 
of constant desquamation and exfoliation. Soap and water should 
be used for the dead epithelium. Vesicles, blisters, and pustules 
should be opened and all loose epithelium removed. For purulent 
types ammoniated mercury ointment is used. This may also be 
used at night in the dry types. Good results are obtained, espe- 
cially during the day by a powder containing salicylic acid, 10 to 
15 per cent., in talcum. This should be dusted between the toes 
and in the socks. Precipitated sulphur may be combined with 
salicylic acid either in powder or ointment form. Well-developed 
lesions respond to almost any germicidal treatment, but hidden 
fungi will delay recovery. 
90. What is pediculosis? Pediculosis is a contagious animal parasitic 
disease, characterized by the presence of pediculi (lice), hemor- 
rhagic points, and scratch marks. 
91. How is pediculosis classified? Pediculosis is classified into three 
varieties: (a) pediculosis capitis, (b) pediculosis corporis, (c) 
pediculosis pubis. The second class is of interest to the podia- 
trist. DERMATOLOGY AND SYPHILOLOGY 
91 
92. Describe pediculosis corporis. Pediculosis corporis is produced by 
the body louse. The parasite resides in the seams of the under- 
clothing and is present on the skin only when foraging. The 
patient suffers greatly from itching, so that scratch marks are 
numerous all over the body. Blood crusts, pigmentation, and 
thickening may also be seen. The disease is common among 
poorer classes of adults, but is rare in children. Careful examina- 
tion of the seams of the underclothing will reveal the presence of 
the parasite. 
93. What is the treatment for pediculosis corporis? The treatment is 
first disinfection of the clothing and bed linen. These are thor- 
oughly boiled or baked. Phenol will relieve the itching. When 
the clothing cannot be disinfected sulphur is the best agent to 
prescribe. It is used on the body in an ointment form, about 10 
or 15 per cent., and powdered sulphur should be sprinkled in the 
clothing, bed linen, etc. 
94. What is scabies? Scabies, or itch, is a contagious animal para- 
sitic disease due to the acarus scabiei, and characterized by bur- 
rows and a multiform eruption, and attended with severe itching. 
95. What are the symptoms of scabies? The parasite burrows into 
the skin and produces a papule, vesicle, or pustule at the point of 
entrance. Later a burrow is formed at this point. In well-marked 
cases there is an eruption of vesicles, pustles, crusts, and scratch 
marks. There is intense itching which is worse at night. The 
disease develops rapidly and if untreated will last many months. 
96. What is the etiology of scabies? The disease is caused by the 
invasion of the acarus scabiei, a microscopic parasite. It is trans- 
mitted by direct contact or through bed clothes, etc. 
97. What is the treatment of scabies? Scabies is treated much the 
same as the other parasitic skin diseases. The parasite must be 
destroyed and the inflammation must be subdued. The itch mite 
is easily killed by sulphur, balsam of Peru, or tar, sulphur being 
the most popular. Treatment is commenced by thoroughly wash- 
ing the body with soap and water and then thoroughly an- 
nointing the entire body from the neck down with sulphur oint- 
ment. This is done twice a day for three days. Then another 
bath is taken and the underclothing and bed linen changed and 
sterilized. This usually suffices to cure. 
98. Describe ichthyosis. Ichthyosis is a chronic hypertrophied dis- 
ease of the skin characterized by dryness and scaliness of the 
skin and a variable amount of papillary hypertrophy. It is also 
called fish-skin disease. 
99. What are the symptoms of ichthyosis? The skin is dry and hard 
with variously sized reticulated scales, resembling fish scales. It 
is influenced by the seasons, being worse in cold weather. There 
is no inflammation or itching, but it may be complicated with 
eczema. 92 
QUIZ COMPEND 
100. IF hat is the etiology of ichthyosis? The condition is congenital, 
although it does not usually manifest itself before the first or 
second year. In some cases heredity is an influence. 
101. What is the treatment for ichthyosis? The treatment is purely 
external and consists of the use of agents which will remove the 
epidermal scales and soften the skin with ointments. Sodium bicar- 
bonate baths are of value and should be used frequently. Lanolin 
or olive oil rubbed into the skin is also beneficial. In severe cases 
washing with soap and water twice a day followed by the use of 
ointments is indicated. 
102. What is elephantiasis? Elephantiasis is a chronic hypertrophic 
disease of the skin and subcutaneous tissue, due to obstruction of 
the lymphatic channels. Its most common seat is the leg and foot 
and it results in enormous enlargement of the lower extremity, 
with papillary outgrowth. 
103. What are the symptoms of elephantiasis? The disease begins as 
an erysipelatous infection, accompanied by fever, lymphangitis, 
pain, swelling, and heat and followed by a more or less perma- 
nent enlargement of the foot and leg. The acute attack recurs 
at intervals, the limb becomes larger with each successive attack. 
The limb becomes chronically hypertrophied and the skin and 
subcutaneous tissues are greatly thickened. The surface is pig- 
mented and covered with warty growths and fissures. There is an 
offensive odor, and usually no pain. 
104. What is the treatment for elephantiasis? The infective attacks 
are treated by rest, cold applications, and saline cathartics in- 
ternally. Good food, tonics, and change of climate are important. 
Elastic compression by rubber bandages is the most efficient treat- 
ment for the leg. The X-rays are also used to promote absorption 
of the thickened tissues. In advanced cases treatment is of little 
value. 
105. How does tuberculosis manifest itself in the skin? Tuberculosis 
of the skin appears in several ways: (a) lupus vulgaris, (6) scrofu- 
loderma, (c) tuberculosis cutis orificialis, (d) tuberculosis ver- 
rucosa cutis. Lupus erythematosus is also thought to be due to 
the toxins of the tubercle bacillus. 
106. What is lupus vulgaris? Lupus vulgaris is a tuberculous cellular 
new growth characterized by reddish or brownish patches con- 
sisting of papules and nodules and terminating in ulceration and 
scarring. 
107. What is the etiology of lupus vulgaris? The etiology of lupus 
vulgaris is the invasion of the skin by the tubercle bacillus. 
108. Where is the favorite site of lupus vulgaris? The favorite site of 
lupus vulgaris is the face. The extremities are only occasionally 
affected. 
109. What are the symptoms of lupus vulgaris? The disease starts as 
small reddish or brownish papules. They are softer than the sur- DERMATOLOGY AND SYPHILOLOGY 
93 
rounding skin and have a characteristic “apple jelly” appearance. 
The disease is chronic, often lasting throughout the life of the 
individual. The disease appears early in life. 
110. What is the treatment of lupus vulgaris? The treatment is in- 
ternal and local. The general treatment is diet, fresh air, exer- 
cise, etc. Cod liver oil, iodide of iron, etc., are used internally 
and tuberculin has also been used. Its value, however, is ques- 
tioned. The local treatment is directed against the lupus tissue 
either by the use of chemical caustics or by the curette. Silver 
nitrate stick, pyrogallic acid, arsenous acid, and chloride of zinc 
are generally employed. 
111. What is tuberculosis verrucosa cutis? This disease called also 
postmortem wart or anatomic tubercle, is a warty tuberculosis of 
the skin occurring usually on the hands and feet and charac- 
terized by one or more verrucous nodules. 
112. What is the etiology of anatomic tubercle? The disease occurs 
in those who come in contact with the cadaver in the dissecting 
room. Butchers are also subject to the infection. 
113. What are the symptoms of anatomic tubercle? At the sight of an 
abrasion, there is first the appearance of an inflammatory vesieo- 
pustule. This becomes larger and burns and itches. When the 
lesion is fully developed it appears as a bean-sized, flattened 
warty growth. The fingers and toes are the favorite seats. 
114. What is the treatment for postmortem wart? When seen early, 
repeated applications of tincture of iodine will cure the condition. 
Otherwise chemical caustics or curetting must be used. 
115. What is syphilis? Syphilis is an infectious disease which may 
infect all the tissues of the body including those of the central 
nervous system. 
116. What is the cause of syphilis? Syphilis is caused by the in- 
vasion through the skin or mucous membrane of the spirochaeta 
pallida, a microorganism of the spirillum type. 
117. How does syphilis first appear? Syphilis first appears on the body 
at the point of infection as a primary sore or chancre. This sore 
may be genital or extra-genital. 
118. Describe the primary sore. The primary sore may be a super- 
ficial abrasion, fissure, or ulcer, or it may be the characteristic hard 
cartilagenous, punched-out ulcer known as a Hunterian chancre. 
The chancre usually appears three to four weeks after exposure, 
and remains from six to eight weeks if untreated. 
119. What are the secondary symptoms of syphilis? The secondary 
symptoms of syphilis appear after the primary sore has dried up. 
First, there is a swelling of neighboring lymphatic glands, followed 
by a generalized lymphatic enlargement. There are constitutional 
symptoms, sore throat, etc. The skin eruption is generalized and 
symmetric and is either macular, papular, or pustular. The lesions 94 
QUIZ COMPEND 
are superficial and not destructive. The eruptions are often pre- 
ceded by fever, headache, muscular and osseous pains, and general 
lassitude. 
120. What are the late or tertiary symptoms of syphilis? The late or 
tertiary symptoms of syphilis may appear shortly after the sec- 
ondary symptoms or there may be a lapse of years before they 
manifest themselves. The eruption is limited and unilateral and 
of a tubercular, gummatous, or ulcerative type. The lesions are 
deep seated and destructive. 
121. What is the course of the skin manifestations of secondary and 
tertiary lesions of syphilis? The secondary skin lesions very 
often disappear even without treatment, whereas the tertiary lesions 
rarely do so, and continue indefinitely, progressing with time. 
122. What is a gumma? A gumma is a new growth of connective tissue 
which appears some time after the contraction of the disease. It 
may involve any part of the body. The gummata found in the 
skin are a result of the infiltration of the subcutaneous tissue. 
Frequently they last for long periods before the overlying skin 
becomes inflamed and breaks down and ulcerates. The ulcer can 
be recognized by its punched-out appearance, dirty base, and un- 
dermined edges. Its favorite location is the upper third of the 
shin. 
123. What form of syphilis is found on the foot? The papulosquamous 
syphiloderm is the form most often found on the sole of the foot. 
If both soles are involved, the eruption is probably an early one, 
but if it is unilateral, it is late. The lesions are flattened and 
covered with thin, scanty, dirty grayish scales. The size of the 
lesions is uniform but they present varied shapes. Beneath the 
scales are infiltrated, dull-red papules. 
124. What is the Wasserman reaction? The Wasserman reaction is a 
chemical test made from the blood serum of a person in whom 
syphilis is suspected. A positive reaction is an absolute indica- 
tion of the presence of syphilis in the body, but a negative re- 
action is not absolute. Thus, a person may be suffering with 
the disease and still have a negative Wasserman reaction. 
125. What is the treatment of syphilis? The treatment of syphilis has 
for its object the complete destruction of spirochaetes in the body. 
Thus, it becomes necessary to use some agent which can be put 
into the blood stream which will reach everywhere so as to kill 
the organism. The earlier in the course of the disease that treat- 
ment is started the better will be the prognosis. Mercury and the 
organic forms of arsenic have proven to be the best remedial 
agents. Intravenous injections of salvarsan, neosalvarsan, and 
silver salvarsan are being used in conjunction with intramuscular 
injections of salicylate or bichloride of mercury. This combina- 
tion of treatment given in regular and sufficient doses is ap- 
parently curing syphilis. 126. What is the local treatment of syphilitic skin lesions? Local treat- 
ment without the general treatment is worthless. In conjunction 
with general treatment, mercurial ointments and powders are 
used. White precipitate ointment and calomel dusting powders are 
the two most commonly used mercurials. 
127. Why is it important that the chiropodist be able to recognize syph- 
ilis? This disease can be easily contracted in the course of treat- 
ing a patient who is infected so that recognition and care against 
infection is essential. Further, the disease can also be transmitted 
from one patient to another, although this is not likely if asepsis 
and antisepsis are practiced. 
128. What syphilitic lesions are most infective? The active moist 
lesions contain large numbers of the spirochaetes and while the 
microorganisms remain moist they are virulent. 
129. How can the presence of syphilis be positively determined? If 
suspicious, the practitioner should diplomatically advise the pa- 
tient to have a Wasserman test made. If this report should be 
positive, the case is immediately referred to the syphilologist. If 
the report be negative, and the clinical signs be sufficiently posi- 
tive, the patient should be induced to visit the specialist. He can 
soon determine the absolute presence of syphilis by giving the 
patient a dose of salvarsan, which will make the blood positive if 
the patient be syphilitic. This is called a provocative dose. 
DERMATOLOGY AND SYPHILOLOGY 
95 CHAPTER VIII. 
SURGERY 
1. What is surgery? Surgery is that branch of the healing art 
which deals with the treatment of morbid conditions by manual or 
instrumental agencies. 
2. What are morbid conditions? Morbid conditions are those condi- 
tions in the body which are not normal. 
3. How many classes of morbid conditions are there? Three: (1) 
injuries, (2) infections, (3) diseases. 
4. What are injuries? Injuries are processes due to physical agencies 
and include traumatism, the effects of heat and cold, chemicals, 
light, and electricity. 
5. What are infections? Infections are the invasion of pathogenic 
bacteria into the system where conditions are favorable to their 
growth and multiplication. 
6. What are diseases? Diseases and infections are closely linked. 
In this group come new growths, changes due to age and environ- 
ment, and the idiopathic diseases. 
7. What is meant by the term idiopathic? The term idiopathic in- 
dicates a disease which is primary and originates without any 
apparent extrinsic cause. 
8. What are bacteria? Bacteria are unicellular plants of micro- 
scopic size, which produce fermentation, decomposition, or disease. 
9. How are bacteria classified? Bacteria are classified according to 
their shape as follows: bacilli, cocci, spirillae. 
10. What are bacilli? Bacilli are rod-shaped bacteria. 
11. What are cocci? Cocci are round or oval bacteria. 
12. What are spirillae? Spirillae are spiral-shaped bacteria. 
13. Are all bacteria capable of causing disease? No. Those that 
cause disease are called pathogenic; those that do not cause dis- 
ease are called non-pathogenic. 
14. What is a toxin? A toxin is a poisonous chemical substance 
which is produced by bacteria or is formed in the tissues as a 
result of the presence of bacteria. SURGERY 
97 
15. How do bacteria enter the tissues? Bacteria enter the tissues 
through wounds and abrasions and by penetrating the mucous 
membrane. 
16. What is meant by the term resistance? The power of the tissues 
to resist the invasion of bacteria, although not thoroughly under- 
stood, is called resistance. The power of the white blood cells 
to destroy invading hosts (phagocytosis) may account for it in 
part, and the germicidal power of the blood serum may also ac- 
count for this power. Resistance may also be due to the absence 
from the tissues of some substance necessary for the successful 
growth and multiplication of bacteria. 
17. What lowers the resistance of the body? Anything that lowers the 
vitality by depressing the system will lower the resistance. Ex- 
hausting diseases such as anemia, diabetes, alcoholism, or ex- 
posure to cold, etc., will help lower resistance. 
18. What is meant by the term immunity? By immunity is meant the 
ability to resist the invasion of any species of bacteria. 
19. How many kinds of immunity are there? Two: natural and ac- 
quired immunity. 
20. What is natural immunity? Natural immunity is the ability to 
resist disease which is natural with the individual. Thus, races of 
people are immune to certain diseases due to something in the 
body which does not allow that particular disease to develop. 
21. What is acquired immunity? Immunity which has been produced 
by artificial means such as the injection of anti-toxins and serums, 
or by having had a disease and thus developing immunity against 
future attacks. 
22. What is sterilization? Sterilization is the process of destroying 
pathogenic bacteria, usually by means of heat. 
23. What are the most important things to sterilize in any surgical 
procedure? The instruments, the field of operation, the hands of 
the operator, and the dressings. 
24. What is an approved method of sterilizing the instruments? In- 
struments are best sterilized by boiling them in water for about 
twenty minutes. A small amount of sodium carbonate (washing 
soda), a teaspoonful to the pint, is added to prevent rusting of the 
instruments. 
25. What is an approved method of sterilizing the field of operation? 
The part is first cleansed with soap and water, then washed with 
ether to dissolve fats, then with alcohol, and finally painted with 
half strength tincture of iodine (3*4 per cent.). 
26. What is an approved method of sterilizing the hands of the oper- 
ator? The hands are scrubbed with tincture green soap and 
water up to the elbow for ten minutes, then rinsed in sterile water, 
then immersed in a solution of mercuric chloride (bichloride of 98 
QUIZ COMPEND 
mercury), 1-2000, and finally dipped in alcohol, 60 per cent. Ad- 
ditionally they may be rubbed with equal parts of chlorinated lime 
and washing soda, this to be done after scrubbing and before 
rinsing. 
27. IF hat is an approved method of sterilizing the dressings? Dress- 
ings are best sterilized by subjecting them to superheated steam 
for a period of thirty minutes. This is done in an autoclave with 
a pressure of two or three atmospheres. If this apparatus is not 
available, then placing the dressings in an oven and subjecting 
them to a temperature of not more than 100 degrees centigrade for 
one hour, will suffice. 
28. What are antiseptics? Antiseptics are agents which prevent or 
inhibit the growth of pathogenic bacteria. 
29. Into how many classes are antiseptics divided? Two—general and 
local antiseptics. 
30. What are general antiseptics? General antiseptics are those used 
for general purposes such as disinfecting a room, etc. 
31. Mention some general antiseptics. Sunlight, heat, formaldehyde, 
chlorinated lime, sulphur, etc. 
32. What are local antiseptics? Local antiseptics are agents which 
are used on a localized area, externally. 
33. Mention some local antiseptics. Iodine, alcohol, phenol, peroxide 
of hydrogen, boric acid, Dakin’s solution, mercuric chloride, etc. 
34. What is inflammation? Inflammation is the reaction of the tissues 
of the body against injurious influences. 
35. What causes inflammation? Inflammation is caused by any in- 
jury to the tissues by mechanical, thermal or chemical means, by 
the effect of electricity, or by the entrance and growth of bacteria 
in the tissues. 
36. What are the cardinal symptoms of inflammation? The cardinal 
symptoms are redness, pain, heat, swelling, and impaired function. 
37. What causes redness? Redness is due to the congestion of the 
blood. 
38. What causes pain? Pain is caused by pressure exerted upon the 
sensory nerves by the surrounding swelling. The pulsation felt is 
due to the beating of the heart which forces the blood into the 
inflammed area, thus increasing the pressure at regular intervals. 
39. What causes the heat? The heat is caused by the increased supply 
of warm arterial blood. 
40. What causes the swelling? The swelling is caused by the dilated 
vessels and by the escape of blood serum into the tissues. 
41. What causes the impaired function? The impaired function is 
caused chiefly by the pain which is increased by any attempt to 
use the part. Occasionally the loss of function is due to the 
direct action of the inflammation upon the nerves. SURGERY 
99 
42. What are the constitutional symptoms of inflammation? The con- 
stitutional symptoms of inflammation are rise in temperature, with 
or without chill. There is also nausea, vomiting, diarrhea, sweat- 
ing, and polyuria. 
43. IF hat are the terminations of inflammation? Inflammation may 
result in resolution, suppuration, necrosis or sloughing, or in the 
establishment of the chronic state. 
44. What is resolution? Resolution is the gradual cessation of all 
the symptoms of inflammation until the part is normal. 
45. What is suppuration? Suppuration means the formation of pus. 
46. What is pus? Pus is serum containing white blood cells, dead 
and dying tissue cells, and bacteria. 
47. What is sloughing? Sloughing is the death of tissues. Gangrene 
or necrosis is the death of the tissues from any cause. The dead 
part is called a slough. 
48. What is meant by the term “chronic state” in inflammation? A 
chronic state is one in which there has been an interruption at 
some stage of resolution and there is a continuance of mild symp- 
toms. Chronic inflammation usually lasts over a long period of 
time. 
49. What are the general indications to be observed in the treatment 
of inflammation? The general indications to be observed in the 
treatment of inflammation are: (1) to combat the congestion of 
the parts, (2) to relieve tension, (3) to give free issue to the 
products of inflammation, (4) to produce early separation of 
sloughs. 
50. What is an approved method of relieving the congestion in inflam- 
mation? An efficient method of relieving congestion is the appli- 
cation of a light gauze dressing, applied cold and continuously 
wet with any evaporating solution. This assists the inflamed tissues 
in combating irritating substances. 
51. What is an approved method of relieving tension in inflammation? 
Cold constricts the blood vessels and in this manner relieves ten- 
sion. Cold also checks the development of bacteria and thus often 
stops suppuration. 
52. What is an approved method of giving free issue to the products 
of inflammation? The drainage of the products of inflammation 
(pus) is important in the treatment of such conditions. Free in- 
cision is indicated wherever possible and the drainage is hastened 
by the use of mild antiseptic wet dressings. The moist gauze 
absorbs the fluids from the wound and the chemical in the solu- 
tion inactivates and washes away the bacteria. 
53. How can the separation of sloughs be hastened? The separation 
of the dead tissue in an inflammatory condition is best hastened 
by stimulating granulation beneath the slough. This will cause 100 
QUIZ COMPEND 
pressure on the slough and thus it will be separated from the living 
tissue. The use of ointments is often indicated to soften the 
necrotic area, the milder antiseptic ointments such as white pre- 
cipitate ointment or scarlet red, 4 per cent., are usually employed. 
54. What is the effect of heat on inflammation? Heat as well as cold 
exerts a soothing effect upon inflamed areas. Heat dilates the 
blood vessels and thus hastens repair in bruised or torn tissues. 
In infected areas the heat encourages bacterial growth and in- 
creased pus formation and is, therefore, contra-indicated where 
pus manifests itself. 
55. What is the effect of antiseptic wet dressings on inflamed areas? 
Wet dressings are of great value in the treatment of inflammation, 
but antiseptic solutions should only be used where pus is draining 
from the lesion. Antiseptic wet dressings should never be used 
on the unbroken skin, for not alone is it valueless, except for the 
benefit of the moisture and cold, the chemical action of the sub- 
stance may cause constitutional symptoms as well as local slough- 
ing. 
56. What is the effect of astringent wet dressings on inflamed areas? 
Astringent wet dressings have a beneficial effect by contracting the 
blood vessels, thus reducing tension. These should not be used in 
draining wounds unless the drainage is very free. The best 
astringent wet dressing is the official solution of aluminum acetate, 
diluted with an equal quantity of water. 
57. What is a wound? A wound is a solution or loss of continuity 
or division of the soft tissues produced by some external force. 
58. How are wounds classified? Wounds are classified according to 
their causation or nature as: incised, lacerated, contused, punc- 
tured, poisoned, and gunshot. 
59. What is an incised wound? An incised wound is one that re- 
sults from a sharp-edged instrument. 
60. What is a lacerated wound? A lacerated wound is one in which 
the tissues are extensively torn or separated. 
61. What is a contused wound? A contused wound is one that is the 
result of a diffused force and in which the edges and surrounding 
tissues are crushed. 
62. What is a punctured wound? A punctured wound is one that is 
produced by a narrow instrument and is deeper than its external 
surface is broad. 
63. What is a poisoned wound? A poisoned wound is when some 
poisoned substance enters a wound and causes local infection or 
constitutional symptoms. 
64. What is a gunshot wound? A gunshot wound is one that re- 
sults from firearms or from powder explosion. SURGERY 
101 
65. What is a contusion? A contusion or bruise is a subcutaneous 
laceration in which the skin above is uninjured. 
66. What is an ecchymosis? An ecchymosis, or black-and-blue mark, 
is a diffuse subcutaneous hemorrhage and is the result of a con- 
tusion. 
67. What is a hematoma? A hematoma is a blood tumor or a cir- 
cumscribed hemorrhage in the tissues, and is a result of a con- 
tusion. 
68. What is the treatment of wounds in general? The general prin- 
ciples in the treatment of wounds are: (1) arrest hemorrhage, 
(2) bring about reaction, (3) remove foreign bodies, (4) make 
the wound aseptic, (5) drainage, (6) bring the edges in apposi- 
tion, (7) proper dressing, (8) rest to the wounded part, and (9) 
combat inflammation. 
69. Briefly describe the arrest of hemorrhage in a wound. Digital 
pressure immediately over the wound will control hemorrhage. 
Slight bleeding will soon stop on exposure to the air. Moderate 
hemorrhage ceases after the bleeding vessel has been compressed 
or clamped for a period of time. When a large vessel is injured it 
will be necessary to clamp and ligate it before blood will stop 
flowing. Various chemical agents called styptics are used for 
slight capillary bleeding. 
70. How is reaction brought about? By reaction we mean response of 
the body to the shock induced by the production of the wound. 
In slight wounds there is little if any shock, but in larger wounds 
this is quite common. The body should be put in a recumbent 
position and the feet elevated slightly above the head. Hot-water 
bottles and hot blankets should be wrapped around the patient and 
injections of strychnine, brandy, or digitalis, or inhalations of 
amyl nitrate should be given. Do not give these stimulants until 
the bleeding part has been cared for, as all of these cause an 
increased heart action and a consequent increase in blood flow. 
71. How are foreign bodies removed from wounds? Foreign bodies 
are removed by the forceps, being careful to remove everything 
visible to the eye. In badly lacerated or contused wounds, tissue 
that has been injured beyond repair should be considered a foreign 
body and removed with the scissors and forceps. 
72. How can the wound be made aseptic? After foreign bodies have 
been removed, the surface, if hairy, should be shaved. The wound 
is then washed out with an antiseptic solution and clots, if they 
have formed, are also removed. Irrigation with a solution of 
mercuric chloride (corrosive sublimate), 1-4000, is then in order. 
It must be remembered that all accidental wounds are infected 
and must be treated accordingly. 
73. How are wounds drained? Superficial wounds require no special 
drain. Large wounds should be drained for at least one day, and 
this is done by using a tube, silk, catgut, or gauze, the latter being 102 
QUIZ COMPEND 
most commonly used. Infected wounds must always be drained 
and gauze put into the wound and a moist dressing above it is 
most efficient. 
74. How are the edges of wounds brought in apposition? The edges 
of small wounds require no special care, but if the wound is a 
large one the edges recede and must be brought together by what 
is called suturing. The materials used for suturing are silk, 
silk-worm gut, and catgut. The latter is used where tension is 
slight and silk-worm gut is used where tension is marked. 
75. What is a suture? A suture is the surgical uniting of two sur- 
faces by means of stitches. 
76. What constitutes a proper dressing for wounds? A proper dress- 
ing for wounds is one that will protect the wound from the ingress 
of foreign material and is usually moist or dry. Infected wounds 
are dressed with a moist dressing and sterile wounds with a dry 
dressing. 
77. What is meant by rest to the wounded parts? Physiologic rest is 
essential to the prompt healing of wounds. If a wound is near or 
at a joint, the parts above and below should be immobilized. If 
a wound of the foot or leg is extensive, the patient should be kept 
in a recumbent position. Walking will delay healing, increase pain 
and make less certain the result. 
78. How is inflammation combated in a wound? This is done by first 
thoroughly cleansing the wound and making it aseptic. Then, if 
it is properly protected and the patient rests properly, inflammation 
will be prevented. 
79. What is toxemia? Toxemia is a condition in which one or more 
poisons are present in the blood which are not necessarily of bac- 
terial origin or production. This condition includes diseases due 
to animal, vegetable, and mineral poisons. 
80. What is septicemia? Septicemia is a systemic disease in which 
microorganisms or their toxins are present in the blood stream. 
81. What is sapremia? Sapremia is the presence of the products of 
the putrefactive bacteria such as ptomains and toxalbumins. 
82. What is pyemia? Pyemia is a condition in which metastatic 
abscesses arise due to the presence in the blood of pus-producing 
bacteria, either free or contained in pus cells. 
83. What are the symptoms of septicemia? The symptoms of septi- 
cemia are chill about four to seven days after an injury, followed 
by fever. The pulse is small, weak, and frequent and there is 
vomiting and diarrhea. As the condition progresses delirium and 
stupor appear followed by coma and finally death. Urinary se- 
cretion is scanty. 
84. What are the symptoms of sapremia? There is a marked rise in 
temperature, the skin becomes cold and clammy, there is marked 
prostration, and sometimes diarrhea. If these symptoms appear SURGERY 
103 
when there is a wound present, immediate cleansing of the lesion 
and the practice of perfect antisepsis will prevent further com- 
plications. There is also a diminution of urine. 
85. IVhat are the symptoms of pyemia? The symptoms of pyemia 
are severe chill and sudden rise in temperature which lasts for a 
few hours and passes off with profuse sweating. The chills recur 
at irregular intervals. The general symptoms of vomiting, etc., 
resemble septicemia. 
86. What is hemorrhage? Hemorrhage is the escape of blood from 
the blood vessels in large or small quantities and may occur either 
spontaneously or because of injury. 
87. What is spontaneous hemorrhage? Spontaneous hemorrhage is 
bleeding that occurs in the organs and cavities of the body as a 
.result of constitutional diseases such as tuberculosis and cancer, 
in which the erosion of the tissues has extended to the vessels. 
It is also a result of a constitutional tendency. Persons who have 
this tendency are called hemophiliacs. 
88. What is hemophilia? Hemophilia is a disorder marked by a 
permanent tendency to profuse hemorrhages, spontaneous or trau- 
matic, due to a defect in the coagulating power of the blood. 
89. How is hemorrhage due to injury classified? Hemorrhage due 
to injury is classified as follows: (1) arterial, (2) venous, (3) 
capillary. 
90. How does arterial hemorrhage manifest itself? Arterial hem- 
orrhage may be easily recognized by the rapid spurting jets of 
red blood, occurring in time with the heart beat. 
91. How is venous hemorrhage recognized? Venous hemorrhage oc- 
curs as a steady, even stream of dark blood. It is not affected by 
the heart beat and seems to flow from the wound like a spring 
wells from the earth. 
92. Describe capillary hemorrhage. Capillary hemorrhage flows in a 
steady stream from the surface of a tissue. It is intermediary in 
color, being a mixture of both arterial and venous blood. 
93. Describe nature’s efforts to control hemorrhage. When an artery 
is cut, the inner structures curl up, thus partly closing the lumen 
of the vessel. Further, when the blood comes in contact with any- 
thing but the lining of the vessels, it coagulates. Thus, with the 
blood stream slowed up by the curled ends of the vessel, a clot 
develops in the cut end which seals it. 
94. How is arterial hemorrhage controlled? Arterial hemorrhage is 
controlled by pressure above the wound, clamping of the bleeding 
vessel, and ligation of the cut ends. 
95. How is venous hemorrhage controlled? Venous hemorrhage is 
controlled by pressure below the wound, clamping the vessel, and 
ligating the cut ends. 104 
QUIZ COMPEND 
96. How is capillary hemorrhage controlled? Capillary hemorrhage 
is controlled by pressure immediately above the bleeding surface 
and by the use of styptics. 
97. What type of hemorrhage is usually met in the practice of chi- 
ropody? The usual type of hemorrhage is capillary. 
98. What precautions must be taken when a patient is made to bleed? 
Due to the fact that the feet are always contaminated with bacteria, 
hemorrhage, no matter how slight, is dangerous and may cause 
infection. The wound produced must be thoroughly cleansed with 
any of the standard antiseptics, iodine being a very popular drug. 
The wound must be dressed with a suitable dressing after all 
signs of bleeding have stopped. 
99. Describe an approved method of treating a wounded surface caused 
in removing an heloma. The wound is washed with alcohol and 
then a cotton wound applicator dipped in Monsel’s solution is ap- 
plied. When bleeding has stopped, the part is painted with tinc- 
ture of iodine and dressed with ichthyolated collodion or with a 
gauze dressing. 
100. What are styptics? Styptics are agents which control local bleed- 
ing. 
101. Mention some of the common styptics. The commoner styptics 
are Monsel’s solution, alum, tannic acid, adrenalin chloride, and 
ferric chloride. 
102. Mention the various surgical conditions of which the chiropodist 
should have a knowledge? It is not essential for the chiropodist 
to have a comprehensive knowledge of surgery, but he must under- 
stand the commoner surgical lesions that may manifest themselves 
in the foot. Among these are fistulae, fissures, sinuses, abscesses, 
furuncules, ulcers, synovitis, arthritis, various bone diseases includ 
ing periostitis and osteomyelitis, gangrene, the various new growths 
or tumors, phlebitis, fractures, dislocations, sprains, and the 
various mechanical deformities of the foot. 
103. What is a fistula? A fistula is an abnormal passage or communi- 
cation between the surface and a deeper part of the body or 
connecting two natural cavities in the body. 
104. What is a fissure? A fissure is a crack or a cleft in the skin. 
105. What is a sinus? A sinus is a tract leading from the skin or an- 
other free surface into the cavity of an imperfectly healed abscess, 
or it may be the unhealed portion of a wound. 
106. What is the treatment of fistula and sinus? The treatment of the 
conditions is similar in most instances. The tract is first cleansed, 
all foreign particles being removed. The channel is then laid 
open and the walls are curetted and touched with pure phenol 
and packed with plain or iodoform gauze. In severe cases, it 
becomes necessary to cut away all of the fibrous structures and 
suture the parts. SURGERY 
105 
107. What is the treatment for fissure? Fissure usually occurs on 
the foot in the toe webs and is treated with astringents. (See 
Chiropody quiz.) 
108. What is an abscess? An abscess is a circumscribed cavity in the 
tissues containing pus. The cavity is of new formation. 
109. Describe the formation of an abscess. When pyogenic bacteria 
are deposited into the tissues, they multiply and immediately the 
tissues react to their presence, thus producing inflammation. 
The usual changes that occur in inflammation take place and 
soon there is an accumulation of the various constituents of pus. 
In the course of the inflammation, the surrounding tissues are 
protected by the formation of a fibrous wall which is called the 
abscess wall. 
110. What are the symptoms of abscess? The local symptoms of 
abscess are marked swelling, redness, throbbing pain, and a 
sense of tension. The skin is glossy and after a time the fluid 
can be felt in the cavity. There may be chills and fever, de- 
pending on the severity of the condition. 
111. What is meant by pointing or “coming to a head”? When pus 
is pent up in the tissues, such as is the case in abscess, the 
pressure within is great, and the pus will follow the line of least 
resistance to escape. This is toward the surface, and soon a 
small white area will appear, usually in the center of the in- 
flamed area. The tissues of the skin soon break down at this 
point and the pus exudes. 
112. What is the treatment for abscess? The treatment is free in- 
cision and drainage. The abscess should be opened early, even 
before pointing. This prevents a great deal of tissue destruction 
and hastens recovery. Wet dressings may be used when the 
abscess has been incised as this helps drainage and hastens the 
reduction of inflammation. 
113. What is furuncle? A furuncle, or boil, is an acute circum- 
scribed inflammation of the subcutaneous tissue and the deeper 
layers of the skin. 
114. What causes a furuncle? Furuncle is caused by the entrance 
of the staphlococcus pyongenes aureus into the hair follicle 
through a slight wound. 
115. What are the symptoms of furuncle? The symptoms are a red 
elevation which stings and itches. This elevation becomes 
larger and dusky in color. A pustule forms which discharges 
slightly and forms a crust. Inflammation spreads rapidly and 
soon the boil has a large red, tender base which is very painful. 
The swelling increases, the skin becomes edematous, the pain 
is severe and the center of the boil becomes raised. About the 
seventh day rupture occurs, pus runs out, and a core of necrotic 
tissue is found in the center of the opening. 106 
QUIZ COMPEND 
116. What is furunculosis? Furunculosis is a condition where there 
are several boils which appear at one time or when one develops 
after another. 
117. What is the treatment for furuncle? The treatment of furuncle 
consists of making a cross-shaped incision and applying wet 
dressings. 
118. What is an ulcer? An ulcer is a loss of substance due to ne- 
crosis of a superficial structure or it may be defined as a sup- 
purating open sore which shows no tendency to heal. 
119. What are the causes of ulcers? There are two divisions to the 
cause of ulcers: (1) predisposing, (2) exciting. The predisposing 
causes are age, sex, occupation, and mode of living. The ex- 
citing causes are traumatism and infection. 
120. What are the varieties of ulcer found on the foot and leg? The 
varieties found on the foot and leg are: (a) indolent or callous, 
(b) varicose, (c) tubercular, (d) syphilitic, (e) diabetic, (/) 
perforating. 
121. What is the cause of indolent or callous ulcer? The cause of 
callous ulcer is both general and local. The general causes are 
typhoid fever, chronic inflammation of the kidneys, anemia, poor 
hygiene, improper food, overwork, and lack of sleep. Local 
causes are injury, exposure to heat and cold, irritation of the 
tissues, the presence of a foreign body such as a splinter, etc. 
122. What are the symptoms of callous ulcer? The shape of these 
ulcers varies greatly as does the size. They may be round, irregu- 
lar, or funnel shaped. The base of the ulcers are usually shallow, 
inflamed, and grayish yellow. The edges are flat and thin and 
the surrounding tissue is red and inflamed. Callous ulcer re- 
sponds rapidly when treated antiseptically. 
123. What is the treatment for callous ulcer? If inflammation is 
present and the part is painful, mild wet dressing such as boric 
acid solution is indicated. Rest is a very important part of the 
treatment and the patient must be impressed with the necessity 
of this measure. If necessary, the part must be splinted to pre- 
vent walking. When the acute inflammation has subsided, then 
granulation is stimulated by the use of ointments such as balsam 
of Peru, 10 per cent., or scarlet red, 4 per cent. 
124. What is a varicose ulcer? A varicose ulcer is a chronic ulcer 
of the leg associated with varicose veins. 
125. What are the symptoms of varicose ulcer? Before the actual 
appearance of the ulcer the patient complains of deep aching 
pains in the leg with a sense of fullness and fatigue. The 
ankles are swollen and the feet are cold. Small soft blue tumors 
appear on the leg which disappear on pressure. These are caused 
by a dilated vein. The surface of the ulcer presents unhealthy 
and imperfect granulations, secreting thin pus. The edges and SURGERY 
107 
base are thickened and callous and the surrounding area is 
deeply pigmented. The parts look like a large pigmented scar 
which has broken down in the center. 
126. What is the treatment for varicose ulcer? The treatment for 
varicose ulcer is first antiseptic cleanliness. The circulation of 
the blood and lymph must be improved by increasing the nutri- 
tion to the body. The ulcer should be washed once or twice a 
day and dressed with some mild antiseptic such as boric acid 
solution. When the discharge is slight ointments may be used. 
Rest is most important and support for the dilated veins should 
be provided. This is best done with elastic bandages or elastic 
stockings or with flannel bandages. A desirable method of 
supporting the veins is by the application of Unna’s gelatine. The 
varicose veins are often operated upon. 
127. What causes a tuberculous ulcer? A tuberculous ulcer is usually 
caused by the bursting of a tuberculous abscess through the skin. 
128. What are the symptoms of tuberculous ulcer? The base of the 
ulcer is pale and covered with feeble granulations and gray 
shreddy sloughs. The edges are dull blue or purple in color and 
are undermined. The outline is irregular and a thin watery dis- 
charge containing shreds of debris escapes. The ulcer is super- 
ficial and with little or no pain. At times the ulcer is crusted 
over, the crust being thin and brown or black. 
129. What is the treatment for tuberculous ulcer? If the ulcer is 
limited, the best treatment is the complete removal by means 
of the knife or sharp spoon, of the ulcerated surface and all 
of the infected area around it. This leaves a healthy surface from 
which granulations may grow. If there is danger of contraction 
due to the scar, then skin grafting should be employed. General 
treatment, consisting of tonics, fresh air, nutritious food, etc., 
is necessary. 
130. What causes syphilitic ulcers? Syphilitic ulcers are caused by 
the breaking down of gummata in the tertiary stage of syphilis. 
Occasionally a superficial ulcer will appear resulting from a 
pustule in early syphilis. 
131. What are the symptoms of syphilitic ulcer? The edges are sharp 
and have a punched-out appearance. The base is indurated, dirty, 
and sloughing, the slough being green. The remaining scar is 
characteristic; it is thin, dead white in color, pigmented irregu- 
larly, and when pinched, it wrinkles like tissue paper. 
132. What is the treatment for syphilitic ulcer? The treatment is 
both general and local. Antisyphilitic treatment is essential. 
This consists of injecting mercury and salvarsan or neosalvarsan, 
or rubbing mercury into the skin. Local treatment consists of 
the use of mercuric chloride solution to wash the lesion, and 
dressings of mercurial ointments such as white precipitate, or 
the ulcer may be dusted with calomel powder. The lesion will 108 
heal only when constitutional treatment is given and local treat- 
ment is useless otherwise. 
133. What is the cause of diabetic ulcer? Diabetic ulcer is caused 
by a trauma over a given area which breaks down and ulcerates. 
It does not heal, due to the fact that the patient is suffering 
with a constitutional disease known as diabetes mellitus. This 
is a disease in which sugar is found in the blood and is excreted 
in the urine. 
134. What are the symptoms of diabetic ulcer? Diabetic ulcer ap- 
pears at any spot that has been injured or is subject to pressure, 
so that very often such an ulcer will develop in the foot over 
the site of a corn or callosity. There is a gradual breaking 
down in the center of the callous and the ulcer appears as a 
bluish, indolent, foul-smelling ulcer which secretes a small 
amount of watery pus. The callous surrounding the lesion is 
very abundant and often hides the ulcer. 
135. What is the treatment of diabetic ulcer? Constitutional treat- 
ment is essential, and such cases belong to the specialist in dis- 
eases of metabolism. Rest of the parts is necessary, baking to 
stimulate circulation, and the use of stimulant ointments are in 
order. Scarlet red, 4 per cent., is useful as well as balsam of 
Peru, 10 per cent. 
136. What is the cause of perforating ulcer? The cause of perforat- 
ing ulcer is varied. There are several local as well as general 
factors responsible for it. The theories as to its cause are 
classified as mechanical, vascular, nervous, and mixed. The 
mechanical theory regards injury as the sole cause. If this 
were so, however, this type of ulcer would be common, whereas 
it is quite rare. The vascular theory assumes that arteriosclerosis 
is always present and is responsible. The nerve theory, which is 
the one most commonly accepted, is that perforating ulcer is due 
to a chronic peripheral neuritis. The mixed theory is that 
either vessels or nerves or both may be at fault. 
137. With what diseases is perforating often observed? The dis- 
eases with which perforating ulcer is seen are locomotor ataxia, 
fractures of the spine, injuries to the spinal cord, diabetes, and 
injury and division of the peripheral nerves. 
138. What are the symptoms of perforating ulcer? Perforating ulcer de- 
velops most readily where parts are subjected to pressure and irri- 
tation. It is found more often in males than in females and in 
adults between the ages of 40 and 60 years. Usually only one foot 
is involved, but occasionally it is bilateral. There is a formation 
of callous above the ulcerated area which when removed shows 
an unhealthy foul-smelling area which is usually deep. The 
ulcer eats into the surrounding tissues gradually involving all 
the tissues, including tendons, muscles, joints, and bone. The 
lesion shows no tendency to heal, even with the most careful and 
painstaking treatment, and is not painful or tender. 
QUIZ COMPEND SURGERY 
109 
139. What is the treatment for perforating ulcer? Where the cause 
is locomotor ataxia or diabetes, this must be cared for. Great 
care must be taken in fitting the shoes so that no irritation is 
produced from this source. Rest is most important and little, 
if any walking should be permitted. All of the calloused epi- 
dermis should be removed and drainage must be perfected by en- 
larging the opening if necessary. Any pockets or sinuses should 
be opened thoroughly. Occasional curetments and cauterization 
with silver nitrate is often of benefit. The dressing may be 
either dry or wet, depending on the amount of discharge. These 
ulcers are most unsatisfactory to treat and should be cared for 
by the specialist. 
140. What is synovitis? Synovitis is an inflammation of the synovial 
membrane of a joint. 
141. What is the cause of synovitis? Synovitis is caused by simple 
injury, contusion or sprain, exposure to cold, and the presence 
of movable cartilage. 
142. W'hat are the symptoms of synovitis? The joint is painful, espe- 
cially upon motion and particularly so at night. It is swollen, 
tense, and fluctuating. Local heat and tenderness are not usually 
marked. If there has been hemorrhage into the joint, stiffness 
will result due to the formation of a clot. 
143. What is the treatment for synovitis? The treatment is rest and 
the application of ice bags. Even pressure with bandages will 
hasten absorption, but are painful when first applied. Occasionally 
it becomes necessary to aspirate the joint. This procedure is a 
very delicate operation, and should be done only as a last resort 
where one is reasonably certain that absorption will not take 
place. 
144. What is arthritis? Arthritis is an inflammation of all the struc- 
tures which enter into and form a joint. The structures that 
make up a joint are bone, cartilage, ligament, synovial mem- 
brane, and fibro-cartilage. Inflammation may begin in anyone 
of these tissues and sooner or later all are involved. The only 
structure which will sometimes become inflamed and not affect 
the other structures is the synovial membrane. 
145. How many classes of joint inflammation are there? There are 
two distinct classes of joint inflammation: (1) the varieties of 
synovitis and (2) the varieties of arthritis. These inflammations 
may be acute or chronic. 
146. What are the symptoms of arthritis? The symptoms are more 
severe than those of synovitis and are both local and general. 
The bacteria or their toxins are absorbed into the system produc- 
ing the signs of general sepsis. The local symptoms are pain, 
tenderness, swelling, heat, redness, and loss of function. These 
symptoms are the same in synovitis, but in arthritis a sensation 
of crepitus is felt which is absent in synovitis. 110 
QUIZ COMPEND 
147. What is crepitus? Crepitus is a scraping or scratching sensa- 
tion felt when two bony surfaces are moved against each other 
with no protective structures between. This is caused by the 
destruction of the synovial covering of the bone ends in arthritis. 
148. What is the cause of arthritis? The causes of arthritis are 
many. Trauma will cause it as will many constitutional diseases 
such as tuberculosis, syphilis, etc. Much of the so-called rheu- 
matic arthritis has been traced to infections in the body far 
remote from the actual seat of trouble. These have been called 
focal infections and the most common locations are the teeth, 
tonsils, and urinary tract. When the infection is treated and 
cured, the local joint manifestation readily responds. Arthritis 
is also due to other infectious diseases such as measles, scarlet 
fever, smallpox, and erysipelas. 
149. What is traumatic arthritis? Traumatic arthritis is an inflamma- 
tion of the joint due to injury. There are two divisions of trau- 
matic arthritis: (1) non-penetrating, (2) penetrating. The 
former is an ordinary twisting or contusion at the joint, and the 
latter is a violent injury in which the tissues within the joint 
have been torn. 
150. What are the symptoms of traumatic arthritis? The symptoms 
of non-penetrating traumatic arthritis are much the same as those 
of synovitis except that they are more pronounced. Those of 
the penetrating type depend greatly on the extent of the injury. 
The great danger in this form of arthritis is the fact that in- 
fection very often follows the injury. This is called septic 
arthritis and is much more severe. The complications are 
many and often complete loss of the joint is the result. 
151. What is the treatment of traumatic arthritis? The treatment for 
simple traumatic arthritis is rest and wet dressings. This will 
soon bring about a cure. The penetrating form requires a 
great deal of care, mostly of an antiseptic nature. It is essential 
that infection, if not already present, be prevented if possible. 
All cavities containing pus should be opened and drained and 
the wound frequently irrigated. Complete rest is necessary, and 
the patient must not be allowed to move the joint. The usual 
result in this type of case is ankylosis. 
152. What is ankylosis? Ankylosis is a fixation or a stiffening of a 
joint. True or bony ankylosis is caused by the union of the 
bones in the joint. 
153. How is arthritis produced by focal infections? The infection, 
located somewhere in the body, continues to discharge bacteria 
or their toxins into the system. These are carried by the blood 
stream to parts far remote where they lodge and accumulate. 
Soon there is sufficient irritation to set up an inflammation which 
gets progressively worse. 
154. How can the chiropodist be guided in determining focal infec- SURGERY 
111 
tion as a cause for arthritis? When an inflamed joint does not 
respond to proper treatment, and continues to remain inflamed, 
regardless of what local treatment is employed, it is a sign that 
the cause of the trouble is beyond the foot. Further examination 
will often show other parts of the foot involved and a careful 
notation of the patient’s history will act as a clue. 
155. What is gonorrheal arthritis? Gonorrheal arthritis is an in- 
flammation of the joints due to the presence of the gonnococcus 
in the joints. It is a typical example of how infections in one 
part of the body will cause trouble in another remote part. 
156. What are the symptoms of gonorrheal arthritis? The inflamma- 
tion is nearly always acute, beginning as an acute synovitis and 
soon involving the entire joint. The symptoms are those of 
septic arthritis with the exception that usually only one joint 
is involved. A chill with high fever is usually manifest. 
157. What is the treatment of gonorrheal arthritis? Treatment must 
be directed toward the urinary tract so as to eradicate the supply 
of bacteria to the joint. The part must be immobilized and kept 
at rest. Very hot or very cold applications are comfortable and 
efficient. In the subacute stage, baking is of value, or better 
still, the application of diathermic electricity. 
158. What is periostitis? Periostitis is an inflammation of the perios- 
teum or bone covering. 
159. Into how many classes is periostitis divided? Two: (1) acute, 
(2) chronic. 
160. Describe acute periostitis? Acute suppurating periostitis rarely, 
if ever, occurs alone. Most of these cases are mild, superficial 
cases of osteomyelitis which form abscesses beneath the perios- 
teum with an inflammation of the periosteum itself. 
161. What are the symptoms of acute periostitis? The symptoms are 
those of acute osteomyelitis in a very mild form. There is a 
rise in temperature with a chill, and tenderness is felt over the 
shaft of the bone. 
162. What is the treatment for acute periostitis? Incision over the 
area and drainage of the pus is often sufficient, but if the bone 
has become necrotic, it will necessitate the removal of the necrotic 
bone. 
163. Describe chronic periostitis? A great many diseases cause an 
irritation to the periosteum, which results in a proliferation of 
the osteogenetic cells of the periosteum and a subsequent thick- 
ening of that structure. Such a thickening with the formation 
of new bone is seen after injuries and blows and sometimes after 
the occurrence of a superficial abscess in the soft tissues imme- 
diately above the bone. 
164. What are the symptoms of chronic periostitis? Chronic perio- 
stitis is really not a disease itself, but is a manifestation of the 112 
QUIZ COMPEND 
reaction of the periosteum to some irritant. Occasionally the 
pain is dull and heavy and sometimes it is more or less acute. 
In many instances the patient has no pain at all and recognizes 
the condition by the enlargement of the bone. The radiograph 
is a definite method of recognizing the exact character of the 
lesion. 
165. What is the treatment for chronic periostitis? The cause must 
be recognized and removed if possible. In many cases, especially 
those in which no pain is felt, nothing can be done therapeu- 
tically. 
166. What is osteomyelitis? Osteomyelitis is an acute suppuration of 
the bone due to an infection of the bone marrow by pyogenic 
bacteria. 
167. How does osteomyelitis begin? The infection begins in the bone 
marrow and being confined in the hard substance of the bone, 
rapidly spreads within the marrow cavity. 
168. Mention some of the general causes that favor the occurrence of 
osteomyelitis? Children are affected more than adults and boys 
about three times as often as girls. After an injury even of 
moderate severity, the resistance of the bone is lowered and it is 
more susceptible to pyogenic infection. Compound fractures, 
if not given strict aseptic care, will often terminate in osteo- 
myelitis. 
169. What bones are usually affected in osteomyelitis? The femur 
and the tibia are most usually affected, but no bone is exempt. 
170. What are the symptoms of osteomyelitis? The onset is usually 
severe, beginning with a sharp localized pain. This pain is in- 
tense and in typical cases is excruciating. Swelling of the soft 
tissues about the bone is first cold but soon becomes edematous, 
red, and shows pitting on pressure. The adjacent joint may 
become tender and swollen, even though the infection has not 
involved the joint itself. There is high fever and the pulse is 
very rapid. The tongue is dry and coated and the face is 
drawn and flushed. 
171. What are the symptoms of chronic osteomyelitis? Chronic osteo- 
myelitis presents a characteristic picture. The limb is enlarged, 
and sinuses run from the skin into the bone, from which exude 
foul purulent discharges. When a probe is passed into the 
sinuses dead bone is felt at the bottom. 
172. What is the treatment of acute osteomyelitis? Acute osteo- 
myelitis is treated much the same as any other acute suppura- 
tion. The pus is drained by freed incision not only into the 
soft tissues but into the shaft of the bone itself. All necrotic 
bone must be removed. 
173. What is the treatment of chronic osteomyelitis? In chronic osteo- 
myelitis all necrotic bone must be removed and the cavity does SURGERY 
113 
not heal for a long time. Discharges continue for months and 
there is always danger of secondary infection or erysipelas. 
Osteomyelitis in any form should be treated by the surgeon. 
174. What is osteomalacia? Osteomalacia is an acquired disease in 
which the bones become softened. The first sign is pain in the 
bones, which is increased by pressure. There is also muscular 
cramps and contractures. 
175. What is osteoma? Osteoma is a bony tumor which arises by- 
growth from the periosteum. When it has no direct connection 
with the cortex of the bone it is called an exostosis. 
176. What is the treatment for osteoma? Osteoma is usually paim 
less unless it is near a joint where it interferes with normal 
motion. Complete removal is the only treatment. 
177. What is subungual exostosis? Subungual exostosis is an over- 
growth of the bone on the distal phalanx of the toe immediately 
under the nail. 
178. What are the symptoms of subungual exostosis? There is a dis- 
tinct elevation of the nail which causes it to grow in a grotesque 
manner. Pressure against the nail causes pain and often the: 
parts are red and inflamed due to the irritation of the shoe against, 
the elevated tissues. 
179. What is the treatment for subungual exostosis? The growth must 
be completely excised, first removing the nail and taking care 
not to injure the nail bed. This precaution will insure a good 
nail when the wound has healed. 
180. What is gangrene? Gangrene is the death of tissues in mass. 
181. What is mortification? Mortification is a term used synonymously 
with gangrene. 
182. What is necrosis? Necrosis also means the death of tissues, but 
is usually employed to denote the death of bone. 
183. What are the forms of gangrene? There are two forms of gan- 
grene : (1) dry and (2) moist. 
184. What is dry gangrene? Dry gangrene is a condition which oc- 
curs because of the gradual cutting off of the blood supply, 
with the venous circulation intact. This permits of evaporation 
and a gradual drying of the tissues. Diseases of the arteries and 
pressure from growing tumors cause this form of gangrene. 
185. What is moist gangrene? Moist gangrene is a condition in which 
there is a sudden cutting off of the blood supply or the blocking 
of the venous return. This form usually is caused by accidents, 
cold, acids, thrombosis, and embolism. 
186. What is thrombosis? Thrombosis is a condition in which there 
is a blood clot occluding the lumen of a vessel. 
187. What is embolism? Embolism is a condition in which a part 114 
QUIZ COMPEND 
of a thrombus or any other foreign substance such as a particle 
of fat or a detached piece of tissue from a growth, is free in the 
blood stream. Such a particle may find lodgment in a blood 
vessel, thus blocking it. 
188. What are the causes of gangrene? The causes of gangrene are 
trauma, constitutional diseases, thrombosis and embolism, cold, 
and the effect of certain chemicals. 
189. How does trauma act as a cause of gangrene? The sudden cut- 
ting off of the blood supply due to a cutting or crushing accident 
will cause moist gangrene. The main artery alone need be 
cut to produce this. The crushing or pressure on a large vein 
will do the same thing, because the blood will not circulate due 
to the fact that there is no outflow. 
190. How do constitutional diseases act as a cause of gangrene? 
Certain diseases affect the lumen or size of the blood vessels, 
slowly reducing it and finally arresting the stream of blood flow- 
ing through them. The dry or moist form may develop, depend- 
ing on the length of time required to cut off the circulation. 
191. Mention some of the diseases which will cause gangrene? Dia- 
betes, arteriosclerosis, Reynaud’s disease, obliterating endarte- 
ritis, and thromboangiitis obliterans. 
192. Explain how thrombosis and embolism cause gangrene. These 
conditions cause a sudden or a gradual stoppage of the blood 
stream in a vessel and consequently produce moist or dry gan- 
grene depending on the time required for the obstruction in the 
vessel to become complete. 
193. Explain how cold acts as a cause of gangrene. When the body 
is exposed to extremely low temperatures, the vessels are affected 
and blood ceases to flow in them. This causes death of the tissues 
to a greater or lesser degree, depending on the severity and length 
of exposure. Tissue destruction may be limited to a circumscribed 
patch or an entire extremity may be affected. This form of gan- 
grene is always moist. 
194. Explain how chemicals act as a cause of gangrene. Carbolic 
acid and other chemicals when applied to the tissues even in weak 
solutions will cause death of the part by direct action of the 
chemical. Moist gangrene is the rule and the part presents a 
hard, shriveled, black appearance. 
195. What are the symptoms of dry gangrene? Dry gangrene usually 
develops in the toes and feet and the principal symptoms which 
point to its advent are coldness, numbness, pain, and tingling in 
the feet and muscles of the leg. Very often for months be- 
fore there are any local signs the patient will complain of severe 
burning pain at night when the feet are warm in bed. An injury 
such as a bruise or the cutting of a corn may act as the excit- 
ing cause of the lesion. The parts become congested and gradu- 
ally assume a dark purple color which finally becomes black. SURGERY 
115 
The gangrenous area itself is painless but the surrounding tissues 
are congested and often are very painful. The dead tissue emits 
little odor. 
196. How does dry gangrene spread? Dry gangrene spreads slowly. 
One or two toes may be first involved and the disease may then 
spread to the rest of the foot and the leg. There may be fever, 
depending on the size of the area involved. During the progress 
of the disease pain is usually present to a greater or lesser de- 
gree, sometimes being very intense. This is due to the fact that 
the nerves are usually the last of the tissues to die. 
197. What are the symptoms of moist gangrene? Moist gangrene 
comes on suddenly and the affected part is insensitive. The skin 
is cold, pale and mottled, purple, green and red, and finally dark 
colored. Blebs containing brownish serum form upon the sur- 
face, and the tissues rapidly undergo putrefactive changes. The 
living tissues become inflamed and the separation of the dead 
tissue from the living is effected by an ulcerative inflammation. 
198. What are the constitutional symptoms of moist gangrene? The 
patient will exhibit the signs of inflammation, viz., fever, rapid 
pulse, etc., and if septic infection is intense, may die from 
septicemia. 
199. How is the living tissue separated from the dead tissue? In 
both forms of gangrene, when the gangrenous process has been 
arrested, the dead tissue is separated from the living by a process 
of inflammation. The living tissue becomes acutely inflamed and 
granulations spring from the living tissue as a result of the in- 
flammation and there is pus secreted from the granulations. 
200. What is the line of demarcation? The line of demarcation is 
the line or zone of inflammatory reaction which separates the 
living from the dead tissue in gangrene. 
201. How can the chiropodist assist in making an early diagnosis of gan- 
grene? It must be remembered that gangrene is most common 
in those past middle life and precautions must be taken to pre- 
vent abrasions and wounds to these patients. It should become a 
regular practice to take the foot pulses of every patient of this 
class, both the dorsalis pedis pulse and the posterior tibial pulse 
being easily detected with practice. If such pulses cannot be 
felt the patient should be diplomatically advised to consult the 
physician. When the foot becomes red or blue when hanging 
and pale when elevated it should act as a warning to the chi- 
ropodist that something is wrong with the circulation. 
202. IF hat is the treatment for gangrene? Amputation back of the 
affected area, through healthy tissue is the rule in gangrene. In 
diabetic gangrene, the amputation must be done unusually high. 
Thus, if a toe is gangrenous, it will be necessary to amputate 
through the lower third of the leg. In other forms, after the line 
of demarcation has been established, amputation through the 
joint above is the procedure. 116 
QUIZ COMPEND 
203. What are varicose veins? Varicose veins are irregular, perma- 
nently dilated veins which pursue a tortuous course. They are 
usually found in the leg, and are very common in adults. 
204. What are the causes of varicose veins? The causes are obstruc- 
tion to venous return and weakened heart action which lessen the 
propulsion of the blood. Standing upon the feet for long periods 
is a cause and these veins are found in females during and after 
pregnancy. Pressure upon the vein causes a weakening of the 
valves contained therein and dilation is more marked. The veins 
also become longer and thus do not remain straight, but twist 
and turn. 
205. What is the treatment of varicose veins? The treatment of vari- 
cose veins is either palliative or curative. The palliative treatment 
consists of attention to the general health, stimulation of the cir- 
culation, and the prevention of constipation. Locally the veins 
are supported by flannel or elastic bandages or by elastic stockings. 
The curative treatment consists of resecting the vein or cutting 
out the vessel. There are several operations for this condition. 
206. What vein is most commonly affected in varicose veins? The vein 
most frequently affected is the internal or long saphenous vein. 
207. What is phlebitis? Phlebitis is an inflammation of a vein. 
208. What are the symptoms of phlebitis? The symptoms of phlebitis 
are pain along the track of the inflamed vein and tenderness. The 
overlying skin is red, hot, and tender and the lymphatics in the 
groin swell. There is marked edema, but the inflamed veins may 
be felt through the swelling. There is high fever, and chills fol- 
lowed by profuse sweats. The tongue is dry and parched, there 
is delirium and general distress. 
209. What is the treatment for phlebitis? Wounds of any description 
should be kept aseptic, thus preventing phlebitis. The part is 
rested and the foot or leg kept elevated. An aqueous solution of 
ichthyol, 25 per cent., is of benefit for the superficial inflammation. 
Poultices of kaolin are of great benefit as are compresses of lead 
and opium wash. If infection is manifest it becomes necessary to 
operate. There are several operations, depending on the state and 
development of the inflammation. 
210. What is a tumor? A tumor is any swelling, but technically it is 
a circumscribed growth not inflammatory in character, which arises 
from a pre-existing tissue but which grows independent of normal 
rate of growth and serves no physiological function. 
211. How are tumors classified? Tumors are classified in several ways 
such as malignant and innocent, and solid and cystic. 
212 What are malignant tumors? Malignant tumors are those which 
grow rapidly, infiltrate or adhere to surrounding tissues, are very 
painful, recur after removal, cause loss of weight and strength, 
and finally cause death. They are called cancers. SURGERY 
117 
213. What are innocent tumors? Innocent or benign tumors are those 
which grow slowly, the symptoms are purely local, and the general 
health is not effected by them, except indirectly. 
214. What are solid tumors? Solid tumors are those which are made 
up of solid tissues. 
215. What are cystic tumors? Cystic tumors are hollow and filled with 
fluid or semi-fluid contents. 
216. Mention the types of malignant tumors. There are two types of 
malignant tumors: (1) carcinomata, which spring from epithelial 
tissue, and (2) sarcomata, which spring from connective tissue. 
217. Mention the types of innocent or benign tumors. Innocent or be- 
nign tumors are classified according to the tissue in which they 
grow. Thus, bone tumors are called osteomata; muscle tumors, 
myomata; fibrous tissue tumors, fibromata; fatty tissue tumors, 
lipomata; cartilage, chondromata; blood vessels, angiomata; lym- 
phatics, lymphangiomata; glandular, adenomata, etc. 
218. What is the treatment for tumors? All tumors must be excised. 
The malignant growths require very extensive surgery, for there is 
a tendency to recurrence in these. The benign tumors are excised, 
and if properly done, show no tendency to recurrence. 
219. What is a sebaceous cyst? A sebaceous cyst is a tumor result- 
ing from retained sebum. 
220. What are the characteristics of sebaceous cyst? They are found 
almost anywhere on the body surface and occasionally on the sole 
of the foot. They range in size from a millet seed to the size of an 
egg. They may be single or multiple and occasionally they break 
down and ulcerate. 
221. What is the treatment for sebaceous cyst? The treatment for 
sebaceous cyst is much the same as for other innocent tumors. 
Incision followed by dissection and removal is curative. 
222. What is a fracture? A fracture may be defined as a broken bone. 
223. How are fractures classified? Fractures are classified as follows: 
Incomplete, complete, comminuted, impacted, and compression or 
crushing fractures. 
224. What is an incomplete fracture? An incomplete fracture is one in 
which the fragments are not completely detached and which in- 
volves only a portion of the bone. Among the incomplete fractures 
are the greenstick, which is a bending rather than a breaking of 
the bone and seen mostly in children; fissured fractures in which 
there is a split or crack in the bone; depressed fractures in which 
one or more segments of broken bone are depressed. This latter 
type is common in fracture of the skull. 
225. What is a complete fracture? A complete fracture is one in which 
the fragments are entirely separated. They are classified as simple, 
multiple, complicated, and compound. 118 
QUIZ COMPEND 
226. What is a simple fracture? A simple fracture is one in which the 
bone is broken into two or more fragments, the lines of which are 
continuous with each other. 
227. What is a multiple fracture? A multiple fracture is one in which 
there is a simultaneous fracture of two or more non-adjacent bones 
or in which there are two or more fractures in the same bone, 
the lines of which are not continuous with each other. 
228. What is a complicated fracture? A complicated fracture is one 
in which the fracture is accompanied by injury to the nerves, 
muscles, etc. 
229. What is a compound fracture? A compound fracture is one in 
which a fragment of the bone has penetrated the soft tissues and 
protrudes through the skin. This type of fracture is serious be- 
cause infection often follows it. 
230. What is a comminuted fracture? A comminuted fracture is one 
in which there has been extensive splintering of the fragments. 
231. What is an impacted fracture? An impacted fracture is one in 
which the fragments are driven into each other, causing a short- 
ening of the bone. This is common in the neck of the femur. 
232. What is a compression or crushing fracture? A compression or 
crushing fracture is one in which the broken bones are compressed 
or crushed. This type occurs after falls from great heights on the 
sole of the feet. 
233. What is the cause of fractures? The cause of fractures is trau- 
matic and pathologic or spontaneous. In traumatic fracture the 
bone which is normal, breaks as a result of violence, and is the 
most usual type of condition. In pathologic or spontaneous frac- 
ture, the strength of the bone has been diminished by some 
preceding abnormal or pathologic change. When such a bone 
is broken the violence necessary to cause the break would have 
no such effect upon a normal bone. 
234 Why do bones break more readily in aged people than in young 
people? The bones of the body are strongest at middle age. Up 
to that time they are elastic and yielding. In old age certain 
changes take place which cause the hard outer portion of the 
bone to become thinner. Such a bone is more easily broken than 
otherwise. 
235. What are the symptoms of recent fracture? In a recent fracture 
a careful examination will reveal swelling, pain, and restricted mo- 
tion. Movement of the parts will produce crepitus, and the muscles 
will be found to be spastic. A radiograph will positively deter- 
mine the presence of a fracture and should always be made at 
two different angles. 
236. What is the treatment of fractures? The treatment is divided into 
first aid and permanent treatment. First aid is of great importance, 
for the final result in the treatment of fracture often depends on SURGERY 
119 
what was done for the patient immediately after the fracture oc- 
curred. The patient is made comfortable and the part should be 
immoblized by the use of temporary splints. The type of dressing 
must depend on the nature of the fracture as well as on the mate- 
rials available. After first-aid treatment has been given, the sur- 
geon will care for the condition by properly reducing the fracture 
and applying proper permanent splints and dressings. 
237. What is meant by the term reduction? Reduction means the re- 
placement of fragments of broken bone as nearly as possible in 
the proper positions. 
238. What are the common fractures of the foot and leg? The most 
common fractures of the foot and leg are Pott’s fracture, fracture 
of the tarsal bones, fracture of the metatarsal bones, and fracture 
of the phalanges. 
239. What is Pott’s fracture? Pott’s fracture is a fracture of the lower 
end of the fibula and the tibia. This is caused very often by forcible 
inversion or eversion of the foot. If the foot turns inward, then the 
outer malleolus will be broken first and if the movement continues, 
the inner malleolus will also be broken. If the foot turns out- 
ward, then the reverse is the order. 
240. What is a dislocation? A dislocation is a displacement from each 
other of the articular ends of the bones which make up a joint. 
241. What are the symptoms of dislocation? A careful history will re- 
veal the exact nature of the accident and examination should be 
made to note the position of the part, alterations in contour, and 
the presence or absence of bony prominences. The part must be 
carefully examined with the fingers (palpation) to learn the rela- 
tion of the displaced ends of the bone, unless swelling be too great 
or the patient be too fat. The X-ray is of great value in cases of 
this kind. 
242. What is the treatment of dislocation? Reduction as soon as possi- 
ble is necessary and this often causes the displaced bones to go 
back to their normal position with a snap and motion is imme- 
diately restored. In some severe cases this is not possible and other 
methods must be employed. After reduction, a bandage which is 
sufficiently strong to keep the joint immobilized should be ap- 
plied for about two weeks, after which passive motion and massage 
are used. 
243. What is a sprain? A sprain is an injury to a joint in which the 
ligaments are pulled upon and lacerated but without dislocation 
and fracture. It is due usually to a sudden wrenching of the joint. 
244. What joint is most usually sprained? The ankle joint, due to its 
flexibility and constant use in weight bearing, is most frequently 
sprained. 
245. What are the symptoms of sprained ankle? The pains in the joint 
are very severe and there is often nausea. Motion is lost and 120 
QUIZ COMPEND 
swelling is marked. After a few days pain and tenderness become 
intense and discoloration appears. An Z-ray should be taken of 
the injured part so as to make certain that no fracture exists. 
246. What is the treatment of sprained ankle? Immediately after in- 
jury the part should be kept cold and under pressure to limit in- 
flammation. This is done by applying absorbent cotton, wet with 
cold water, bandaging with a wet gauze bandage, and then apply- 
ing an ice bag. Lead and opium wash is often used as a wet 
dressing and when swelling begins to subside, massage and passive 
motion are used. Bandaging and adhesive-plaster dressings, prop- 
erly applied are very valuable in relieving the pain of sprained 
ankle and often permit the patient to walk where ordinarily this 
would be impossible. Such dressing should not be used, however, 
when the lacerations to the ligaments have been very severe and 
there is marked extravasation. The basket-weave dressing and the 
Gibney dressing are the most popular dressings for sprained ankle. 
247. What is hallux flexus? Hallux flexus, or hammer toe, is a de- 
formity of the toe, usually the second or third, in which the distal 
phalanx is flexed and rests on the ground, while the second and 
first phalanges point upward, causing a prominence which is sub- 
ject to helomata and callosities. 
248. What is the treatment for hammer toe? Attempts to straighten 
out the toe with various splints and dressings are usually unsuc- 
cessful. Tenotomy of the flexor tendon in which the lateral liga- 
ments have been cut is of value occasionally, especially if the joint 
capsule is sufficiently injured in the course of the operation so as 
to cause ankylosis of the joint while it is being held in its normal 
position by a splint. When these methods fail, amputation is the 
only certain procedure. 
249. What is hallux valgus? Hallux valgus is a deformity in which the 
great toe is bent outward. 
250. What are the symptoms of hallux valgus? The great toe is dis- 
placed outward and the skin over the prominence of the joint is 
red and shiny. Often the bursa at this point is enlarged and in 
a chronic state of inflammation, and the joint is sensitive and 
painful upon pressure. 
251. What is the treatment for hallux valgus? The treatment is palli- 
ative and curative. Palliative treatment consists of wearing shoes 
which do not press upon or irritate the enlarged joint, and the 
application of shields for further protection. The curative treat- 
ment consists of operating so as to remove the enlarged head of 
the metatarsal bone. There are several operations for this con- 
dition all of which vary slightly but all accomplishing the same re- 
sult. Where the patient suffers so that palliative measures prove 
futile, an operation at the hands of a skilled surgeon should be 
advised. 
252. What is talipes, or club foot? Talipes, or club foot, is a congenital SURGERY 
121 
or an acquired deformity in which the foot assumes various shapes 
and accordingly is divided into: (1) talipes equinus, (2) talipes 
equinovarus, (3) talipes equinovalgus, (4) talipes calcaneus, and 
(5) talipes cavus. 
253. What is talipes equinus? Talipes equinus is a permanent exten- 
sion of the foot so that only the ball of the foot rests on the 
ground. 
254. What is talipes equinovarus? Talipes equinovarus is a perma- 
nent extension and inversion of the foot. 
255. What is talipes equinovalgus? Talipes equinovalgus is a perma- 
nent extension and eversion of the foot. 
256. What is talipes calcaneus? Talipes calcaneus is a permanent 
dorsi-flexion of the foot so that the weight of the body rests on 
the heel only. 
257. What is talipes cavus? Talipes cavus, pes cavus or hollow foot, is 
a condition in which the arch of the foot is greatly exaggerated. 
(Note: No mention has been made of the various orthopaedic con- 
ditions which the chiropodist treats, nor have the chiropodial foot 
lesions been discussed, this being left for another section of this series 
of quizes.) CHAPTER IX. 
PRACTICAL CHIROPODY 
1. What is chiropody? Chiropody is the scientific care of the foot 
in health and in disease. 
2. What is podiatry? Podiatry is a newer term used to designate the 
science of foot care. 
3. What type of foot lesions are usually included in the practice of 
chiropody or podiatry? The minor foot lesions are usually in- 
cluded in the practice of chiropody and in some parts of the 
United States the laws also permit the treatment of mechanical 
disturbances by other than operative means. The scope of prac- 
tice is limited by laws in most states and practitioners must be 
governed by these laws. 
4. How is the practice of chiropody or podiatry usually divided? The 
practice of chiropody or podiatry is usually divided into two divi- 
sions: (a) The surgical, which includes those lesions that are 
treated by operative means; (6) orthopaedic, which includes those 
lesions which are treated by mechanical means. (The former type 
of lesions will be the subject of this quiz.) 
5. Mention the various lesions usually treated by the chiropodist. 
The lesions usually treated by the chiropodist are: (a) heloma, 
(b) verruca, (c) calloused nail groove, (d) ingrown toe nail, (e) 
cub nail, (/) atrophy of the nail, (g) bursitis, (h) chimatlon, (i) 
fissures, (;') blisters, (k) burns, (Z) hyperidrosis, (m) bromidrosis, 
(n) anidrosis, (o) ulcers, (p) vocational foot disorders. 
6. Why is a knowledge of asepsis and antisepsis essential to good 
chiropody practice? Nearly all of the procedures in chiropody are 
such that the patient is exposed to infection from pathogenic 
organisms. Unless the necessary precautions against bacterial in- 
vasion are taken, infection must ensue. 
7. What local antiseptics are best suited for chiropody practice? 
The following local antiseptics are usually employed in chiropody 
practice: alcohol, iodine, bichloride of mercury, boric acid, 
Dakin’s solution, hydrogen peroxide, phenol, white precipitate, so- 
lution of cresol compound, potassium permanganate, etc. (See 
Surgery quiz.) 
8. In what forms are antiseptics used in chiropody? Antiseptics are 
used in three forms: (a) liquids, (b) ointments, (c) powders. PRACTICAL CHIROPODY 
123 
9. What is sterilization? Sterilization is the process of destroying 
bacteria, usually by means of heat. 
10. How can the instruments used in daily practice be sterilized? 
The best procedure is to boil the instruments immediately before 
using them and this should be done wherever extensive incisions 
are to be made. For the instruments used in operations where 
hemmorhage is accidental, immersion in pure phenol followed by 
alcohol is efficient. (For details of sterilization, see Surgery quiz.) 
11. What is meant by the term “hygiene” ? Hygiene is the science of 
health. 
12. What is meant by the hygiene of the foot? By hygiene of the- 
foot is meant those procedures which should be followed to keep 
the foot in a healthy condition. 
13. What does hygiene of the foot comprise? Hygiene of the foot 
comprises the proper fitting of shoes and stockings, the cleansing 
of the foot, and the proper exercising of the muscles of the foot 
and leg so that function can continue without strain or fatigue. 
14. What general advice should be given to the patient about shoes 
and stockings? The patient must be advised about the danger of 
wearing short and narrow shoes, especially with high heels. The 
shoe must be sufficiently long and wide to accommodate the foot 
under weight bearing and must be snug in the heel to prevent 
slipping of the foot in the shoe. The value of vici kid leather over 
calfskin and patent leather should also be explained. The stock- 
ings must be sufficiently long so that the toes are not pulled toward 
the central line of the stocking and should be of a material which 
will absorb moisture. 
15. What is the alternate foot bath? The alternate foot bath is a 
hygienic measure which acts as a tonic for the structures of the 
foot. It is given by immersing the feet in hot water for two 
minutes and then immersing them in cold water for one minute. 
This is continued five or six times, starting with hot water and 
ending with cold water. The feet are then thoroughly dried and 
care is taken that no moisture is allowed to remain between the 
toes. 
16. Why is exercise essential to good foot care? Persons who are 
engaged in sedentary occupations do not use certain groups of 
muscles in the foot and leg and unless these muscles do a given 
amount of work each day they will become atrophied and shortened. 
The calf muscles are most often affected in those who sit for most 
of the day and in those who wear high heel shoes. Thus, if the 
calf muscles are not given a certain amount of exercise, they soon 
become incapable of performing their functions, and strain is put 
upon parts which soon terminates in serious disorders. 
17. Should the style of a shoe be changed suddenly or gradually? 
The style of shoe should never be suddenly changed, especially in 
an adult. A person who has been wearing a certain type of shoe 124 
QUIZ COMPEND 
for a long period of time has permitted the various structures to 
become adapted to the shoe, and if a sudden change be permitted, 
great strain will be put on the parts that have not been in use. No 
matter how bad a shoe might be, and this is especially true in high- 
heel shoes, the patient should be advised to make the change to a 
good shoe gradually, so as to slowly permit the parts to become 
accustomed to the change. 
18. IF hat is a dressing? A dressing is the material applied to a wound 
for the purpose of protection, stimulation, exclusion of air, or the 
prevention of irritation of the affected area. 
19. How many classes of dressings are used in chiropody? There are 
four classes of dressings used in chiropody: (a) the moist dress- 
ing, (6) the dry dressing, (c) the ointment dressing, (d) the 
occlusive dressing. 
20. JFhat is the moist dressing? The moist dressing is composed of 
several thicknesses of gauze applied to a part and moistened with 
some antiseptic or astringent solution. There are two kinds of 
moist dressings—the evaporating and the non-evaporating. 
21. Describe the evaporating moist dressing. This dressing is called 
a wet dressing, and is composed of several thicknesses of gauze, 
saturated with a solution and allowed to remain uncovered so 
that evaporation takes place. The gauze is remoistened from time 
to time so that the dressing is kept continuously wet. Independent 
of the action of the drug used in the solution, this dressing re- 
duces heat and causes local anemia. 
22. Describe the non-evaporating moist dressing. This dressing is 
composed of several thicknesses of gauze saturated with a solution 
and then covered with some impervious covering such as oil silk, 
gutta percha, or fishskin. This dressing, independent of the drug 
used, is heat producing and hyperemic. 
23. IF hen is the evaporating moist dressing indicated? The evaporat- 
ing moist dressing is used wherever infection and inflammation are 
present, especially in draining wounds. 
24. JFhen is the non-evaporating moist dressing indicated? The non- 
evaporating moist dressing is used only on the unbroken skin in 
cases such as sprains and bruises, but never in the presence of 
pus. The warmth produced by this dressing is congenial to bac- 
terial growth and in infections, aggravates the condition. 
25. Describe the dry dressing. The dry dressing is several thick- 
nesses of sterile gauze which is applied to a part and allowed to 
remain dry. The dry dressing may be composed of the gauze 
only or a dusting powder may be added which is either antiseptic, 
asiringent, or stimulant. 
26. JFhen is the dry dressing indicated? The dry dressing is indi- 
cated in cases where the wound is aseptic and is to be kept so, or 
where there is free drainage and no drugs are indicated. The PRACTICAL CHIROPODY 
125 
gauze may be inserted into the wound to act as a wick for drainage 
or it may be applied over the entire area. Dusting powders are 
never used on a draining wound and are indicated only when a 
specific action of a drug is desired. Thus parathesin may be 
dusted into a painful wound to relieve pain and the entire area 
then protected with gauze. 
27. Describe the ointment dressing. The ointment dressing is one in 
which an ointment is held in place either by gauze, cotton, or lint. 
The ointment may be spread upon the fabric used or it may be 
applied directly to affected part. 
28. When is the ointment dressing indicated? The ointment dressing 
is indicated in superficial inflammations such as chilblains, bur- 
sitis, etc., but is never used on a wound that is discharging freely, 
as it tends to retard drainage. 
29. Describe the occlusive dressing. The occlusive dressing is one 
which excludes the air and completely seals the parts. This is 
obtained by the use of collodion, either plain or medicated, and 
compound tincture of benzoin. 
30. Mention the various collodions used in chiropody. There are four 
preparations containing collodion used: (a) iodized collodion, (b) 
ichthyolated collodion, (c) benzoated collodion, (d) salicylated 
collodion. 
31. What are the uses of iodized collodion? Iodized collodion is used 
to protect the tender tissues after the removal of helomata and 
callositas. The collodion protects and the iodine acts as an anti- 
septic and counter-irritant. It contains 5 per cent, iodine. 
32. What are the uses of ichthyolated collodion? Ichthyolated col- 
lodion is used to protect previously pared callouses and also in 
chilblains as an antiphlogistic and stimulant. It contains 15 per 
cent, ichthyol. 
33. What are the uses of benzoated collodion? Benzoated collodion 
may be used to protect helomata and callositas after cutting. It 
is also efficient as a stimulant in chilblains and as a protective for 
blisters. It contains 5 to 10 per cent, of the compound tincture 
of benzoin. 
34. What are the uses of salicylated collodion? Salicylated collodion 
is used in the medical treatment of helomata and callositas, acting 
as a disintegrant to the skin. It should never be used on normal 
epidermis. It contains about 10 to 15 per cent, salicylic acid and 2 
per cent, extract of cannabis Indica, in plain collodion. 
35. When is collodion and its preparations contra-indicated? Col- 
lodion, either plain or medicated, is never used on a surface that 
is discharging. The collodion seals up the parts and thus pre- 
vents throwing off of exudates. Retention of these is harmful to 
the healing of the parts. 
36. Describe the impervious coverings used in moist dressings. There 126 
QUIZ COMPEND 
are three materials most commonly used for non-evaporating moist 
dressings: (a) Oiled silk, (b) gutta percha tissue, (c) fishskin. 
These materials when applied over a moist dressing prevent 
evaporation. Oiled silk is the strongest of the three, but is more 
bulky and it is on that account that gutta percha or fishskin are 
preferred in chiropody practice. The gutta percha may be firmly 
adhered to the surrounding skin by heating the edges and then 
lightly pressing them against the skin. The heating melts the 
rubber and it is thus vulcanized to the epidermis. 
37. What is a bandage? A bandage is a strip of gauze, muslin, 
flannel, or other material of varying widths and lengths used for 
retaining dressings, applications, and splints and to produce com- 
pression. Occasionally they are used to retain heat. 
38. What materials are used for bandages? The various materials 
used for bandages are gauze, muslin, flannel, elastic cloth, and 
rubber. 
39. What is a roller bandage? A roller bandage consists of one piece 
of material rolled in the shape of a cylinder, having a core and a 
free end. 
40. What is a double roller bandage? A double roller bandage con- 
sists of one piece of material rolled from both ends so that when 
it is completed there are two cylinders and no free end. 
41. What is a plaster of Paris bandage? A plaster of Paris bandage 
is composed of a piece of gauze or crinoline into the meshes of 
which plaster of Paris has been thoroughly rubbed. The bandage 
is rolled and when ready for use is immersed in water and then 
applied. It then becomes hard and solid and is used to prevent 
motion in a part. It is used in general surgery for fractures and 
in chiropody for making impressions of the feet for mechanical ap- 
pliances. 
42. What bandages are used in the practice of chiropody? The band 
ages most commonly used in the practice of chiropody are the 
spiral bandage of the great toe, the figure-of-eight bandage of the 
ankle, and the spiral reverse bandage of the leg. 
43. Describe the spiral bandage of the great toe. The spiral bandage 
of the great toe is made by first locking the bandage at the base 
of the toe by one or two circular turns. Recurrent turns are then 
made to cover the distal end of the toe and these are secured by a 
circular turn at the base of the toe and then the spiral turns are 
made to the distal end of the toe. The spirals are then applied to 
the base of the toe and the bandage finished by tying off or adher- 
ing with adhesive plaster. One-inch bandage is used. 
44. Describe the figure-of-eight bandage of the ankle. The bandage 
is locked by a few circular turns around the ankle. These turns 
should be started with the free end pointing toward the inner side 
of the foot. The roller is then passed from behind the tendo 
Achillis over the inner malleolus, diagonally across the dorsum of PRACTICAL CHIROPODY 
127 
the foot to the base of the fifth metatarsal, across the plantar 
surface, and diagonally back over the dorsum of the foot to the 
outer malleolus and around the tendo Achillis. The second turn 
is then started, overlapping the preceding one about two-thirds or 
three-quarters, and this is continued until the desired area is 
covered. 
45. Describe the spiral reverse bandage of the leg. The bandage is 
started by making one or two figure-of-eight turns around the ankle 
and then making ascending turns up the leg. These turns are ap- 
plied in the same manner as a regular ascending turn with this 
difference: as the roller is brought around the limb, it is turned 
so that the inner side of the bandage becomes the outer and the 
outer side becomes the inner. These reverse turns must be made 
evenly and over the fleshy part of the leg so that no irritation re- 
sults. 
46. IF hat principles must be observed in the selection and care of in- 
struments? There is a gradual tendency to standardization of in- 
struments, and as this progresses, manufacturers are giving more 
thought to quality and temper. It is essential that the steel of 
the instruments, especially the cutting edges, be well tempered 
so that they can be sharpened and retain their keen edges. The 
handles should be of steel or aluminum or some other metal that 
can be easily boiled. Instruments which are mounted in other 
than metal handles cannot be sterilized by boiling and should not be 
used. Instruments should be polished at regular intervals as 
continued sterilizing will cause them to stain and after a time they 
do not look presentable. 
47. What is a hone? A hone is a smooth block of fine stone which is 
used for sharpening instruments. There are several kinds of 
hones, the best of which for chiropody purposes is the Belgian 
hone. A hone should be soft so that the blade of the instrument 
can take hold when drawn across its surface, but should not be 
rough and gritty. 
48. What is a strop? A strop is a piece of leather, usually horsehide, 
mounted on a piece of wood and is used for straightening and 
smoothing the edge of an instrument after honing or after cutting. 
The leather is smooth and soft enough to allow the steel of the 
instrument to compress it when being passed over its surface. 
49. Define a shield. A shield is an appliance made of some soft mate- 
rial and used to protect a part from pressure or friction. 
50. What materials are generally used for shielding? The materials 
generally used for shielding are felt, chamois, buckskin, moleskin, 
and lamb’s wool. 
51. Describe the felt used for shielding. The white wool piano felt 
of soft texture is best for shielding and varies in thickness from 
1/16 inch to % inch. The thin felt is used for small shields on 
and between the toes and the thick material is used for the great 128 
QUIZ COMPEND 
toe joint and for pads for the arches of the foot. Pure wool felt 
can be easily skived and fitted, but when mixed with cotton it 
loses its firmness and is easily pulled out of shape. The latter is 
used for padding the arches only. 
52. Describe chamois. Chamois is an ideal shielding material where 
thick shields are not required. The material is soft and pliable 
and is suitable for shields between the toes. 
53. Describe buckskin. Buckskin is one of the most popular mate- 
rials used for shields. The skin has good body and can be skived 
very thin without losing its firmness. The thickness of buckskin 
varies sufficiently to permit its use in nearly all parts of the foot. 
54. Describe moleskin. Moleskin is an adhesive plaster made on a 
cloth which is thin yet it has good body and does not lose its shape 
or stretch when used. Because of its thinness and texture it re- 
quires no skiving and is ideal where thin shields are indicated. 
55. Describe lamb’s wool. Lamb’s wool is really not a shielding ma- 
terial, but is used in the sole of the shoe to act as a cushion for 
the plantar surface, in painful callosities, and other plantar 
troubles. 
56. IF hat fundamentals must be observed in making and fitting 
shields? The fundamental principles of shielding are: (1) the 
location of the area to be protected so that the size and shape 
of the shield can be determined; (2) the thickness of the shield, 
which must not be too thick or too thin; (3) the skiving, so that 
pressure is evenly distributed away from the area to be protected; 
(4) the aperture, which must be of the proper size and shape so as 
to permit the rest of the shield to act as a protective; (5) adhering 
the shield so that slipping and irritation are prevented. 
57. Describe skiving. Skiving is a process by which the edges of a 
shield are cut away to a feather edge. This is accomplished by the 
skiving knife, which is a fairly large blade which tapers toward 
the front of the knife. A shield is skived after it has been cut 
to the proper size and shape; the material is placed on a smooth 
surface (a skiving board is sold for this purpose) and the edges 
of the shield are thinned by cutting around its entire area, until 
a uniform bevel is obtained. 
58. What fundamentals must be observed in strapping a shield? 
When a shield is strapped to any part of the foot the following 
must be observed: (1) the strapping must not be applied too 
tightly, remembering that the foot being strapped is at rest and 
that under weight bearing the tissues expand; (2) allowance should 
be made for swelling, especially on the toes, so that straps should 
not completely encircle a toe that is inflammed and which may 
therefore swell; (3) the edges of the shield should be covered as 
much as possible with the adhesive plaster, which prevents the 
shield from being raised from the skin during normal motions of 
the foot; (4) the ends of the plaster should be cut round, which will prevent loosening at the edges. It has been found that ad- 
hesive plaster will loosen more readily when allowed to have 
sharp angulated corners. 
59. What is local anesthesia? Local anesthesia is insensibility to pain 
brought about in a given area by means of agents called local 
anesthetics. 
60. How is local anesthesia classified? Local anesthesia is classified 
into (a) hypodermatic injection, (b) freezing. 
61. Describe hypodermatic injection local anesthesia. This method of 
inducing local anesthesia is accomplished by the use of the hypo- 
dermic syringe and is divided into two subdivisions: (a) infiltra- 
tion and (b) conductive anesthesia. 
62. Describe infiltration anesthesia. This form of local anesthesia is 
used most and consists of carefully and thoroughly infiltrating the 
area to be operated upon with the anesthetic agent. All of the 
tissues are saturated so that all of the sensory nerves contained 
therein are acted upon by the fluid. 
63. Describe conductive anesthesia. This form of local anesthesia, 
also called nerve blocking consists of injecting into or around a 
nerve trunk. When the fluid acts upon the nerve fibers it causes a 
loss of sensation from that point to the periphery. Injection into 
the trunk is called endoneural anesthesia and injection around the 
trunk is called perineural anesthesia. The former is difficult of 
attainment unless the nerve trunk is exposed by first cutting down 
on it. The latter is most practical, especially when the anatomy of 
the parts is thoroughly understood, and with sufficient practice, 
becomes quite simple. 
64. What is the advantage of conductive anesthesia over infiltration 
anesthesia? The former method causes loss of sensation over 
larger areas and is to be preferred when extensive incisions are 
to be made. When the operation is limited, infiltration is to be 
preferred. 
65. What period of time must elapse before operation after inducing 
local anesthesia? If infiltration is used and is thoroughly done, 
the operation can be started almost immediately. With conductive 
anesthesia, if injection is made directly into the nerve trunk, 
the effect is also immediate. With perineural injections, the time 
varies with the size of the trunk around which injection has been 
made. The larger the trunk and the thicker the fibrous covering 
around it, the longer it will be necessary to wait until anesthesia 
is complete. Sometimes it is necessary to wait even for twenty 
minutes to a half hour before commencing to operate. 
66. Describe local anesthesia by freezing. This method depends on 
the rapidity of evaporation of certain drugs. When any liquid 
evaporates it extracts heat from surrounding bodies. The more 
rapid the evaporation the more heat will be extracted. Thus, if 
the evaporation takes place on the skin, the heat will be taken 
PRACTICAL CHIROPODY 
129 130 
QUIZ COMPEND 
from this structure and if sufficiently intense, freezing will result. 
Ethyl chloride is the best substance to use for this form of anes- 
thesia and should be sprayed immediately over the area to be 
operated. When the area turns white and frosted, sensation to 
pain is lost. 
67. When is freezing indicated as a local anesthetic? Freezing should 
only be used when the operative procedure is slight, such as in the 
incision of an abcess. It should not be used in extensive work, as 
its effects are limited, and too much freezing will bring about an 
inflammatory reaction which may terminate in the destruction of 
tissue. 
68. What drugs are used for hypodermatic injection as local anes- 
thetics? The drugs most commonly used for this purpose are 
cocaine, novocaine, alypin, quinine and urea hydrochloride, etc. 
Novocaine is the best agent to use as it is safer than cocaine and a 
better anesthetic than the others. 
69. What strength solution of novocaine is usually employed? For 
infiltration anesthesia, one per cent, is sufficient and for con- 
ductive anesthesia, two per cent will suffice. 
70. How should a solution of novocaine be prepared? The solution 
should be prepared by dissolving the novocaine in a sterile physio- 
logic salt solution, and the solution boiled. This makes a solution 
which is isotonic and thus more agreeable to the tissues and more 
readily absorbed by them. Ampoules of novocaine can be se- 
cured which are prepared in this manner and which are sterile. 
After the outside of the ampoule has been sterilized, it is ready 
for use. 
71. What technic is employed in preparing the hypodermic syringe? 
The entire apparatus is first sterilized by boiling in water, and 
when cooled, the needle is put in place and the solution drawn up 
into the barrel of the syringe. The syringe is then turned needle 
upward and all the air expelled by pressing on the piston. If air 
should be injected into a blood vessel it might cause death. When 
all the air has been excluded, the apparatus is ready for use. 
72. What is an heloma? An heloma, corn, clavus, or horn is a cir- 
cumscribed overgrowth of the epidermis, with a central core or 
radix which presses down upon the derma. 
73. How are helomata classified? Helomata are classified according 
to their appearance, texture, or composition as (a) heloma durum 
or hard corn; (6) heloma molle or soft corn; (c) heloma vascu- 
lare or vascular corn; (d) heloma miliare or seed corn. 
74. Define heloma durum. Heloma durum is a hard circumscribed 
overgrowth of the epidermis usually found on the outer side of 
the fifth toe, the dorsum of the three middle toes, and on the 
plantar surface of the great toe. 
75. What are the symptoms of heloma durum? The patient complains 
of sharp pains in the toes when the shoes are worn which increases PRACTICAL CHIROPODY 
131 
when the weather is about to change. There is a mass of horny, 
epithelial cells of a characteristic yellow color which is separated 
from the surrounding skin by a sharp line of demarcation. Within 
the growth and usually in the center is a darker, more compact mass 
called the radix or nucleus. The surrounding skin is somewhat 
congested. 
76. What is the etiology of heloma durum? Heloma durum is caused 
by intermittent friction or pressure of ill-fitting shoes. The shoes 
may be too tight or they may be too loose. Helomata dura on the 
plantar surface of the foot are caused by some roughness in the 
sole of the shoe or by downward displacement of one or more of 
the heads of the metatarsal bones. 
77. What is the pathology of heloma durum? The pathology of 
heloma is mostly morphologic. Leading up to the formation of 
jhe heloma there is first an excitation of the cutaneous nerves 
which causes an afflux of blood. This increase of blood supply 
dilates the vessels and increases the nourishment to the skin. 
There is a consequent over-production of skin cells and as the 
cells crowd upward they soon form a mass which is known as a 
callosity. Usually at the center the crowding is more marked and 
the cells form concentrically to form the radix. As this portion con- 
tinues to become larger it takes the shape of a cone, the apex 
of which points downward into the derma. 
78. What is the prognosis of heloma durum? The prognosis of 
heloma durum is uncertain. Some helomata disappear after a 
single treatment while others continue to return even after years 
of regular attention. 
79. Why do helomata dura recur after being removed? There are two 
factors responsible for this recurrence. The shoe which caused the 
heloma continues to be worn and after a time the blood vessels be- 
low and around the corn become permanently enlarged so that 
the growth continues even if the style of shoe be changed and 
proper treatment be given. 
80. How is the treatment of heloma durum classified? The treatment 
of heloma durum is divided into three groups: (a) non-operative, 
(b) non-radical operative, (c) radical operative. 
81. Describe the non-operative treatment of heloma durum. This 
form of treatment is a palliative method and consists of the use 
of chemical agents which dessicate the growth. The agents usually 
employed for this are silver nitrate and salicylic acid. The latter 
is the most popular and is used in an ointment, 25 per cent., put 
into the aperture of a shield and allowed to remain for three or 
four days. When the dressing is removed, the skin will be white 
and soft and is easily peeled off the toe. This is repeated as 
often as is necessary to remove the entire growth. 
82. Describe the non-radical operative treatment of heloma durum. 
This procedure is the one practiced by practitioners of chiropody 132 
QUIZ COMPEND 
and consists of removing the overgrown epidermis and dissecting 
out the radix. This is done in one of two ways: (a) shaving, in 
which the growth is removed piece by piece either by the knife 
or chisel; (b) dissection, in which the corn is removed in one 
piece by specially made chisels. 
83. Describe the radical operative treatment of heloma durum. This 
procedure is directed not alone against the growth itself but also 
against the enlarged blood vessels under and around the corn. 
Local anesthesia by novocaine, 1 per cent., is secured and then a 
semi-elliptical incision is made around one side of the corn. The 
tissues are dissected from under and a second semi-elliptical in- 
cision is made, meeting the first and completing the ellipse in the 
center of which is the growth. When all of the underlying tissue 
has been freed, the entire mass is removed and the resultant wound 
is sutured by interrupted sutures. 
84. What is the treatment for a suppurating heloma durum? The 
toe will appear red and swollen and when the outer layers of the 
epidermis are removed, pus will exude from the lesion. All of 
the epidermis is cut away, and a wet dressing of mercuric chloride 
(1-5000) is applied for one or two days. When drainage of pus 
is not rapid enough, it may be helped by increasing the size of 
the wound by incision. When the infection has cleared up, the 
part is dressed with a suitable shield and in the aperture may be 
placed a healing ointment. A desirable remedy for lesions of 
this kind, which are painful, is the compound parathesin oint- 
ment which will relieve pain as well as help healing. 
85. Define heloma molle. Heloma molle, or soft corn, is a soft, white, 
macerated growth found between the toes, principally in the web 
between the fourth and fifth toes and on the lateral sides of the 
interphalangeal joints of the toes. 
86. What are the symptoms of heloma molle? The pain varies with 
the degree of pressure brought to bear on the toes. The patient 
will complain of something annoying, like a foreign body such as 
a pebble, and as the growth becomes larger, this becomes worse. 
Examination shows a white macerated mass of epidermis with a 
sharp line separating it from the normal skin. The lesion is 
superficial and the radix is shallow. 
87. What is the etiology of heloma molle? Heloma molle is also 
caused by improper shoes, but here the shoe is an indirect factor, 
Crowding of the toes by the shoe causes the opposite heads and 
bases of the bones to be pressed against each other with an im- 
pingement of the skin between them. The skin is thus irritated 
and the overgrowth begins. The normal function of perspiring 
continues and with the crowding, evaporation is impossible. Thus 
the moisture, which is acid in character, accumulates and acts 
upon the skin, causing it to become white, soft, and macerated. 
88. What is the pathology of heloma molle? The morphologic changes 
accompanying the formation of heloma durum are again mani- PRACTICAL CHIROPODY 
133 
fested, except that the growth is not so deep seated. Inflamma- 
tion terminating in suppuration is often encountered, due to the 
action of the perspiration which may produce small fissures which 
permit the bacteria to enter the tissues. 
89. What is the prognosis of heloma molle? Heloma molle, properly 
treated, will respond and clear up. A careful analysis of the 
cause must be made and treatment directed against the etiologic 
factors. 
90. What is the treatment of heloma molle? The treatment of heloma 
molle is divided into (a) non-radical surgical, (b) therapeutic. 
91. Describe the non-radical surgical method of treating heloma molle. 
The footgear, both shoes and stockings, must be corrected to “stop 
crowding of the toes. With specially made instruments, the golf 
stick” and the soft corn spoon, the thickened mass of skin is care- 
fully cut away and the radix carefully dissected out with a small 
pointed knife. When all of the growth has been removed, a 
shield is applied and if the part is irritated, a soothing ointment 
may be placed in the aperture. 
92. Describe the therapeutic treatment of heloma molle. Two drugs 
find great favor for the treatment of heloma molle. They are 
salicylic acid and silver nitrate. Salicylic acid is used in an oint- 
ment, 25 per cent., and is allowed to remain for four or five 
days. After that time, the skin can easily be peeled away. Silver 
nitrate is used in a 25 or 50 per cent, solution, applied every other 
day. This hardens the skin before it peels off. 
93. Of what importance is shielding in the treatment of heloma molle? 
Shielding is the most important phase of the treatment of heloma 
molle. The separation of the toes and the proper alignment of 
the bones will do the most toward curing the condition. When 
the helomata appear on the lateral sides of the toes, an oval 
shield suffices. When the growths appear in the web of the 
fourth and fifth toes, then the “ duck shield ” should be used. 
This shield will keep the toes apart and will also raise the head 
of the fourth metatarsal bone which has dropped and is rotated 
outward. These with proper footgear will bring about a cure. 
94. Define heloma vasculare. Heloma vasculare is an overgrowth of 
the epidermis in which enlarged and elongated blood vessels are 
found. 
95. What are the symptoms of heloma vasculare? The growth is 
usually found on the plantar surface of the foot, but it may de- 
velop in old helomata dura or callouses on the outer aspect of the 
fifth toe. Pain is more severe than in other forms of helomata, 
especially a burning sensation when the foot is at rest. It appears 
the same as heloma durum except that dark red spots are seen 
scattered throughout it. These bleed when cut and are not to be 
confused with blood clots sometimes found in heloma durum as 
a result of injury. 134 
96. What is the etiology of heloma vasculare? The overgrowth of 
the epidermis is caused by the same factors as in heloma durum, 
the blood vessels being forced into the epidermis by lateral pres- 
sure of the shoes or by the pinching of tight stockings. The 
normal papillae are usually very long at the seat of heloma vas- 
culare, thus making them more easily forced into the epidermis. 
97. What is the pathology of heloma vasculare? There is an over- 
growth of the cells of the epidermis but there is no increase in 
connective tissue or in the number of blood vessels as in verruca. 
The blood vessels leave the papillary layer of the derma and enter 
directly into the epidermis without affecting the surrounding con- 
nective tissue. There is a limited amount of inflammation, but 
this rarely terminates in suppuration. 
98. What is the prognosis of heloma vasculare? The prognosis is 
good if treatment is thorough. There may be a recurrence of 
heloma durum, but the vascular lesion, once eradicated, should 
not return. 
99. What is the treatment of heloma vasculare? The treatment is di- 
vided into (a) surgical, (b) medicinal, (c) mechanical. 
[00. What is the surgical treatment of heloma vasculare? The sur- 
gical treatment consists of an operation much the same as the 
radical surgical treatment for heloma durum. The part is anes- 
thetized and two semi-elliptical incisions are made around the 
growth which meet to complete an ellipse. The tissue is then 
dissected out and the resultant wound sutured. 
LOT. What is the medicinal treatment of heloma vasculare? The me- 
dicinal treatment consists of the use of various chemical agents 
which gradually destroy the growth and terminates in an ulcer. 
(See treatment of verruca for details.) 
[02. What is the mechanical treatment of heloma vasculare? The me- 
chanical treatment of heloma vasculare consists of the use of 
electricity in its various forms for the cure of this condition. 
(The treatment of heloma vasculare is much the same as the 
treatment of verruca; see that subhead for details.) 
L03. What is heloma neurofibrosum? Heloma neurofibrosum or neuro- 
fibrous corn is an heloma in which there are found enlarged 
nerve endings. This condition is much like heloma vasculare 
structurally, except that the nerve terminals instead of blood 
vessel loops have been involved. They are extremely painful and 
great care is necessary when operating upon them unless local anes- 
thetics be used. They are found on the inner plantar edge of 
the great toe and on the outer plantar edge of the fifth toe. It is 
at this point that the size of the papillae change from short ones 
on the dorsum to long ones on the plantar and this point is sub- 
jected to irritation more easily than when the size of the papillae 
is uniform. 
L04. What is the treatment of heloma neurofibrosum? The treatment is 
QUIZ COMPEND PRACTICAL CHIROPODY 
135 
the same as for heloma vasculare except that agents which cause 
pain must not be used. Procedures requiring local anesthetics 
are preferred. 
105. Define heloma miliare. Heloma miliare or heloma disseminatura 
or seed corn is a small excresence found on the plantar surface- 
of the foot, usually in large numbers and most often seen aroundl 
the heel. The growth is about the size of a millet seed. 
106. What are the symptoms of heloma miliare? The patient does not: 
suffer the pain caused by other forms of helomata, and only whem 
the lesions appear in great numbers do they become painful. A. 
peculiar sensation is felt as if there were a foreign body in the; 
shoe. Examination will reveal several small helomata which ap- 
pear to be all nucleus. 
107. What is the etiology of heloma miliare? When the surface of the 
sole of the shoe becomes roughened by nails protruding or by 
the insole becoming wrinkled, heloma miliare may develop. Stock- 
ings that have been poorly mended are also factors. Persons with 
dry skin are prone to this lesion and this factor is often responsi- 
ble for large clusters of growths. 
108. What is the pathology of heloma miliare? Hypertrophy of the; 
epidermis occurs over a very limited area so that the growth ap- 
pears to be all radix. The area surrounding is not involved ex- 
cept that it might be slightly congested. The papillae between the; 
growths are normal. 
109. What is the prognosis of heloma miliare? Careful operation 
and intelligent after-care will bring about a cure in a few treat- 
ments. The etiologic factors must be removed. 
110. What is the treatment of heloma miliare? The treatment of he- 
loma miliare may be surgical or medicinal. The growths may be 
carefully dissected out, but in cases where the lesions are very 
numerous and appear in clusters, it is simpler to treat them with 
salicylic acid. Adhesive plaster containing 25 per cent, of this 
drug can be purchased and a piece cut the size of the cluster and 
placed directly on the skin. It is allowed to remain in place for 
four or five days when it is removed and the lesions may be easily 
taken out. The skin, if dry, should be treated by instructing the 
patient to rub lanoline into it at least every other day. This will 
supply the oil that is lacking in the skin and help to keep its 
texture normal. 
111. Define callositas. Callositas, callouses, callosity, tyloma or tylosis 
is a thickening of the epidermis usually found on the plantar sur- 
face of the foot. This thickening may occur on any part of the 
body which is subjected to irritation. Thus, coachmen have cal- 
louses between their fingers because of the manner in which the 
reins are held. Mechanics using hand tools develop callouses on 
the hands. 136 
QUIZ COMPEND 
112. What are the symptoms of callositas? The symptoms of callositas 
are characteristic. Pain is not marked unless helomata develop 
within the lesion. The lesions appear as variously sized areas of 
thickened epidermis of a grayish color and which is thickest in the 
center, gradually becoming thinner at the periphery. There is no 
sharp line separating the lesion from the normal skin such as is 
seen in heloma. 
113. What is the etiology of callositas? A callosity is the result of 
some form of mechanical irritation and the growth develops prim- 
arily as a protective to the more delicate structures beneath the 
skin. The outer layers of the epidermis become thicker as the 
irritant becomes more severe. Callouses may result from chronic 
skin diseases such as eczema, psoriasis, etc. 
114. What is the pathology of callositas? The changes that occur in 
the formation of callositas are much the same as in heloma, ex- 
cept that the deeper layers of the epidermis and the true skin are 
not so much involved. There is no inflammation unless there has 
been accidental injury or infection. The outer layers of the 
epidermis only are affected and the condition is more physiologic 
than pathologic. The overgrowth may continue to a great extent 
and even helomata may develop within the callosity. 
115. What is the prognosis of callositas? The removal of the irri- 
tant will usually suffice to bring about a cure. In callositas on the 
sole of the foot, changing the shoe and correcting the foot con- 
dition present will affect a cure. 
116. What is the treatment of callositas? The thickened epidermis re- 
quires no special treatment unless it becomes thick enough to cause 
discomfort. This is accomplished by softening the skin and then 
scraping or paring it with a knife. Chemicals can also be used 
to disintegrate the mass and salicylic acid ointment, 25 per cent., 
or potassium hydroxide, 5 per cent., are most often used. Too 
much of the skin should not be removed as it will leave the part 
very sensitive. If this should occur, moleskin adhesive plaster 
should be applied as a protective. To effect a permanent cure of 
the callosity requires that the cause be permanently removed. 
Thus, if a bone is out of alignment it must be corrected or if the 
shoe is at fault it must be changed. 
117. Define verruca. Verruca, sometimes called papilloma, is a benign 
or innocent tumor of the skin, both the derma and epidermis. It 
is a neoplasm in which there is an overgrowth of all of the skin 
structures, especially the blood vessels. 
118. Where do verrucae occur? Verrucae occur on the feet, hands, 
and face. 
119. How are verrucae found on the foot classified? Verrucae found 
on the foot are classified as (a) verruca arida or dry wart, (6) 
verruca humida or moist wart. 
120. What is verruca vulgaris? Verruca vulgaris is that form of PRACTICAL CHIROPODY 
137 
growth which appears on the hands and is really a type of ver- 
ruca arida. 
121. What is the etiology of verruca? There is no definite etiology. 
At one time it was supposed to be caused by a microorganism, but 
no definite results were ever obtained in the attempt to isolate 
the offending microorganism. Trauma as a factor seemed to have 
more status, for often these growths appear in the skin after in- 
juries. The latest and perhaps the most scientific work done in 
determining the cause of verruca has shown that a filterable virus, 
extracted from a wart, when injected into the skin, will produce 
similar lesions. 
122. What is the pathology of verruca? There is an overgrowth of the 
true skin covered with a thickened epidermis. The surface of the 
growth may be smooth or it may have a cauliflower appearance. 
The lesion may be elevated or it may be flattened to the level of 
the surrounding skin. The blood vessels contained therein are 
greatly enlarged, and there is hypertrophy of all the connective 
tissue structures. A vertical section shows a branching arrange- 
ment of the vessels, each with a connective tissue framework and 
an epithelial covering. 
123. Describe verruca vulgaris. Verruca vulgaris appears on the hands 
and arms, and affects children more often than adults. The growths 
often appear in large numbers and seem to occur spontaneously. 
The lesion is round and elevated and looks like a cauliflower. 
Early in its formation it has the same color as the surrounding 
skin, but later it becomes darker. It causes no pain, but bleeds 
readily when injured. 
124. Describe verruca arida. Verruca arida appears on the sole of the 
foot, over the metatarsals and at the ends of the toes. It is 
flattened and is covered with a heavy callous. This latter is due 
to the pressure to which the growth is subjected when the patient 
stands and walks. 
125. Describe verruca humida. Verruca humida is usually found on the 
inner aspect of the plantar surface of the heel and between the 
toes. It is soft and spongy and has a sharp line of demarcation 
separating it from the surrounding skin. The center is white 
and crater-like. Occasionally it is covered with a layer of soft 
callous, resembling heloma molle. 
126. What is the diagnosis of verruca? Verruca can be recognized by 
the characteristic cauliflower-like appearance, but on the plantar 
surface, where this is lost, it is distinguished by the fact that it 
bleeds readily when cut and when the superficial callous has been 
removed, its limited extent is recognized. Verruca may be con- 
fused with epithelioma, a malignant tumor, but a careful history 
of the case, plus its appearance will make a diagnosis possible. 
127. What is the prognosis of verruca? Some verrucae disappear spon- 
taneously, but those which appear on the sole of the foot persist 138 
QUIZ COMPEND 
and are very painful unless treatment is given regularly and thor- 
oughly. 
128. What is the treatment of verruca? The treatment of verruca is 
varied. There are six approved methods of treatment: (1) po- 
tential cautery, (2) excision, (3) fulguration, (4) electrolysis, 
(5) direct cautery, (6) carbon dioxide pencil. 
129. Describe potential cautery. Potential cautery consists of the use 
of chemical agents which destroy the growth. Nitric acid, acetic 
acid, monochloracetic acid, trichloracetic acid, salicylic acid, silver 
nitrate, potassium hydroxide, sodium hydroxide, and pyrogallic 
acid are some of the agents used. The technic is much the same 
for all of the drugs with the exception of salicylic acid. The agent 
selected is applied every other day, the eschar or crust being re- 
moved before each application. When the entire growth has been 
destroyed, a suppurating area will be found beneath the eschar. 
This latter is treated by any healing stimulant. Salicylic acid is 
applied in a 60 per cent, ointment and allowed to remain for a 
week. Then the procedure is as above. 
130. Describe excision. Local anesthesia with novocaine, 1 per cent., 
is first induced, and then an incision is made half way around the 
lesion. This is called a semi-elliptical incision and is made into 
the derma and down to the adipose tissue. Another such incision 
is made on the other side of the growth, thus completing an 
ellipse. The entire structure between the two incisions is then 
dissected out and the resultant wound is closed by a few inter- 
rupted sutures which are removed within a week or ten days. 
131. Describe fulguration. Fulguration is an electric method in which 
the concentrated spark of a high-frequency coil is applied over 
the verruca until it is all white in color. The crust is removed in 
a few days, and the application of the spark continued until the 
lesion is destroyed. Fulguration with diathermic current is also 
used but this method is dangerous unless the apparatus is well 
understood and it further requires the injection of local anes- 
thetics. The spark from an Oudin coil is best for the former 
method of fulguration. 
132. Describe electrolysis. This too is an electric method and con- 
sists of the application of the negative pole of the galvanic current 
to a needle which is passed into the tissues under the growth. The 
positive pole is attached to an electrode at a point on the body 
near the seat of operation. The current is then turned on and 
soon hydrogen bubbles appear around the needle. When bubbling 
is well marked the current is turned off and the needle removed. 
If there has been sufficient electrolysis, the growth will dry up 
and fall off in a few days. 
133. Describe direct cautery. This method consists of the use of a very 
hot substance, preferably a piece of metal, which is applied to the 
growth, destroying it by actual contact with heat. Platinum 
cautery knives can be secured which can be heated by attachment PRACTICAL CHIROPODY 
139 
to a small electric coil and which are very efficient for this 
method. Some practitioners use glowing carbon for cautery. 
134. Describe the carbon dioxide pencil. This method causes destruc- 
tion of the part by freezing. Liquid carbon dioxide is permitted 
to escape into a glove-finger or other suitable receptacle where it 
solidifies. This solid mass, called a pencil, is then placed over 
the growth for a few minutes which completely devitalizes the 
area. In a few days the growth will slough off and the resultant 
ulcer is then treated by the use of antiseptic stimulants. These 
ulcers are often painful and can be relieved by the use of the 
compound parathesin ointment. 
135. Define calloused nail groove. A calloused nail groove is a condi- 
tion in which there is a thickening of the epidermis of the lateral 
nail groove with or without formation of helomata. 
136. What are the symptoms of calloused nail groove? The patient 
complains of pain on slightest pressure and in severe cases 
throbbing and heat are also manifested. The lateral nail fold is 
usually red and swollen and examination will reveal the thick- 
ened skin and helomata. The nail presses against the soft tissues 
but is not embedded therein. 
137. What is the etiology of calloused nail groove? The condition may 
be caused by irritation of the nail fold by the patient persisting in 
treating the edges of the nail with some instrument. The usual 
etiologic factor is a short or narrow shoe or stocking. The im- 
proper footgear causes the soft tissues of the nail fold to be forced 
against the lateral edge of the nail and the callous results as a 
protection to prevent the nail entering the tissues. The helomata 
are caused by localized pressure of a sharp corner of nail. 
138. What is the treatment of calloused nail groove? There are vari- 
ous methods of treatment for the relief or cure of this painful con- 
dition and are divided into: (a) surgical, (b) medical. 
139. Describe the surgical treatment of calloused nail groove. This 
method consists of removing the callous by means of a gouge, 
pointed scalpel, or curette. The skin may first be softened by 
the application of pledgets of cotton saturated with liquor potassae. 
The nail should only be cut when there is insufficient room to 
operate, and then only a small portion of the edge is removed. 
The surgical method of treating calloused nail groove is used with 
some success, but the amount of skill required to successfully do 
this is such that the use of local medical applications is preferred. 
140. Describe the medical treatment of calloused nail groove. There 
are two drugs that find great favor in the treatment of this con- 
dition and they are salicylic acid and liquor potassae (potassium 
hydroxide, 5 per cent.). The former drug is used in the ointment 
form, about 15 to 25 per cent., which is placed in the nail groove 
and covered by a cotton packing. This is permitted to remain for 
a week when the groove will be found to be white and soft and 140 
QUIZ COMPEND 
the callous easily removed with an excavator. Liquor potassae is 
used where the callous is general rather than where there are 
helomata. An applicator is saturated with the solution and is then 
rubbed over the calloused area until it is softened, when it may- 
be easily removed. Both these methods can be combined with the 
surgical treatment and it depends entirely on the judgment of the 
operator which is to be preferred. 
141. Define ingrown toe nail. Ingrown toe nail or onychocryptosis is a 
condition in which the lateral edge of the nail has penetrated 
through the epidermis of the nail groove and has become em- 
bedded in the adjacent soft tissues. 
142. What is the etiology of ingrown toe nail? The cause of ingrown 
toe nail is mostly injudicious cutting of the nail by the patient 
plus lateral pressure of the shoe against the nail fold. The ama- 
teur cutting of the lateral edge of the nail, produces sharp points 
or shoulders which readily cut into the skin of the nail groove 
when pressure is sufficient. 
143. What are the symptoms of ingrown toe nail? The lateral side of 
the toe is red and swollen and the patient suffers intense pain, 
especially when pressure is exerted against the soft tissues or 
downward on the nail plate. Proud flesh or superfluous granu- 
lations are seen protruding above the groove and pus exudes from 
the wound. 
144. What is the pathology of ingrown toe nail? The nail entering the 
tissues acts as a foreign body and thus causes the usual inflamma- 
tory reaction found wherever foreign bodies become lodged in the 
tissues. The usual terminus is suppuration and subsequent forma- 
tion of scar tissue. Granulation tissue forms in the attempt to heal 
the wound and the nail being interposed causes this structure to 
pile up in a mass which appears pink or red and is highly vascular. 
145. What is the prognosis of ingrown toe nail? The prognosis is 
favorable even with palliative operations, provided after-treatment 
is carried on for a sufficient length of time. When there has been 
repeated recurrences, and the tissues of the nail flap have become 
hardened by scar tissue, nothing but a radical operation will bring 
about a cure. 
146. What is the treatment of ingrown toe nail? The treatment of 
ingrown toe nail is divided into (a) non-operative, (b) non-radical 
operative, (c) radical operative. 
147. Describe the non-operative treatment of ingrown toe nail. This 
procedure is utilized only in incipient cases and consists of forc- 
ing the soft tissues back from the offending portion of nail and 
keeping them back by packing with sterile gauze. Some prac- 
titioners use this procedure in combination with astringents, espe- 
cially the iron salts. 
148. Describe the non-radical operative treatment for ingrown toe nail. 
Asepsis is practiced and then the portion of the nail that has PRACTICAL CHIROPODY 
141 
become embedded is removed with a chisel, the nail being cut from 
the distal end diagonally backward to the lateral free edge. It 
should not be cut straight back to the root of the nail. When the 
nail is removed, the groove is lightly packed with sterile gauze 
and the toe bandaged. Wet dressings of bichloride of mercury 
(1-5000) or of Burrow’s solution are applied for two days and 
if all drainage has ceased, the wound is dressed with an anti- 
septic stimulant, usually in ointment form. Proud flesh is de- 
stroyed by either snipping off with the scissors or by cautery with 
silver nitrate (50 per cent.). After the wound has healed the 
nail groove must be packed at regular intervals until the nail 
has grown completely out of the lateral fold. This part of the 
treatment is most important to prevent recurrence as it forces 
the soft tissues back to their normal position. Proper footgear 
must be worn and unless the patient is willing to change the 
style of shoe and stocking recurrence will follow. 
149. Describe the radical operative treatment of ingrown toe nail. 
This form of treatment should only be used when non-radical 
measures have failed. There are several operations all of which 
seek to eliminate either the offending soft tissues or destruction 
of a limited portion of the nail matrix under the ingrown nail. 
Whether one or the other procedures is used, the work must be 
thorough. If the nail flap is removed it must be done com- 
pletely and if the nail matrix is to be destroyed, it is better to 
dissect it away rather than to curette. Local anesthesia must be 
used in all radical operations for ingrown toe nail. 
150. What is onychia? Onychia, or onychitis, is an inflammation of the 
nail matrix with suppuration and final shedding of the nail. 
151. What is the etiology of onychia? Onychia is caused mostly by 
bacterial infection. It may also be caused by trauma causing in- 
jury to the nail and subsequent inflammation of the matrix. Im- 
proper and septic treatment of ingrown toe nail may also cause 
the condition. Syphilis, tuberculosis, and eczema are also etiologic 
factors. 
152. What is the pathology of onychia? Either bacteria or trauma 
causes the matrix of the nail to become inflamed and with it are 
all the pathologic changes that accompany inflammation. There 
is a gradual solution of continuity of the nail and its attachment 
at the matrix, and as suppuration continues, the tissues are de- 
stroyed and the mechanical union of the nail and the matrix is 
lost. The nail then falls off. If the entire matrix is destroyed 
during the suppuration, no nail will grow again, but usually there 
is a partial destruction of the matrix only, which results in mal- 
formation of the new nail. 
153. What are the symptoms of onychia? There is severe pain when 
pressure is exerted on the nail plate. The nail bed and grooves 
are involved and the inflammation may continue to such an extent 
as to destroy large areas of tissue. Pus forms at the root of the 142 
QUIZ COMPEND 
nail and the posterior portion of the nail plate becomes loosened 
from the bed. When the etiology is bacterial or traumatic, one 
or perhaps two toes may be involved. If the cause be systemic, 
all of the nails, including those of the hands are usually affected. 
154. What is the treatment for onychia? The pus must be drained 
and the nail must be removed in part or entirely to accomplish this. 
Wet dressings of bichloride of mercury (1-5000) are used and 
when drainage is complete the parts must be protected from fur- 
ther irritation either by the shoe or by the remaining nail. The 
soft tissues must be kept separated from the nail by packing with 
sterile gauze. Severe cases often require extensive surgical in- 
terference. 
155. Define paronychia. Paronychia, paronychitis, felon, panaris or 
whitlow is an inflammation of the tissues around the nail and may 
involve all of the structures of the distal phalanx including the 
bone. 
156. What is the etiology of paronychia? Paronychia is due to bac- 
terial infection from unclean instruments, or it may be of systemic 
origin. It often is associated with onychia in which the inflam- 
mation has spread. An ingrown toe nail may also terminate in 
paronychia. 
157. What is the pathology of paronychia? All of the signs of inflam- 
mation are present and pus usually is found in the posterior nail 
fold. Tissue destruction is rapid unless proper treatment be 
given and the bone is often involved producing ostitis or peri- 
ostitis. 
158. What are the symptoms of paronychia? Inflammation with its 
clinical signs is present to a greater or lesser degree and the pa- 
tient complains of throbbing pain which affects the entire toe. 
There is a red line which runs around the posterior nail fold and 
continues up the sides of the lateral grooves. 
159. What is the treatment of paronychia? The treatment of parony- 
chia is much the same as for onychia. The pus must be drained 
and incision is usually made through the posterior nail fold. Wet 
dressings are used until the drainage has ceased and the wound 
is then dressed with an antiseptic ointment. White precipitate is 
a valuable drug in this type of wound and should be used with 
or without parathesin depending on the degree of pain. 
160. Define onychauxis. Onychauxis or hypertrophy of the nail is an 
overgrowth or enlargement of the nail. When the nail becomes 
deformed or grotesque in shape the condition is called club nail 
or onychogryphosis. 
161. What is the etiology of onychauxis? The nail becomes enlarged 
as a result of enlargement of the papillae of the nail matrix. Pres- 
sure is often responsible and injury to the matrix will often ter- 
minate in club nail. Chronic skin diseases such as eczema, 
psoriasis, and diseases like syphilis, gout and rheumatism, and PRACTICAL CHIROPODY 
143 
nerve diseases or injury to the nerves will act as causes for ony- 
chauxis. 
162. What is the pathology of onychauxis? Pressure or injury causes 
a widening of the nail fold which permits the nail to grow thicker. 
The nail is irritated and a horny mass forms on the bed which, 
in turn, acts as a barrier to the normal forward movement of the 
nail cells. The papillae of the matrix become enlarged and may 
be seen protruding above the normal structure when the nail is 
removed. 
163. What is the treatment of onychauxis? The cause must be de- 
termined and if it is systemic, treatment must be directed against 
this by the physician. For onychauxis caused by local agents, 
treatment is either palliative or radical. The former consists of 
keeping the nails as near normal as possible by cutting and filing 
with the surgical drill. Radical measures are used on club nails 
that are extremely painful and in which palliative measures give 
no relief. The nail is removed and that portion of the matrix 
which is still vital is destroyed by dissecting it away or curreting. 
164. Define onychatrophia. Onychatrophia or atrophy of the nails is a 
condition in which the nails become smaller, streaked, and brittle 
and are often shed from the grooves. 
165. What is the etiology of onychatrophia? Atrophy of the nails may 
be caused by one of many factors among which are the inflam- 
matory skin diseases, nervous diseases, constitutional disorders, 
and injuries. Injury to the nail matrix causes complete or partial 
cutting off of nourishment. In wasting diseases such as tuber- 
culosis, nephritis, and diabetes mellitus, the matrix is usually 
under-nourished and the nails become soft and brittle. Chemical 
poisons such as arsenic, silver, and lead may cause atrophy of the 
nails. 
166. What is the pathology of atrophy of the nails? When the nourish- 
ment of the matrix has been interfered with, the cells do not de- 
velop as rapidly as normal and the nail becomes thin and 
streaked. The luster is lost and the nail becomes gray or yellow 
and often brittle. Infections at the matrix cause destruction of 
the matrix by solution, which, in turn, produce complete or 
partial loss of nail. White spots (leuconychia) seen under the 
nails are said to be caused by air under the nails. 
167. What is the treatment of onychatrophia? If the cause is sys- 
temic, local treatment is of little avail. Local treatment consists 
of protection and the use of stimulants to induce nail growth. 
Cocoon dressings under which pure balsam of Peru is used, is 
found of value. The nails must be properly cut and smoothed 
with the file. 
168. Define fissures. Fissures are cracks or clefts in the surface of the 
skin which may involve the epidermis and also the derma. 
169. What is the etiology of fissures? Fissures may be caused by 144 
QUIZ COMPEND 
trauma, but the usual causative factors are hyperidrosis, uric acid 
diatheses, and other systemic conditions. The skin between the 
toes becomes weakened and irritation due to drying the skin with 
a rough towel or the presence of a foreign body between the toes 
will cause it to crack. Fissures may also be produced in spread- 
ing the toes too far apart, and chiropodists in working between 
the toes are often responsible for this. 
170. What are the symptoms of fissures? The patient complains of a 
burning pain between the toes. The skin is red and there is a 
crack or fissure in the skin. This may be superficial or it may 
be deep. 
171. What is the treatment of fissured toe ivebs? Superficial fissures 
are treated by painting compound tincture of benzoin over the 
parts. Dusting powders such as thymol iodide, tannoform, etc., 
are also used. Deep fissures require more care, however, and 
silver nitrate is the drug that is most efficient. The strength solu- 
tion varies from 10 per cent, to as high as 50 per cent., depending 
upon the condition of the fissure. The lesion must be thoroughly 
cleansed before any medication is used. Tincture of iodine followed 
by silver nitrate has been used with success, the reaction of the 
drugs producing silver iodide which heals the fissure. If proud 
flesh is a complication, this should be snipped off or cauterized 
with a strong solution of silver nitrate. 
172. Define blister. A blister or bulla is a collection of fluid which 
causes an elevation of the outer layers of the epidermis, the base 
being formed by the rete. 
173. What is the etiology of blister? Trauma is the most common 
cause of blister and those met in chiropody are caused by fric- 
tion of ill-fitting shoes. Blisters may also occur in connection with 
certain skin lesions or in burns. 
174. What is the pathology of blisters? The pathology of traumatic 
lesions is simple. The friction causes a loosening of the layers of 
the epidermis and further, the irritation causes a serous exudation 
from the blood stream into the lower layers of the rete. The fluid 
collects and further loosens the upper layers of the epidermis. If 
the trauma is severe, occasionally a blood vessel will rupture and 
its contents will enter the epidermis, causing a “blood blister.” 
175. Where are blisters usually found on the foot? The most common 
site of blister is on the posterior portion of the heel over the 
tendo Achillis. Oxford ties are the style of shoe responsible for 
this lesion. Blisters are also found on the dorsum of the great 
toe over the tendon of the extensor longus hallucis. They are 
also occasionally found on the plantar surface, the ends of the 
toes, and between the toes. 
176. What is the treatment of blisters? Treatment depends greatly 
upon the condition of the lesion when the patient presents him- 
self for treatment. If the skin is intact, the blister should be PRACTICAL CHIROPODY 
145 
drained at the edges, and the superimposed skin allowed to re- 
main in place. The part is washed with alcohol, 60 per cent., and 
protected with a cocoon dressing or a gauze dressing, under which 
has been placed a soothing ointment, such as ichthyol, 10 per 
cent., or compound parathesin ointment. If the skin is broken 
there is grave danger of infection, and the wound must be treated 
accordingly. All precautions must be taken and a wet dressing 
of bichloride of mercury (1-5000) is used for one or two days. 
If there is no suppuration, the part may be dressed with a suit- 
able shield or gauze pad and stimulants such as ichthyol, 25 
per cent., or balsam of Peru ointment, 5 per cent, should be ap- 
plied. No shoe should be worn during the process of repair. 
177. Define a burn. A burn is an inflammatory lesion caused by heat 
or by caustics. They are classified according to their severity as 
first, second, and third degree burns. They may involve only the 
superficial layers of the skin or they may penetrate the deeper 
layers and may cause permanent injury or death. 
178. What are burns of the first degree? Burns of the first degree 
are those which involve the outer layers of the epidermis and 
manifest themselves by a tingling sensation, without loss of 
tissue. A mild sunburn is an example. 
179. What are burns of the second degree? Burns of the second de- 
gree are those which involve the layers of the epidermis including 
the rete. They are painful and cause the formation of blisters. 
180. What are burns of the third degree? Burns of the third degree 
are those which involve the deeper structures and cause slough- 
ing, severe shock, and even death. 
181. What is the treatment of burns of the second degree? The lesion 
is primarily aseptic and this should be maintained during treat- 
ment. Exclusion of air will help relieve pain and ointments are 
best suited for this. Carron oil (linseed oil and lime water, equal 
parts), is a valuable emergency dressing. Compound parathesin 
ointment will also keep the part aseptic and relieve pain. The 
patient must rest as much as possible until healing is well ad- 
vanced. 
182. What is the treatment of third degree burns? Treatment of this 
condition belongs to the practitioner of medicine, especially where 
large areas are involved and shock is present. The paraffin treat- 
ment is being used with success in addition to rest and im- 
mobilization. An important part in the treatment of severe burns 
is the prevention of deformities. The scar tissue that forms in 
burns causes contraction and this in turn often produces serious 
deformity. 
183. Define bursitis. Bursitis is an inflammation of the bursa sac. The 
bursae are closed sacs or pouches which are found in joints or 
where tendons move over bones. There are two kinds of bursae, 
the bursae mucosae, which secrete a mucous substance and the 146 
QUIZ COMPEND 
bursae synovia, which secrete a thin fluid called synovia. The 
latter type are found mostly in the foot. 
184. Where does bursitis usually occur in the foot? The most com- 
mon location is the great toe joint. The fifth toe joint is another 
common site as well as the under and posterior surface of the 
heel and the tarso-metatarsal region on the dorsum of the foot. 
185. How is bursitis classified? Bursitis is classified as acute, subacute, 
and chronic. 
186. Define acute bursitis. Acute bursitis is a condition in which the 
symptoms of inflammation are very active, the course short, and the 
synovial fluid has found an outlet and is being discharged on the 
surface. 
187. Define subacute bursitis. Subacute bursitis is a condition in 
which the inflammatory symptoms have not reached the stage of 
severity of acute bursitis, but which is more active than the chronic 
stage. 
188. Define chronic bursitis. Chronic bursitis is a condition in which 
the inflammation is of long standing and not active. The walls of 
the bursa sac have become thickened and there is no great amount 
of overproduction of synovia. This is the usual type seen on the 
great toe joint and is called “ bunion ” by the layman. 
189. What is the etiology of bursitis? The cause of bursitis on the 
foot is nearly always traumatic. A sudden blow, the foot being 
stepped on, or the pressure of a shoe, all may be exciting causes. 
Hallux valgus is a secondary cause in bursitis of the great toe 
joint. In calcaneal bursitis, focal infection is responsible for the 
lesion occasionally. 
190. What is the pathology of bursitis? The pathology of bursitis is 
that of inflammation. The trauma causes an increased blood sup- 
ply, serous infiltration occurs and the sac increases its function. 
The sac then becomes distended and when pressure from within is 
sufficient, the fluid seeks an outlet. Following the line of least 
resistance, a small sinus forms leading to the surface and thus the 
excess fluid is thrown off. 
191. What are the symptoms of bursitis? The objective symptoms are 
swelling, redness, and heat. There is loss of function and fluctua- 
tion is present. The patient complains of pain on slightest pres- 
sure and a feeling of fullness in the part. The area is swollen and 
the sac is so distended that it can be taken in the fingers and 
fluctuated. A callous often covers the top of the lesion and when 
. this is removed the sinus is seen from which will exude a thin, 
viscid, clear fluid, the synovia. This fluid is readily differentiated 
from pus, the application of hydrogen peroxide proving it easily. 
Pus will cause ebulition with this antiseptic while synovia will 
cause little if any. 
192. What is the treatment of bursitis? Treatment for bursitis is di- PRACTICAL CHIROPODY 
147 
vided into three classes: (a) radical operative, (6) non-radical 
operative, (c) palliative. 
193. Describe the radical operative treatment of bursitis. With proper 
asepsis and under local anesthesia, an incision is made through 
the skin above the lesion and the entire bursa is then dissected 
out. The wound is closed with a few interrupted sutures and 
the patient kept in bed with the foot elevated for a few days. 
If the bursa be infected, the incision must be made through the 
infected area, and drainage affected in the proper manner by 
means of wet dressings, etc. 
194. Describe the non-radical operative treatment of bursitis. If a call- 
osity or an heloma are present, they must be removed in the 
usual manner. This will often be sufficient to afford relief to the 
patient. Drainage of the bursal fluid will usually occur when this 
is done, but if not, the sac can be drained by means of an aspirat- 
ing needle inserted into it. 
195. Describe the palliative treatment of bursitis. This procedure is 
usually combined with the non-radical operative treatment. All 
measures that will help to give relief from pain should be utilized. 
Rest is an important factor especially in acute bursitis. Two or 
three days of complete rest will often do more than all other 
available measures. Shielding plays an important part in treat- 
ment as it relieves pressure from the affected area and shields 
must be applied with great care as the surrounding tissues are 
often swollen and allowance must be made for this. Water is a 
valuable remedial agent and can be used as either hot or cold 
compresses. Drugs find considerable use in the treatment of 
bursitis. They are usually applied in ointment form in the aper- 
ture of the shield. Stimulating drugs are used in chronic bur- 
sitis and soothing agents are best for acute bursitis. Astringent 
wet dressings are valuable in acute bursitis, Burow’s solution 
being the most popular agent used in chiropody practice. Lead 
and opium wash is valuable in those lesions which are extremely 
painful. In chronic cases, baking, massage, and electricity (dia- 
thermy and violet ray) are of value. 
196. Define chimatlon. Chimatlon, or pernio, is an inflammation of the 
skin and deeper structures due to exposure to varying degrees of 
cold and dampness. It is divided into two classes: (a) chimatlon 
mild and (6) chimatlon severe. 
197. Define chimatlon mild. Chimatlon mild, or chilblains, is an in- 
flammation of the skin due to exposure to cold and dampness. 
198. Define chimatlon severe. Chimatlon severe, or frostbite, is an in- 
flammation of the skin and deeper tissues due to exposure to se- 
vere cold for a prolonged period of time. 
199. What is the etiology of chimatlon mild? Chimatlon mild is due 
primarily to exposure to a mild degree of cold. This affects the 
vaso-motor nerves and the circulation of the blood to the skin 148 
QUIZ COMPEND 
is enhanced. The parts of the body most usually affected are the 
hands and feet. The distance of the extremities from the heart is 
probably the reason for this lack of nutrition under abnormal con- 
ditions. Further the skin of the feet is thicker than elsewhere 
and is imperfectly nourished, especially in cold weather when 
there is a natural slowing of the cutaneous blood stream in the 
attempt to conserve body heat. Females are more disposed to 
chilblains than males and young people more than old. 
200. What are the symptoms of chimatlon mild? The symptoms vary 
with the severity of the condition. The pain may be only a 
slight tingling or itch with a light scarlet color to the skin and 
the part feels cold and clammy to the touch. The usual type of 
case presents a dark blue or purple skin with severe itching and 
sharp shooting pains, especially at night when the patient has 
retired. Blebs may form which will discharge serum or even pus. 
201. What is the pathology of chimatlon mild? Immediately after ex- 
posure to cold, the small blood vessels are constricted and the 
blood stream is retarded within. Prolongation of the exposure 
causes a paralysis of the vaso-motor nerve terminals and the control 
over the blood vessels is lost and the muscular coat of the vessels 
becomes atrophied. Thus, the vessels remain in a state of inactivity 
and the movement of the blood within them is slow and sluggish. 
Destruction of tissue beyond this point will terminate in necrosis 
or gangrene and constitutes the pathology of chimatlon severe. 
202. What is the prognosis of chimatlon mild? The prognosis is un- 
certain. Mild cases often respond readily while others persist. 
The painful symptoms can be relieved, but the condition usually 
continues until the change of season. 
203. What is the treatment of chimatlon mild? If the patient is seen 
immediately after exposure, a gradual reaction should be brought 
about by the use of cold water or snow massaged over the affected 
part. After reaction has been established, treatment varies with 
the severity of the lesions. If the skin is unbroken, stimulants and 
anodynes should be used. If the skin is broken it should be 
healed with suitable agents, the best of which is ichthyol. The 
alternate foot bath should be used in all cases, and the patient 
instructed to wear such clothes that will tend to conserve body 
heat. Woolen underwear and stockings should be prescribed and 
broad-toe, low-heel, vici-kid shoes should be worn. Itching can 
be relieved by the use of camphor or phenol. If inflammation is 
so severe that the parts are greatly swollen and walking is pain- 
ful, wet dressings of Burow’s solution should be applied for two 
or three days. Coal oil, or kerosene oil, is very efficient for 
chilblains, especially when the skin is not broken. It must be 
applied with care to prevent blistering of the skin. 
204. What is the etiology of chimatlon severe? Chimatlon severe is 
caused only by prolonged exposure to extreme degrees of cold. 
The lowered temperature causes complete paralysis of the vaso- PRACTICAL CHIROPODY 
149 
motor nerves and the parts are deprived of all nourishment. They 
subsequently are devitalized. 
205. What are the symptoms of chimatlon severe? If seen immediately 
after exposure, the parts appear white, the patient complains of 
numbness and all sensation is lost. When the tissues thaw, they 
may be completely devitalized and gangrene will manifest itself 
immediately. If freezing is not complete, there will be a severe 
inflammatory reaction, and the parts will become purple, swollen, 
and extremely painful. Soon a line of demarcation will appear be- 
tween the living and the dead tissues which latter finally slough off. 
206. What is the pathology of chimatlon severe? The pathologic 
changes in chimatlon severe are much the same as in chimatlon 
mild during the initial stages. The exposure to extreme cold 
causes complete loss of blood supply over a limited area, which 
terminates in death of those tissues. Gangrene may be imme- 
diate or it may appear some time after reaction has commenced. 
207. What is the prognosis of chimatlon severe? If freezing has been 
complete, nothing can be done to save the tissues. If treatment 
is commenced immediately after exposure, much can be done and 
often large areas of tissue can be saved that otherwise would be- 
come gangrenous. The ulcers that result after the dead tissue 
has been removed require a long period of time to heal, and the 
patient complains of pains in the region of the lesion even for 
years after exposure. 
208. What is the treatment of chimatlon severe? The first step in 
treatment, even if the parts seem hopelessly frozen, is to bring 
about a gradual reaction with snow and cold water. Cases in 
which the entire fore-foot has been involved, were treated in this 
way, the primary treatment extending over several hours, with 
the result that only a small portion of two of the toes were lost. 
After a line of demarcation has developed, the gangrenous tissue 
should be removed. The resultant ulcer must receive careful at- 
tention with dressings changed at regular, frequent intervals. Oint- 
ments containing stimulants such as balsam of Peru, ichthyol, or 
scarlet red, with a mild antiseptic such as white precipitate, 2 
per cent., is the most practical therapeutic procedure. Massage, 
electro-therapy, and hydro-therapy are also valuable adjuncts. 
209. Define hyperidrosis. Hyperidrosis, or excessive sweating, is a 
functional disorder of the sweat glands characterized by excessive 
sweat excretion. The condition may be general or it may be 
localized. The hands and feet are most usually affected. 
210. What is the etiology of hyperidrosis? Generalized hyperidrosis is 
due to faulty innervation. Local hyperidrosis is caused by various 
factors. Excessive drinking of tea or water will cause it in some 
persons, and debilitating diseases will often cause local sweating 
which persists for some time after the disease is cured. Neuras- 
thenics often suffer from hyperidrosis of the feet. Physical or 150 
QUIZ COMPEND 
mental excitement is a cause in many persons. 
211. What is the pathology of hyperidrosis? The association of the 
nervous system with sweat excretion is close, and there is a nervous 
cause in pathologic sweating. Probably there is an injury or 
disease that affects the sympathetic nervous system which, in turn, 
causes excessive sweating. Microscopic examination of the glands 
fails to show any change in the structure of these organs. 
212. What are the symptoms of hyperidrosis? The feet are damp and 
clammy. Sweating is most profuse on the soles and between the 
toes. The skin is soggy and macerated and in severe cases the 
parts will become puffy and irritated and the surrounding area 
will be red. In ordinary hyperidrosis there is no offensive odor, 
but the condition is often associated with bromidrosis. 
213. What is the prognosis of hyperidrosis? Localized cases are ob- 
stinate, but persistent treatment will bring good results. Recur- 
rence is the rule, especially when the etiology is nervous in origin. 
214. What is the treatment of hyperidrosis? General treatment con- 
sists of general tonics and attempts to correct the systemic cause. 
Local treatment consists of the use of alternate foot baths and the 
application of astringents such as alum, tannic acid, or zinc sul- 
phate. Dusting powders containing salicylic acid, 2 per cent., 
with alum and lycopodium or talc are beneficial. If the skin is 
badly macerated, ointments containing astringents are advised. 
Hygiene of the foot must he carefully observed, and shoes and 
stockings should be changed twice daily. 
215. What is bromidrosis? Bromidrosis is a functional disorder of the 
sweat glands characterized by a sweat excretion of a foul odor. 
216. What is the etiology of bromidrosis? The etiology of bromidrosis 
is varied. Nervous and anemic persons are often affected, espe- 
cially when hyperidrosis is present. Certain foods such as garlic, 
onions, etc., often give peculiar odors to the perspiration. The 
characteristic odor of bromidrosis of the foot is caused by the 
decomposition of the fatty acids contained in the perspiration, in 
the presence of the bacterium fetidum, which is found on the 
foot, especially between the toes. 
217. What are the symptoms of bromidrosis? The sweat has a dis- 
agreeable odor and is usually associated with hyperidrosis, but not 
necessarily so. The odor is offensive, stale, penetrating, and pe- 
culiar, and in many instances makes the sufferer unfit for society. 
218. What is the treatment of bromidrosis? If the condition is asso- 
ciated with hyperidrosis, astringents must be used, but the offensive 
odor can only be eliminated by the use of deodorants and anti- 
septics. Absolute cleanliness is essential and the feet should be 
washed often. Footgear should be changed twice daily. Boric 
acid may be added to the water in which the feet are washed. 
Potassium permanganate, 1 per cent., applied as a lotion or a 5 
per cent, solution of chromic acid are valuable remedies. Formalin PRACTICAL CHIROPODY 
151 
is a powerful antiseptic and deodorant, but must be used with 
caution as its action is strong. It is usually applied in a 5 per 
cent, alcoholic solution as a lotion. 
219. Define anidrosis. Anidrosis is a functional disorder of the sweat 
glands characterized by a suppression of sweat. 
220. What is the etiology of anidrosis? Anidrosis is usually caused by 
some systemic disease such as diabetes and in some skin diseases 
like ichthyosis. Injury to the nerves is also an etiologic factor in 
localized suppression of sweat. 
221. What are the symptoms of anidrosis? The skin is very dry and on 
the sole of the foot clefts and fissures are often seen. Helomata 
miliare accompany anidrosis in many instances. In marked cases, 
urinalysis should be done as diabetes is very often responsible for 
the skin condition. 
222. What is the treatment of anidrosis? Application of hot water or 
vapor baths externally, the wearing of warm clothing, and general 
tonics is of help. Massage with oil and the uses of galvanic and 
Faradic electricity are also valuable adjuncts. 
223. Define ulcer. An ulcer is a lesion of the skin or mucous mem- 
brane which is attended with more or less suppuration and which 
shows no tendency to heal. A wound caused by trauma is not 
primarily an ulcer, but it may become so. 
224. Mention the ulcers seen on the foot. The types of ulcers found 
on the foot are simple ulcer, indolent or callous ulcer, varicose 
ulcer, perforating ulcer, and syphilitic ulcer. 
225. What are the causes of ulcers? There are both predisposing and 
exciting causes for ulcers. Constitutional diseases such as anemia, 
gout, diabetes, tuberculosis, etc., which lower the resistance of 
the body are predisposing causes. Traumatism and bacterial in- 
fection are the most frequent exciting causes. 
226. Describe simple ulcer of the foot. This type is the most fre- 
quently found ulcer and is usually associated with neglected call- 
osities and helomata, especially on the sole of the foot, under the 
heads of the first and fifth metatarsals. 
227. What is the treatment of simple ulcer? All overlying callous 
must be removed; if part is draining freely, wet dressings are to 
be applied. If drainage is mild, ointment dressings of stimulants 
such as scarlet red, balsam of Peru, or ichthyol are best. Shield- 
ing is important, especially in ulcers on the sole. 
228. Describe indolent or callous ulcer. This type is found on the leg 
and foot and is a chronic lesion, with hard elevated edges, few 
granulations, and is slow to heal. The size varies greatly and it is 
dirty yellow in color with the base firmly attached to the sur- 
rounding tissues. 
229. What is the treatment of indolent or callous ulcer? Treatment 
varies with the stage of the lesion. Wet dressings should be used 152 
QUIZ COMPEND 
in freely draining cases. Cleansing of the surface of the ulcer is 
important and is done with tincture green soap and water. Granu- 
lation is stimulated by the use of such agents as silver nitrate 
solution, balsam of Peru, 50 per cent, in castor oil, etc. 
230. Describe varicose ulcer. Varicose ulcer is associated with varicose 
veins. It is usually seen in the lower third of the leg and is char- 
acterized by the pigment which surrounds the lesion. The edges 
are everted and swollen, the swelling being edematous. The dis- 
charge is thin and often bloody. Granulations are weak and 
flabby. 
231. What is the treatment of varicose ulcer? The veins surrounding 
the ulcer must be supported by proper bandaging. Operation on 
the veins is often done. The standard stimulants are used in con- 
nection with bandaging for compression. 
232. Describe perforating ulcer of the foot. The ulcer is usually found 
where pressure is great and, therefore, the sole of the foot is the 
usual location. It occurs more in males than in females and 
usually between the ages of 40 and 60. The lesion is circular 
and the edges are calloused. There is no sensation in the part, 
evert when the lesion is deeply probed. 
233. What is the treatment of perforating ulcer? Systemic causes, if 
present, must be cared for. Necrotic tissue must be thoroughly 
removed and all burrowing sinuses must be opened wide. Power- 
ful antiseptics should not be used as they irritate. Stimulants are 
used, but treatment is of little avail as recurrence is the rule even 
after the lesion has been apparently completely healed. 
234'. Describe the syphilitic ulcer. This ulcer is associated with syphilis 
and is the result of breaking down of a tertiary lesion called a 
gumma. The upper third of the leg is the most frequent site. 
The appearance is characteristic. The edges are sharp and appear 
as if they were punched out. The slough is greenish and the 
floor of the ulcer is copper color. 
235. What is the treatment of syphilitic ulcer? General treatment di- 
rected against the disease will often be sufficient to heal the local 
lesion. The ulcer is dressed with mercurial ointments, of which 
white precipitate is most popular. Without general treatment, 
local applications are useless.