CHAPTER XX. +local Anesthesia+

+LOCAL ANESTHESIA+

+History.+ From Corning we learn that the ancient Assyrians alleviated and even entirely prevented the pain incident to circumcision by compressing the veins in the neck. Unconsciousness was probably induced in this way together with pressure on the carotids.

In India, centuries ago, the effects of opium and of Indian hemp were known and employed, and the ancient Egyptians were also conversant with the soporific effects of many drugs. We learn, from the same authority, much which he gathered from literature about the history of local anesthesia, and it is from Corning’s well-known book on local anesthesia that most of this history is quoted.

In Peru, the Spanish conquerors learned that the coca loaf was held in high esteem by the natives, inasmuch as they observed that it was chewed by the high priests and nobility only, the vulgar being denied this privilege except as a reward of great merit or of distinguished valor. The leaf was regarded with awe and superstition and was supposed to possess supernatural powers. After the fall of the Incas, the Spanish not only permitted but encouraged the general use of the leaf in order to obtain more work from the natives, a result which the drug seemed to effect. It was also a source of great revenue to them and was sold at exorbitant profit to the natives who became enslaved to its effects but were able to endure great hardship while under its influence.

Chemists throughout the world, recognizing the potent action of the coca leaf, were soon engaged in the effort of extracting its active principle.

In 1859, after many had tried and failed, cocaine was evolved from crude extractives. Authorities differ as to whether it was Mann or Neimann, a pupil of Woehler, who first presented cocaine to the chemical world; however, fifteen added years elapsed before practical use for it was found. In 1862, Professor Schraff discovered that the tip of the tongue was rendered numb, and insensible when a little of the cocaine alkaloid was applied to it and that it remained so for a considerable length of time. Significant though this experiment was, the action of cocaine on the nerve-filaments was not recognized and the matter was not followed up until Dr. Karl Koller, of Vienna, began his experiments which resulted in a universal awakening to the use of a substance which, though known, had been allowed to remain unnoticed for ages.

Its anesthetic effect upon the eye was demonstrated by Koller at the Opthalmologic Congress at Heidelberg in 1884. Dr. H. D. Noyes was first to direct the attention of the American practitioners to Koller’s results in the use of the drug. Its introduction was one of the greatest triumphs of modern surgery. It makes possible the discard of the systemic anesthetics in all minor surgical operations and also in many operations of considerable magnitude.

In the laboratory of Professor Stricker, Koller experimented on the eyes of a number of animals and thus reports his findings:

“A few drops of a watery solution of muriate of cocaine dropped on the cornea of a guinea pig, rabbit, or dog, or instilled into the conjunctival sac in the ordinary way, caused, for a short time, a winking of the eyelids, evidently in consequence of a slight irritation. After one-half to one minute the animal again opens its eyes which gradually assume a staring look. If now the cornea is touched with a pin head (in which experiment we have carefully avoided touching the eyelashes), the lids are not closed by reflex and the eyeball does not move, the head is not thrown back as usual, the animal remains perfectly quiet, and, on application of a stronger irritation we can convince ourselves of the complete anesthesia of the cornea. In this way I have scratched and transfixed the cornea of the animals used for experiment with needles, and have excited them with electric currents so strong as to cause pain in my fingers, and to become quite intolerable to the tongue. I have cauterized the cornea with the nitrate of silver stick until it became milky white; during all of this the animal did not move. The last experiment convinced me that the anesthesia involved the whole thickness of the cornea and did not affect the surface only. But if I incised the cornea, the animals manifested intense pain, when the aqueous humor escaped and the iris prolapsed. I have been unable hitherto to decide, by experiments on animals, whether or not the iris could be anesthetized by dropping the solution into the corneal wound, or by prolonged instillations into the conjunctival sac; for experiments to test the sensibility of non-narcotized animals are very complicated and difficult and do not yield unambiguous results. The last question which I subjected to experimentation on animals, viz., whether or not the inflamed cornea could be anesthetized by cocaine, was answered in the affirmative. The cornea in which I had incited a foreign-body-keratitis, became as insensible as a healthy one.

“Complete anesthesia of the cornea from the use of a two per cent. solution lasts ten minutes on an average. After such successful experiments on animals I did not hesitate to use cocaine also to the human eye, trying it first on myself and on some of my friends, and then on a great number of other persons, obtaining, without exception, the result of a perfect anesthesia of the cornea and conjunctiva.”

Soon after Dr. Koller’s report appeared, cocaine was used for a great many operations upon the eye, and its application to mucous membranes in general was soon taken up by practitioners everywhere.

Rectal, vaginal, otologic, rhinologic, oral and urethral anesthesia were soon found to be easy of accomplishment and many operations in these fields were performed under cocainization. The hypodermic injection of cocaine was experimented with and reported upon in 1884 by Drs. N. J. Hepburn, R. J. Hall, and Halsted.

+PHYSIOLOGIC EFFECTS+

+Nerve Pressure; Anemia.+ That motor and sensory paralysis followed pressure upon a nerve has been well known for many years, and this has been utilized in the effort to produce anesthesia, artifically by applying a rubber tube or bandage around a finger or extremity, with the hope that “ligation anesthesia” would follow the arrest of circulation. This, however, has been unsuccessful as all that was thus accomplished was a slight sensation of numbness with no arrest of the sense of pain. This method could only be successfully carried out, were the nerves themselves subjected to sufficient pressure to injure them. Return to normal sensibility and motor function could not be expected for months.

+Cold.+ The addition of common salt to ice hastens its liquefaction and consequently renders the mixture more cold. This knowledge has been applied in a method of producing anesthesia of limited areas of the skin. A gauze bag of the correct shape and size is filled with salt and ice mixed, and applied to the area to be anesthetized.

This method was used as far back as 1848, by Arnott, but was soon improved upon by Richet and others who used ether or rhigolene sprayed on the part to be anesthetized. It was found that extremely low temperatures could be obtained in this way, especially if a current of air were blown across the field of operation to hasten evaporation, and that a good local insensibility could be brought about if the circulation of warm blood could be either stopped or retarded with an Esmarch bandage or tourniquet. The method of obtaining local anesthesia through the agency of cold was found to be best accomplished by ethyl chloride and this substance is used in preference to any of the others previously mentioned, at the present time. Some years ago Dr. Martin W. Ware of New York experimented with both ethyl chloride and ethyl bromide and he found that the former was more serviceable in producing local anesthesia.

+The Sensibility of Various Tissues.+ Karl G. Lennander, of Upsala, Sweden, shortly before his death, completed a chapter on local anesthesia for Keen’s “Surgery” in which is set forth an elaborate account of the sensibility to heat, cold, pressure, and pain of the various nerve terminals throughout the body. In this great work he has given the world the results of many experiments on living tissues, experiments investigating the degree and kind of the tissues sensibilities; thus it is learned that “all internal organs receiving their nerve supply only from the sympathethic nerve and from the vagus, below the branching-off of the recurrent nerve, have no sensation, and that the abdominal and pelvic viscera are devoid of nerves to convey the sense of pain, heat, cold, or pressure.”

From the same authority we are taught that the parietal peritoneum is highly sensitive but that the visceral covering is devoid of all sensibility, enabling the operator much freedom of manipulation within the abdominal cavity.

In a work of this limited size the sensibility of the various tissues cannot be fully treated but it should be borne in mind that the integument and the subcutaneous tissue, fat and muscles as well as the tendons, their sheaths, the muscles and periosteum and perichondrium covering the bones and cartilages throughout the body, are all highly sensitive to pain. It is also equally true that the bone substance, the bone marrow, and the cartilages are devoid of any of the four modalities of sensation. Articular surfaces covered with cartilage have no sensation, neither have the fibrocartilages any sensation.

+GENERAL CONSIDERATIONS+

+Effect of General Anesthesia.+ Local or regional anesthesia is obviously the method of choice in all cases in which it is applicable. Not only is it desirable in the minor surgical operations and the more important ones upon patients suffering with a cardiac or nephritic derangement, where a general anesthetic is positively contraindicated, but in every instance where it is at all possible, the dangers and annoyances of general anesthesia should be avoided, and the regional or local anesthesia should be employed.

Among the advantages, aside from the number of assistants required and the discomfort immediately following the administration of a general anesthesia, are the absence of remote ill effects of the invasion throughout the entire system of a noxious chemical substance and its direct deleterious effects on many large organs such as the lungs, heart, kidneys, and liver, and the assurance, when a proper drug, dosage, and technic are employed, that death cannot be ascribed to the anesthetic.

Of remote ills of general anesthesia no estimate can be made, but that they are legion and of great severity is established. Deaths from general anesthetics in persons apparently able to bear them well, are extremely numerous. It has been estimated that one in fifteen thousand succumbs from ether anesthesia and this number would probably swell greatly were it possible to obtain the exact figures. Even this minimum of danger does not exist in local anesthesia.

An accurate knowledge of the neural anatomy of a particular region enables the operator to anesthetize large areas and to operate with entire freedom from the necessity of observing the appearance and conduct of his patients, many of whom, notably the alcoholic ones, behave badly, become cyanotic and breathe intermittently when under the effects of inhalation anesthetics. The absorption into the body of the substances employed by inhalation may also exert a baneful influence by reducing the powers of resistance upon an economy already lowered by disease, and also by retarding convalescence.

+Advantages of Local Anesthesia.+ In minor or trivial affairs the elimination of pain is not to be considered lightly, for every patient, even the strongest, will appreciate anything which will expedite a cure and at the same time will relieve him of suffering. Rather than lose time from their work or suffer the nausea and dangers of general anesthesia, these patients often bear for years conditions which could easily be cured by operations under local anesthesia. In this class one must first think of hemorrhoids; of cysts; of fatty tumors; of foreign bodies in the hands and feet; of verruca and of ingrown nails. These conditions would be promptly relieved were the element of pain in surgical interference not to enter as a factor.

With a perfect technic, local anesthesia can also be employed with entire satisfaction for certain major operations, where the subject is suitable. Thus, herniotomies are performed with entire success, especially those cases complicated by strangulation in which the dangers arising from fecal vomiting and inspiration pneumonia, are greatly decreased by omitting the general anesthesia.

In many of the more severe conditions not to be classified as minor surgery, the surgeon may consider the comfort of the patient and his own convenience and employ local in preference to general anesthesia, even tho the patients may be of the most robust type.

In this group may be mentioned benign tumors at any visible part of the body, hernias, many scrotal and anal diseases and some conditions peculiar to the extremities, such as varicose veins. These conditions lend themselves kindly to local insensitization.

In certain emergencies where an operation must be performed immediately, such as tracheotomy, thoracentesis and strangulated hernia, local insensibility is imperative. In these operations local anesthesia is also more desirable because of the ill effects of vomiting, which are thus eliminated.

Weakness of the patient enters also as a demand for the exhibition of a local anesthesia in such operations as resection of a rib for empyema, in which instance the action of the heart or lungs is embarrassed. Other operations performed under local anesthesia for the same reason (weakness of the patient) are the exploratory operation for a probable inoperable cancer and the palliative operations such as gastrostomy, enterostomy and colostomy.

+SOME VALID OBJECTIONS TO THE USE OF LOCAL ANESTHESIA+

There are, however, valid objections to the general application of local anesthesia and the cases for its use should be selected with care. It does not produce relaxation nor does it give the surgeon perfect control over his patient. These are considerations which must be taken into account, especially in operating on patients of highly nervous temperaments. Though the patient may be convinced that he will suffer no pain, the mental attitude toward the local anesthesia, together with fear, may operate so strongly as to constitute a shock to the nervous system so great that a general anesthetic should be used and the local method abandoned, even were it apparently indicated.

Again, the injection of anesthetic drugs in cicatrical and inflamed tissues is quite difficult of accomplishment and because of the peculiarity of these tissues, diffusion throughout a given area is imperfect, hence insensibility is not complete.

The extravagant claims of enthusiastic advocates of this method of anesthesia have retarded its progress. Thus, in the hands of the competent operator it was given but a perfunctory trial to be discarded as impossible. At the present time, however, local anesthesia bids fair to become the method of choice, other things being equal, for many major operations not yet thus performed. Recent investigations alone these lines have developed methods of its application whereby it is possible to render insensible large areas of the integument, and regional anesthesia is performed by anesthetizing nerves proximal to the seat of operation, thus rendering amputations feasible.

A single element which has entered as a factor in retarding the progress of local anesthesia in general surgery, is that of regarding the operation as one fitted to the method rather than to the patient under consideration. It is obvious that this is a fallacy and the main issue in deciding between general and local anesthesia is: what will the patient best tolerate? In coming to a decision in the matter one should make a general survey and weigh first the general health of the patient; whether he be in perfect systemic condition or undermined by disease, whether the shock will be greater from one method than the other, and whether the part of the body to be operated on is one which will lend itself better to one method than to the other.

These elements are being and will continue to be considered as preliminary to operative procedure and in consequence, general anesthesia will cease to be given in a routine way.

+GENERAL PRINCIPLES AND ESSENTIALS+

The first essential to the successful production of local anesthesia is a proper equipment and one that is in good working order. Not only is it necessary to employ the best drug to this end but also to use a syringe having perfect mechanical construction and one not injured by boiling; as also needles of the length, lumen and shape suitable for the surface to be injected.

The old leather pocket syringes, on account of their not bearing water at high temperature without deterioration, should not be employed; this applies also to that variety of glass barreled metal-mounted syringe in which the glass is screwed into the metal end pieces.

The best syringes are those made of all metal or of all glass, the latter being preferred because one may see the contents and express out the air before injecting. Syringes of this type, because of the accurate fitting piston, must be thoroughly dried out after use, as the piston may stick fast within the barrel. All-glass or all-metal syringes must be selected with care as they are often imperfect, the calibre of the barrel being unequal in different parts of its length causing the piston to fit tightly in some parts, and thus to work with difficulty; and in other parts fitting loosely, allowing the fluid to escape backwards.

Syringes are also made in various sizes and shapes to meet certain requirements. For the edematization of large areas of loose tissue, where a considerable amount of a weak solution is intended, the use of a large barreled syringe will be found to save time and the annoyance of refilling.

For such work a five or ten c.c. syringe would be the most useful. The ordinary hypodermic syringe is about of two c.c. capacity (thirty drops), and serves the purposes of every-day work. It does very well for the amount of an anesthetic solution employed in opening an abscess or in the removal of a small cyst or lipoma or papilloma.

A barrel, large in diameter, requires more pressure on the piston in its operation unless the needle employed is also correspondingly large. For this reason, if the tissue in which the solution is to be injected is not loose or cellular, it will be found better to use a syringe in which the barrel is long and narrow. Such is the shape of the syringe intended for the injection of the gums, the peridental membrane, and also for the periosteum, cartilage or bony cellular structure. A long instrument is also required for use in the large cavities of the body such as the mouth, the vagina, or the rectum. In these localities, an extension fitting is often required to lengthen the instrument sufficiently to reach the desired part. It is also possible to attain this end by using a long needle; this, however, sacrifices rigidity.

For accomplishing the best results, the needles must also be selected for the work at hand. For the initial puncture in sensitive or inflamed tissue, it is proper to use a needle of the finest lumen so as to cause the least possible amount of pain. The ordinary needle, which comes with the usual hypodermic outfit, is about the proper length for the ordinary work already mentioned, but could be improved upon for anesthesia by being made a little finer in calibre. This length (three-quarters of an inch) will be frequently found insufficient to reach the deeper tissues and in the removal of a more or less rounded growth, a longer needle must be selected at the start. Curved or angular ones are only needed in dentistry, where strength is also a consideration. Strength is afforded in those of short length by means of a reinforcement at the hub. Needles so augmented may also be of use in operations upon bone or dense structures in general; the curve, however, is not essential.

The surgeon should be fully conversant with the details of the operation which he is about to perform. His work should be definitely in his mind, for in operations under local anesthesia, there is no justification for a change of procedure after the beginning of the work. Account should be taken of the nature of the tissues to be anesthetized, for it is known that cicatricial tissues and inflammatory areas do not lend themselves to the action of these drugs. In a cicatrix, the diffusibility of the solution is impeded, and in an inflammatory or necrotic tissue, the changes in the quantity and quality of the fluids present, alter the action of the anesthetic.

In considering the personal element of the patient one meets a difficulty which is by no means minor, and full explanation for the selection of the local anesthetic with many assurances of the painlessness of the operation are frequently necessary. This is especially true with one of highly emotional temperament, and, to allay fear in such a patient is not always easy.

Whatever may be said regarding the mental state of the patient who is to receive an anesthetic, whether general or local, the surgeon must remember that to be calm does not always lie within the control of his subject, and it will be found that a hypodermic injection of morphine (gr. one-eighth to one-quarter) an hour before the start of the anesthetic, will often render possible the use of the injection method in a patient with whom it would otherwise have been impossible. Morphine injections, as suggested, are of advantage in patients on whom a major operation is contemplated; they loosen the musculature and diminish the sensations of parts not anesthetized.

The deliberate and confident manner and word of the surgeon go a long way in guiding the feelings of his patient, and a worried or apprehensive surgeon makes for a doubtful and sensitive patient, ready to cry out at the first prick of the needle. Therefore it is a part of good general technic for the surgeon to deport himself in a way conducive to cheerfulness, and conversation must be guided along these lines.

There are many who will writhe and groan at sensations (which they will admit later were not painful) incident to local anesthesia, such as the grating vibrations of instrumentation. Such a patient is not well fitted for the method and it is for the discerning surgeon to recognize such in advance, that he may operate under the most favorable circumstances.

+Preparation of the Patient.+ Proper evacuation of the bowels and a stomach free of undigested parts of a previous meal, are desirable. The subject of an anesthetic should not be purged or starved as these are weakening processes and also disturb the tranquility so essential to a perfect anesthesia. The skin should be prepared so as to accomplish surgical cleanliness without irritating it so as to retard healing. It was once thought that soap, water, alcohol, ether and bichloride were absolutely necessary to this end. It has, however, been found that iodin, applied in the ten per cent. tincture to the site of incision, fulfills every requirement. Where shaving is necessary, it should be done first. In operations about the anus and scrotum, iodin is contraindicated because of its irritating properties; it is painful in these parts and dermatitis is frequently the result of its use.

+Instruments.+ The instruments should be prepared and ready before the anesthetic is given, regardless of the form of anesthesia employed. The surgeon’s hands should be rendered aseptic, no matter how trivial the procedure before him, and every precaution should be taken to guard against infection, which is always possible in any surgical procedure however insignificant.

+Technic.+ Various methods of accomplishing the insensitization of a part may be employed. Thus, if the skin alone is to be incised, it alone will require injection and by careful insertion of the end of the needle it may be kept just under the epidermis, thus injecting the anesthetic endermatically in and about the papillae of the papillary layer.

+Endermic Method.+ This method is an end-organ anesthesia, and the solutions employed are strong and act because of their drug content. It is not in any sense a pressure anesthesia. The skin should be picked up and pinched hard for the better insertion of the needle directly into the skin substance. It is therefore endermic and the skin is seen to become blanched as the needle advances delivering its solution on the way. But little of the fluid is pressed out as the needle advances. When the syringe is empty or the needle has advanced to the limit of its length, refill and insert just inside of the last blanched spot and proceed in a line until the end of the contemplated line of incision is reached.

Pressing out too much of the solution at one time causes a burning sensation and should therefore be avoided as the only pain should be that of the initial prick of the needle. Care, however, should be taken to inject just sufficient of the solution to penetrate beyond the zone of operation laterally, to insure sufficient space for the insertion of sutures into anesthetized tissues. Only a small quantity of fluid is necessary in this procedure as it comes in direct contact with nerve terminals. By touching the injected line with the needle in several places along its length and inquiring of the patient if it is felt, we may make sure of the completeness of the anesthesia before making the incision which should begin and end inside the anesthetized area.

+Subdermic Method.+ An appreciable area of skin and subcutaneous tissue may be incised by anesthetizing as previously described, together with depositing the fluid well under the skin, thus affecting many terminal nerve branches before they reach their final distribution in the skin, and widening the anesthetized area considerably.

This method is applicable to such work as the removal of small growths, and the deep incision of a carbuncle. Beneath the skin in the loose connective tissue the fluid is deposited and causes anesthesia by acting upon the nerves just before their emergence into the skin. The two methods may be combined. It is not possible to inject directly into thin skin or mucous membrane and it is therefore employed in such operations as circumcision, where the nerve terminals must be anesthetized by the diffusion of the anesthetic from its position under the skin. A little time should be allowed before beginning the operation to permit of the diffusion of the drug. This applies also to such operations as that for ingrown toe-nail where the deeper tissues down to the root of the matrix are involved.

+Edemitization Method.+ This is the method of Schleich and it is to him that the credit must be given for a procedure which has done more to encourage the use of local anesthetics in operative surgery than any other. He employed weak solutions of cocaine and other local anesthetics in great volumes of water in order to gain the combined action of both drug and of pressure. The method is described under the heading of “Cocaine.” It was designed to obtain anesthesia with cocaine with the elimination of the toxic effects of the latter.

There are decided disadvantages to the filling up of the tissues with fluid; healing is delayed; relations are distorted and coaptation of the edges is difficult. This is probably the method of selection where an indefinite amount of manipulation is expected and where the length and depth of the incision may need to be augmented. A large quantity of a very weak solution is employed and the tissues in all directions are injected until visibly distended.

+Nerve Blocking Method.+ By injecting a small quantity of a fairly strong anesthetic solution either directly into a nerve or beneath its sheath, the entire area supplied by it will be anesthetized. This method of nerve blocking may be spoken of as endoneural when the injection is made directly into the nerve trunk, and perineural when made into its sheath or immediately outside of the nerve. The injection of fluid around nerves too small to inject directly is also spoken of as perineural nerve blocking. (Hertzler).

+DRUGS EMPLOYED+

The essential qualities of a good local anesthetic are:

1. Reliability in producing anesthesia. 2. Constitutional and local harmlessness. 3. Non-irritating qualities. 4. Ability to be rendered aseptic by boiling.

No one local anesthetic can be exclusively relied upon to fulfill all of these requirements at all times. Each one has its advocates and from the large number offered, it is possible to select several which, while not being perfect, are preferable to cocaine in that they obviate the disagreeable train of symptoms peculiar to that drug.

By local anesthetics are understood certain chemical compounds, weak solutions of which, when brought in contact with sensory nerves paralyze them without lastingly injuring them. This effect is dependent upon the presence in these agents of certain atom groups which Ehrlich named anesthiferous. It is possible that just these atom groups enter into certain chemical combinations with the nerve substance and that the nerve thus remains paralyzed until the newly formed compounds are split up and the poison is washed away by the circulating blood.

Cocaine is the original type of a local anesthetic. Einhorn has made possible its synthetic production and has also opened the field for a great number of experiments of scientific and practical importance leading to the discovery of new local anesthetics obtained by exchanging the non-anesthiferous atom groups of cocaine for other groups different for each of the various new agents; thus eucaine, orthoform, anesthesine, alypin, and others have been obtained.

+Cocaine+ occurs as a white, crystalline powder, readily soluble in water and in alcohol. It is an alkaloid which effects all living protoplasm. It first excites, then paralyzes. In greater concentrations it paralyzes immediately. Its effect is very ephemeral, producing no lasting harm to the cocainized protoplasm. Its effect is most readily understood by assuming that cocaine poisons the protoplasm by entering with it into combinations which are easily broken up. The products of decomposition, among which cocaine cannot be recovered, are slightly or not at all poisonous and are carried away by the circulation.

+Effect on the Mucous Membrane.+ The external application of cocaine in solutions of varying strengths has been of great service since its introduction by Roller in 1884, and many operations on the eye and on its coverings are now greatly facilitated, by reason of its use. Small quantities only are required, hence there is little fear of its toxicity. Its anesthetic qualities by contact are also made use of in operations in and about the nose and throat. Here comparatively mild solutions are used liberally but care must be exercised against its noxious effects; it is usually employed in freshly prepared solutions which are held to be less toxic. Where extensive areas of mucous membranes are to be anesthetized, as in the rectum or urethra or bladder, one of the less toxic drugs is preferable.

+Strength of Solutions.+ In the eye, it is customary to employ a 4 per cent. solution. For work in the nose, 2 per cent. is generally considered sufficient. In the latter connection, it is often combined with adrenalin solution in small amounts to mitigate its depressing effects as well as to control bleeding. The latter effect is but transient and is omitted by many as unsatisfactory because of the more profuse subsequent hemorrhage. In this respect cocaine and adrenalin are similar. They both cause constriction of the minute superficial vessels and immediate blanching of the membrane; work in the nose is hence greatly facilitated, the field of operation being clear and enlarged by the shrinkage of the encroaching membrane, but it is incumbent upon the operator to keep his patient under observation at least an hour after the completion of the operation that he may be certain of the degree of hemorrhage after the effects of the drugs have passed away. For the above reason many operators prefer a general anesthetic or one of the local anesthetic drugs which exert no constrictor action so that they may know, ab initio, the exact degree of bleeding.

Whatever drug is used, strong solutions are seldom necessary for application to the mucous membranes but the necessary time for its absorption is a prime requisite. To secure anesthesia of the conjunctiva and cornea, the solution is dropped into the eye at the outer canthus and as it flows off with the tears, it must be replenished three or four times until anesthesia is accomplished. In the nose, a spray over the site of incision or a pledget of cotton saturated with the anesthetic solution and allowed to rest in contact with that locality, will suffice. The flow of mucus from the nasal mucosa is stimulated by the presence of the cotton pledget and it soon becomes entirely coated with a thick mucus which no longer is able to impart to the membrane its anesthetic solution and must therefore be renewed several times before complete insensibility of the part is assured. The topical application of a strong solution on a cotton wound applicator to a limited area or spot is also efficient.

+Application by Injection.+ In order to bring the anesthetic in contact with the nerves, it is necessary, where a skin surface is to be incised, to inject the solution as already described. The technic, previously detailed, applies here, and any of the methods may be employed for the injection of solutions of cocaine, some preferring a single method to the exclusion of all others. The locality to be treated will also influence the operator as to method.

+Endermically.+ The endermic method is the one most generally employed in securing cocaine local anesthesia by injection. The papillary layer of the skin is well infiltrated with a mild solution (one-eighth per cent. to one-half per cent.), frequently with adrenalin 1-1000, in the proportion of 15 to 20 drops to the ounce of the solution. The strongest of the formulas of Schleich may also be used for endermic infiltration.

The skin is injected to a fair degree of tension and a white ridge marks the line of injection which should be sufficiently extensive to permit the manipulation of the cut edges.

+Edemitization.+ Schleich’s solutions are here of extreme value because large amounts of solution are necessary to produce the degree of distention required because of the minute quantity of cocaine present, though the added salt and morphine assist considerably.

+Nerve Blocking and Perineural Blocking.+ Here a stronger solution must be employed; 1 per cent., or even stronger, is injected in small quantities, either into the substance of the nerve or under its sheath, as already described.

+Strength of Solution.+ Schleich has worked out a method whereby very weak solutions of cocaine may be used advantageously. His plan is to enhance the action of the drug by the admixture of morphine in minute quantities and of sodium chloride in proper strength. These substances, in themselves, were found to possess anesthetic powers. Large quantities of Schleich’s solutions may be injected—even several ounces, without ill effects as they contain so little cocaine. The formulas used by him are:

1. Cocaine hydrochlorate 0.2 Morphine hydrochlorate 0.02 Sodium chloride 0.2 Distilled water 100.

2. Cocaine hydrochlorate 0.1 Morphine 0.02 Sodium chloride 0.2 Distilled water 100.

3. Cocaine hydrochlorate 0.01 Morphine 0.005 Sodium chloride 0.02 Distilled water 100.

It will be seen that the strength of cocaine in the respective solutions is from one-fifth to one-hundredth of a gram.

The solutions used in the early days of cocaine anesthesia were much stronger than were found necessary afterward and it has now become the rule to employ weak solutions and to give them time to penetrate the tissues. The less toxic action of mild solutions, even when like amounts of the drug are employed, makes it incumbent upon the operator to follow this plan and the element of time is so important in the matter of securing a perfect local anesthesia that it is customary to wait fifteen or twenty minutes after the completion of the injection before making the incision. The weakest solution possible is the one of choice in the use of this anesthesia.

+Toxicology.+ The repeated use of cocaine in the same patient should be avoided on account of the danger of establishing the cocaine habit. The drug should be given with the greatest care, especially in operations about the head, neck, face, and urethra, as several deaths and many alarming cases of syncope, delirium and paralysis or tetanic fixation of the respiratory muscles have followed its use. Because of its marked depressing effect upon vital organs, it should never be given unless the patient is in the recumbent position. The administration of one drop of a one per cent. solution of trinitrin given at the first onset of the constitutional effects and repeated if necessary every five minutes, will entirely prevent any unpleasant effects as it is a true physiologic antidote.

If the surgeon has a case in which he intends to use large amounts of cocaine, it is best to have at hand and ready for use the following agents: a hypodermic and a rectal syringe, a battery, cardiac and respiratory stimulants, oxygen, and a catheter.

If the patient becomes very delirious and is in no way depressed, chloral or hyoscine should be given. In all cases of cocaine poisoning the patient should be catheterized to prevent re-absorption and should then be treated symptomatically.

Strong solutions should never be employed for any purpose except in cases where, by previous experience with the mild ones, it is known that no idiosyncrasy exists.

The central nervous system, and next the sensory and motor nerves, are affected by cocaine. Respiratory paralysis follows the introduction of appreciable amounts of cocaine into the circulation and respiratory depression may follow the introduction of smaller quantities. A given quantity of the drug in great dilution will, under normal conditions, give no toxic symptoms, whereas the use of the same amount in a more concentrated form will give rise to pallor, cyanosis and even syncope and collapse. It is said that a maximum dose of cocaine can never be fixed; this, however, seems of less importance than knowing the minimum dose, for while it is true that many bear it well, this drug so frequently gives rise to toxic symptoms, and the idiosyncrasy for it is so common, that one can never be certain of an exact dosage. Various pharmacopias place the maximum dose at 0.05 grm. (about seven-eights of a grain).

Bearing in mind that a great dilution of a given amount makes for safety, we are astonished to learn that 7 c. c. (about 2 drams), of a 1 per cent. solution introduced into the urethra has caused death. (Czerny).

Hertzler cites numerous instances in which a few drops of a more concentrated solution (2 per cent. to 4 per cent.) have caused death. It is therefore obvious that the use of this drug must be guarded by a technic so perfect that but the smallest quantity of a very weak solution shall be permitted to enter the circulation.

+Adjuvants, Substitutes and Safeguards.+ The numerous disadvantages in the general use of this most efficient but most treacherous local anesthetic have operated so strongly that efforts have constantly been made to find a substance which, when used with it, would correct its toxic effects.

The desirability of employing large quantities of an anesthetic solution so as to enable the operator to infiltrate large areas of tissue has led to the method of preparing very dilute solutions and mixing them with various chemical substances which in themselves would act as mild anesthetics and at the same time increase the diffusibility of the cocaine. With any of these substances, cocaine still remains toxic and the quantity injected must be kept account of when an operation of any extent is being performed even though the solution be never so mild.

A valuable preventive to this absorption is found in the application of a constricting band or tourniquet to impede the return circulation and allow the washing out of much of the drug before the obstruction is removed. It is evident that no method has yet been devised whereby the use of cocaine is rendered safe and it is for this reason that chemists throughout the world have sought to produce either a new anesthetic drug or to evolve a drug synthetically, from cocaine, minus its toxicity. This has been done, but cocaine still has its adherents because of its superior qualities.

Quinine and urea hydrochloride is one of the new substitutes which has found much favor. Among the synthetic derivatives may be mentioned alypin, novocaine, stovaine, betaeucaine, tropacocaine, anesthesin, subcutin and many others. Each of these has its advocates and all of them have some advantage over cocaine; they have disadvantages as well, which, however, in the hands of skilled operators, may be overcome.

+Quinine and Urea Hydrochloride.+ Among the quinine salts and combinations, the above has found most favor. It consists of a molecule of quinine hydrochloride and one of urea. It occurs as a fine crystalline powder and is readily soluble in water, forming an acid solution.

This substance is one of the most recent and best substitutes for cocaine, being capable of a wide range of usefulness and practically devoid of any toxicity. It causes redness on being injected and, in strong solutions, may delay healing considerably, this constituting the main disadvantage to its use. After the use of this anesthetic, primary union is not usual.

In a one per cent. solution, anesthesia is accomplished by any of the methods already described. Weaker solutions require a more perfect technic, and are therefore not generally employed. They, however, are indicated where it is imperative to secure primary union and when for some reason no other local anesthetic is available. The scar formation which almost always follows the use of this anesthetic would indicate that some other drug be employed in operations about the face and neck. This anesthetic is preferred by many because of its safety in large quantities and because of the length of insensibility following the injection of solutions of from 1 per cent. to 2 per cent. strength.

Notwithstanding knowledge of the facts above enumerated as to the difficulty of primary union and the likelihood of scar formation in connection with the use of urea and urea-hydrochloride for purposes of local anesthesia, this drug is still considered a most valuable and useful one for providing local anesthesia for operative purposes.

+Novocaine.+ This drug is one-seventh as toxic as cocaine but is also weaker in action. It does not cause vascular constriction but has a preliminary vasodilator action. Like quinine, it has a decidedly irritating action when injected. It has a decidedly toxic effect when used in stronger solutions than 2 per cent. and causes tonic and clonic spasm. In a 1 per cent. solution it is probably safest and best as an anesthetic and one-half ounce of such a solution may be injected without fear of unpleasant consequences.

Its dose is said to be about seven grains, but this may often be the cause of alarming symptoms, and half of this quantity would perhaps be a safe limit. The duration of anesthesias of fairly strong solutions is about fifteen minutes; the action is more prolonged if used with adrenalin.

Various combinations of drugs besides adrenalin are employed with novocaine. Fischer recommends its use with thymol, but even so, it is not efficient for a longer period than twenty or twenty-five minutes.

Novocaine is frequently used in alcoholic solutions for injection in neuralgic subjects. The commercial tablet of novocaine and adrenalin is convenient for office use.

+Alypin.+ This substance occurs as a crystalline powder, easily soluble in water, alcohol and ether, and makes a neutral solution.

Alypin is in every respect the equal of cocaine though not quite as strong. Schleich has found that its use, in conjunction with minute quantities of cocaine, permitted of a reduction of the entire amount of anesthetics necessary to accomplish insensibility.

In its use on mucous membranes it does not cause any anemia and therefore no secondary bleeding occurs. This is a great advantage also in the examination of mucous membrane lined cavities, such as the eye, nose, throat and urethra, inasmuch as after the application of cocaine, the blanching of the membrane conveys no idea of the real condition of the parts.

Because of the results he obtained, Schleich now recommends the following solutions for infiltration:

1. Cocaine 0.1 Alypin 0.1 Sodium chloride 0.2 Distilled water 100.

2. Cocaine 0.05 Alypin 0.05 Sodium chloride 0.2 Distilled water 100.

3. Cocaine 0.01 Alypin 0.01 Sodium chloride 0.2 Distilled water 100.

For other operative procedures of a minor character, it has been found that one-fourth per cent. to one-eighth per cent. is sufficient. For application to mucous membranes, as in the urethra, nose and throat, 1 per cent. to 2 per cent. has proved effective.

+Stovaine.+ Stovaine is used more for spinal anesthesia than for local purposes; it is said to work well in inflamed tissues.

Several drugs have been used because of their lessened toxicity and many are constantly being tried but to be abandoned because of their inefficiency or irritating qualities. None of them are as efficient as cocaine and the weak solutions of Schleich are about as active as stronger solutions of many of these and are not more toxic.

Among the other cocaine substitutes in general use are betaeucaine, tropacocain, anesthesin, and subcutin.

These all find a special field of usefulness, but for general work, are limited, because of some disadvantages which each and all of them possess.

Individual selection plays an important part in the use of a local anesthetic, and one operator, by practical experience, may obtain results with a given drug, which another fails to achieve.

The essential feature to be remembered by the practising chiropodist is, that the use of any drug employed for anesthetizing purposes, even though but local, should be safeguarded in every way.

+Cold.+ The methods of using ether, rhigolene, or ice and salt, to produce cold, are slow and unsatisfactory. If cold is to be used to produce local anesthesia the most efficient and convenient method of applying it is by means of ethyl chloride. This fluid is very volatile and is best controlled by having it in air-tight tubes. When not in use, a valve covering one end of the tube prevents leakage. When the valve is pressed upon, the orifice of the tube is opened and the heat of the hand forces out a fine stream of the liquid which is directed upon the parts to be frozen. Rapid evaporation causes intense cold. The nozzle should be held about fifteen inches from the area to be acted upon. When the spray strikes the integument, redness almost instantly results but in a few seconds the part becomes hard and white. This condition indicates local insensibility and lasts about two minutes. If the action is slow, it can be much hastened by gently blowing upon the parts to increase the rapidity of evaporation.

The refrigeration method of local anesthesia is of limited usefulness and is recommended only for the opening of felons and abscesses, for removing wens from the scalp and back, and for producing a painless area in which a puncture is to be made. It must be borne in mind that sloughing and ulceration of the skin are liable to follow the use of cold.

Work under this form of anesthesia must be done with rapidity not always consistent with thoroughness, and should therefore be employed only when a single incision or puncture is indicated.

The pain incident to subsequent thawing is severe and, in general, is about as hard to bear as an incision without an anesthetic.

For the purposes of practical podiatry, the chiropodist is advised to use a substitute for cocaine rather than the cocaine itself when local anesthesia is necessary. In the clinics of the School of Chiropody of New York, novocaine, quinine and urea hydrochloride, and alypin are preferred, and no single instance of toxemia has ever been experienced. There have been cases in which the anesthesia did not prove thoroughly effective, but, in the main, these drugs have well answered the purposes of their use.

THE END

GLOSSARY

+A+

+a-an.+ Without, as in atypical—without type, and as in analgia—without pain.

+ab.+ From, away from, as in abaxial, lying outside of or away from any body or part.

+abduction.+ To move away from the axis (median line) of the body.

+ab initio.+ From the beginning.

+abrade.+ To scrape away.

+acid.+ A compound of an electro-negative element or radical with hydrogen.

+acetic acid.+ A product of the oxidation of ethylic alcohol and of the destructive distillation of wood, applied locally as a counterirritant.

+benzoic acid.+ External uses, antiseptic.

+carbolic acid.+ Used in podiatry, as an antiseptic, as a disinfectant and as an anesthetic.

+chromic acid.+ Has caustic properties.

+dichloracetic acid.+ Used as a caustic application to venereal sores.

+glacial acetic acid.+ Employed externally as a caustic for removal of warts and helomata.

+hydrochloric acid.+ Externally employed as an escharotic.

+monochloracetic acid.+ Used as a caustic for helomata and verrucae.

+nitric acid.+ Used as a caustic against verrucae.

+nitrohydrochloric acid.+ An active caustic agent.

+oxalic acid.+ Removes ink stains.

+sulphocarbolic acid.+ Antiseptic and disinfectant.

+trichloracetic acid.+ Employed as an escharotic for venereal and other warts.

+abscess.+ A circumscribed cavity containing pus.

+acidulated.+ Rendered acid.

+actinomycosis.+ An infectious disease due to the ray fungus.

+actual cautery.+ A substance which acts by virtue of its heat, not chemically.

+adenoma.+ A tumor of glandular epithelium.

+adde.+ Add, used in prescription writing.

+adduction.+ To turn towards the axis or median line of the body.

+adhesive.+ Sticking together.

+adjacent.+ Next to.

+adjuvant.+ A remedy which added to a prescription aids the action of the main ingredient.

+adrenalin.+ Trade name of a principle obtained from the suprarenal glands which has astringent and hemostatic properties.

+aerobic.+ Unable to live without oxygen.

+albuminoid.+ A substance resembling true proteids in origin and in composition.

+albuminous.+ Resembling or containing albumin.

+albuminuria.+ Albumin in the urine as voided.

+albumose.+ An intermedial product of the splitting of proteids by enzymes.

+albumosuria.+ Albumose in the urine.

+algia.+ Pain, as in neuralgia, nerve pain.

+alkaloidal. An organic base of vegetable origin causing toxicologic effects.

+alveolar.+ Pertaining to the alveoli.

+ambi.+ Both, as in ambidexterity, the ability to use both hands with equal ease.

+ambulatory.+ Walking, able to walk.

+ameba.+ A small one-celled animal that constantly changes its shape by sending out processes of its protoplasm.

+amyl nitrite.+ A drug used to dilate the blood vessels.

+anal.+ Relating to the anus.

+anemia.+ A condition in which the blood is reduced in amount or is deficient in red blood cells or in hemoglobin.

+anerobic.+ Living without air.

+anesthesia.+ Loss of sensation.

+anesthesin.+ An ethylic ether used as a local anesthetic.

+aneurism.+ A saclike dilation in the wall of an artery as the result of weakness of its tissues.

+angioma.+ A tumor formed of blood vessels.

+animal.+ An organic being, with life and power of motion.

+ankylosis.+ Stiffening of a joint.

+anthrax.+ The disease produced by the bacillus anthracis.

+anti.+ A prefix signifying against; in relation to symptoms and diseases, curative.

+antidote.+ An agent which neutralizes or counteracts the effects of a poison.

+antipyretics.+ Agents reducing fever.

+antiseptic.+ Preventing, or destroying the germs of putrefaction or suppuration.

+antitoxin.+ A substance in the serum, which binds and neutralizes toxin.

+anus.+ The orificial extremity of the rectum.

+apposition.+ Contact of two bodies or two surfaces.

+argyrol.+ A soluble, non-irritating silver preparation used in the treatment of various inflammations of mucous membranes.

+arsenic.+ A metalic element in chemistry.

+arterial.+ Pertaining to an artery.

+arteries.+ Vessels carrying blood from the heart.

+arteriosclerosis.+ A fibrous overgrowth of the inner coat of an artery.

+arthritis.+ Inflammation of a joint.

+arthrotomy.+ Cutting into a joint.

+articulation.+ A joint.

+aseptic.+ Free from septic matter.

+asepticize.+ To render aseptic or sterile.

+aspiration.+ The withdrawal by air or by suction of fluid from any body cavity.

+astringent.+ An agent producing contraction of organic tissues or the arrest of a discharge.

+atrophy.+ The wasting or diminution of the size of a part from lack of nutrition.

+autoclave.+ Instrument for sterilizing by steam.

+axis.+ A straight line passing thro a spherical body between its two poles and about which the body may revolve.

+B+

+bacillus.+ A genus of schizomycetes, the most important group of bacteria.

+bacteria.+ Microorganisms, microbes, schizomycetes.

+benign.+ Not malignant; mild.

+betaeucaine.+ A local anesthetic used as a substitute for cocaine.

+bi.+ A prefix denoting two, twice or double, as biceps—two heads.

+bicarbonate.+ A compound of two equivalents of carbonic acid and one of a base.

+bichloride.+ A chloride with twice as much chlorin as a protochloride.

+blast.+ Germ, as in blastoderm, the primitive cell layer in the beginning embryo, consisting of three layers.

+blastomycetes.+ Yeasts; budding fungi.

+blistering.+ Producing a blister.

+brain.+ The large mass of nerve tissue contained in the cranium, especially the cerebrum.

+bromide of potassium.+ A salt of potassium.

+bromidrosis.+ Fetid or foul smelling perspiration.

+bubo.+ Enlargement of a lymphatic gland usually in the groin.

+budding.+ Gemmation. A form of tissue division by a bud-like process.

+bulla.+ A large bleb or blister.

+bunion.+ An inflammatory swelling of the bursa over the metatorsophalangeal joint of the great toe.

+bursa.+ A small sac interposed between movable surfaces.

+bursitis.+ Inflammation of a bursa.

+buttock.+ The prominence formed by the gluteal muscles of either side.

+C+

+calcareous.+ Having the nature of lime.

+calcification.+ A degeneration of tissues into salts of calcium or magnesium.

+callosity.+ A circumscribed thickening of the epidermis as a result of friction or intermittent pressure.

+cancellous.+ Resembling lattice work.

+canthus.+ The slit between the eyelids.

+capillary.+ Any one of the small blood vessels which serves to connect an artery and a vein and to allow of the passage of nutrient matter and oxygen from the blood into the tissues and of waste matter from the tissues into the blood.

+carboluria.+ Carbolic acid in the urine.

+carbuncle.+ A phlegmonous inflamation of the skin and subcutaneous tissues.

+carcinoma.+ A malignant epithelial growth.

+cardiac.+ Pertaining to the heart or cardium.

+caries.+ Molecular bone decay.

+carotid.+ The principle artery of the neck.

+cartilage.+ A non-vascular elastic tissue, softer than bone.

+cartilaginous.+ Partaking of the nature of cartilage.

+caseation.+ Transformation of necrotic tissue into a mass resembling cheese.

+caseous.+ Cheesy.

+catheter.+ A hollow cylinder of silver, rubber or other material designed for passage thru the urethra and other channels.

+caustic.+ Corrosive; capable of tissue destruction; syn. escharotic.

+cautery.+ An agent which by heat or chemical action scars tissues.

+cavities.+ Hollows.

+cele.+ Tumor, as in hydrocele, a watery tumor.

+cell.+ A small protoplasmic mass, usually nucleated.

+cellular.+ Composed of cells.

+cellulitis.+ Inflammation of cellular tissue.

+cephalic.+ Head, as in hydrocephalic, water on the head (brain).

+chancre.+ The primary syphilitic manifestation. A syphilitic induration.

+Charcot’s disease.+ A form of tabes.

+chemotaxis.+ The attraction or repulsion exhibited by certain chemicals to living cells.

+chimatlon.+ Mild, chilblain; severe, frost-bite.

+chiropodial orthopedics.+ That branch of podiatry which has to do with the treatment of chronic diseases and deformities of the foot and of the foot joints.

+chiropodist.+ Literally, one who treats the feet and hands. Actually, one who specializes in the treatment of foot lesions not requiring major surgical operative procedures.

+chloral.+ An oily liquid formed by the action of chlorine gas on alcohol.

+chlorosis.+ A form of anemia occurring chiefly in young girls.

+chondritis.+ Inflammation of cartilage.

+chondroma.+ A tumor of cartilage tissue.

+chronic.+ Of long standing.

+chyle.+ The milky fluid found in the mesenteric lymph-vessels as the result of fatty digestion.

+cilia.+ The eyelashes; hairlike processes of certain cells.

+circumcision.+ Removing part or all of the foreskin.

+clot.+ The solid portion resulting from the coagulation of blood.

+coagulation.+ Clotting; in the blood, the result of fibrinogen changing to fibrin.

+coalesce.+ To merge in growth.

+coaptation.+ The fitting together of two opposing surfaces.

+cocaine.+ An alkaloid derived from coca. Useful to produce local anesthesia.

+cocci.+ Round, spheroidal or oval shaped bacteria.

+cocoon.+ Shaped like the protection of the silk-worm larva.

+colostomy.+ Opening into the colon to establish an artificial anus.

+collodion.+ A solution of pyroxylin in ether and alcohol.

+compression.+ Decreasing volume and increasing density by pressure.

+concomitant.+ Accompanying. Accessory.

+condyle.+ A rounded articular surface at the extremity of a long bone.

+congenital.+ Existing at birth.

+congestion.+ Hyperemia of a part.

+conjunctiva.+ The mucous membrane covering the anterior surface of the eyeball.

+connective tissue.+ The uniting tissue of the body.

+constitutional.+ Relating to the system as a whole.

+constriction.+ The act of drawing together, a narrowing or binding.

+continuity.+ Connected; the quality or state of being continuous.

+contra.+ A prefix meaning against.

+contused.+ Bruised.

+corium.+ The deep or connective tissue layer of the skin; the true skin.

+cornea.+ A transparent membrane forming the outer coat of the eyeball.

+cornification.+ Conversion into a hard or horny substance or tissue.

+corpuscles.+ Minute bodies. Primary atoms of the blood.

+corrosive.+ A substance that eats or destroys.

+cortex.+ The external gray layer of the brain; the outer covering in plant life.

+cortical.+ External, in contradistinction to other parts, in tissue or plant.

+cosmetic.+ An agent or a means for beautifying the body.

+counterirritant.+ Means or medications to produce irritation to relieve deeper congestion.

+crepitus.+ The grating of fractured bones.

+crisis.+ A sudden favorable change in the course of an acute disease.

+cryptogam.+ A group of plants without flowers and without embryo—containing seeds.

+cuneiform.+ A wedge-shaped bone found in the carpus (one) and in the tarsus (three).

+cupping.+ Blood-abstraction by means of cupping-glasses.

+curette (curet).+ Spoon-shaped instrument for scraping.

+cutis.+ The skin.

+cyanosis.+ Blue discoloration of the skin from non-oxidation of blood.

+cyte.+ Cell or corpuscle, as in leucocyte, white blood cell.

+D+

+dactyl.+ Finger, as in dactylitis, inflammation of one or more fingers.

+debris.+ Scattered fragments.

+decomposition.+ Decay. Breaking up into its original elements.

+deformity.+ A deviation from normal in shape or in size.

+deleterious.+ Injurious, noxious, harmful.

+demarcation.+ A tissue boundary mark.

+dentine.+ The bony structure of the teeth.

+derma.+ The skin.

+dermatitis.+ Inflammation of the skin.

+devitalize.+ To destroy vitality.

+diabetes (mellitus).+ A disease of metabolism characterized by the presence of sugar in the voided urine.

+diagnosis.+ Determination of the nature of a disease.

+diapedesis.+ The passage of the blood-corpuscles through the vessel-walls without rupture of the latter.

+diaphoresis.+ Excessive perspirattion.

+diaphragm.+ The muscular wall between the thorax and the abdomen.

+diaphysis.+ Relating to the shaft of the bone.

+diffusion.+ A scattering about.

+digit.+ A finger or toe.

+dilatation.+ An expansion of a vessel or an organ.

+discutient.+ An agent which causes the dispersal of a tumor or of a pathologic neoplasm of any kind.

+disease.+ A pathologic condition of any part or organ of the body.

+disinfection.+ Freeing from infection.

+disintegration.+ Separation of component parts.

+dislocation.+ Displacement of an organ or of a part.

+dissection.+ A separation by cutting of the parts of the body.

+distortion.+ Mechanical derangement of a part interfering with its function.

+dorsal.+ Pertaining to the back.

+dorsum.+ The back, the posterior part of an organ.

+drainage.+ (Surgically) The gradual removal of the contents of a suppurating cavity.

+d.s. or s.+ Used in prescription writing, meaning to give directions.

+dynia.+ Pain, as in pleurodynia, pain in the pleura.

+E+

+ecchymosis.+ An extravasation of blood or slight hemorrhage under the skin resulting in a purplish patch.

+echinococcus.+ The larval stage of the dog tapeworm, occurring also in human organs or tissues.

+ectomy.+ To cut out, as in prostatectomy, removal of a part or all of the prostate.

+eczema.+ Inflammation of the skin (acute or chronic, moist or dry), accompanied by itching and burning.

+edema.+ Accumulation of serum in the cellular tissue.

+edematous.+ Relating to edema.

+effusion.+ Escape of fluid from within, out.

+embolism.+ The obstruction of a blood vessel by an embolus cleavage.

+embolus.+ A plug composed of detached clot in the circulation.

+embryonic.+ Rudimentary.

+emigration.+ The outward passage of a wandering cell through the walls of a blood-vessel.

+empyema.+ Pus in a cavity.

+en or endo.+ Within, as in endocardium, inner lining of the heart.

+encapsule.+ To inclose in a sheath.

+endermatically.+ Within or through the skin.

+endoneural.+ Within the nerve.

+endosteum.+ Membrane covering bone surface in the medullary cavity.

+endothelial.+ Pertaining to or consisting of endothelium. A lining cavity not communicating with the outer air.

+enteroclysis.+ A high enema.

+enterostomy.+ Establishing an artificial anus through the abdominal wall.

+epidermis.+ The outer layer of the skin constituting the outer investment of the body.

+epiphyseal.+ Pertaining to the epiphysis.

+epiphysis.+ A piece of bone that in early life is separated from a long bone by cartilage, but later becomes part of the bone.

+epithelial.+ Pertaining to epithelium.

+epithelioma.+ A cancerous growth originating from squamous epithelium.

+epithelium.+ The cells covering all cutaneous and mucous surfaces, together with the secreting cells of glands developed from the ectoderm.

+erysipelas.+ An acute specific inflammation of the skin and subcutaneous tissues, accompanied by fever and constitutional disturbances. Caused by the streptococcus erysipelatos.

+erythema.+ Redness of the skin.

+eschar.+ A scar.

+escharotic.+ A substance producing an eschar.

+esia.+ Sensation, as in anesthesia, loss of sensation.

+ethyl bromide.+ A colorless liquid, used for both general and local anesthesia.

+ethyl chloride.+ A colorless liquid, whose spray produces local anesthesia.

+etiology.+ Cause as related to disease.

+eucaine.+ A synthetic compound capable of producing local anesthesia.

+evacuated.+ Removal of waste material from the body.

+evaporation.+ Turning into vapor.

+eversion.+ Turning outward. Turning back an eyelid so as to expose the conjunctiva. Turning the inner border of the foot outward.

+ex.+ Out of or from, as in exostosis, a bony outgrowth.

+exacerbation.+ Increased severity of a disease or of its symptoms.

+excretion.+ The product of a gland or of cells not useful to the economy, in contradistinction to secretion.

+excoriation.+ Removal of the superficial protective layer of the skin or mucous membrane.

+exfoliate.+ To strip off in layers. To desquamate.

+exostosis.+ A bony tumor springing from bone.

+extravasation.+ Effusion of fluid into the tissues.

+F+

+facet.+ A small plane, articulating surface.

+facient.+ To make, as in rubefacient, to make red.

+facultative.+ Pertaining to functional or acquired power.

+Faradic.+ Pertaining to induced electric currents.

+fauces.+ The space between the cavity of the mouth and the pharynx.

+felon.+ Paronychia. Whitlow.

+femur.+ The thigh bone.

+ferment.+ An organic substance which in small quantities is capable of setting up changes in another organic substance without itself undergoing much change.

+fermentation.+ Such changes as are effected exclusively by the vital action of ferments.

+fibrin.+ Active agent in blood coagulation.

+fibroma.+ A tumor of fibrous tissue.

+fibrous.+ Composed of fibres.

+fibula.+ External and smaller of the two bones of the leg.

+fissure.+ A crack in the tissues.

+fistula.+ A pathologic sinus leading from an abscess cavity to the surface.

+flagella.+ The whiplike processes with which certain cells, as the ameba, are provided.

+flexion.+ Bending.

+fluorescence.+ Power of a body to change wave-rate (or color) of light passing through it.

+focus.+ Point at which light rays meet. The starting point of a disease process.

+follicle.+ A small secretory cavity or sac.

+form.+ Shape, as in vermiform, resembling a worm in shape.

+formaldehyde.+ A gas possessing powerful disinfectant properties.

+fracture.+ A break, as of a bone.

+fulcrum.+ The point against which lever is placed to get purchase.

+fungating.+ Rapidly growing (path.).

+fungus (plural fungi).+ A cellular vegetable organism which feeds on organic matter. Example, bacteria.

+furunculosis.+ The systemic condition marked by boil-formation.

+G+

+gangrene.+ A necrosis with putrefaction.

+gastrostomy.+ Making an artificial opening into the stomach.

+gelatinous.+ Resembling gelatine, a semi-liquid substance.

+genesis.+ Birth of, belonging to, as in genesial, relating to generation.

+germicide.+ An agent destructive to germs.

+globular.+ Shaped like a globe.

+gonorrhoea.+ A specific inflammation of the mucous membrane of the genital tract; germal cause, gonococcus.

+gout.+ Podagra. A disease of metabolism characterized by paroxysmal pains in the foot, particularly in the great toe.

+gradus.+ Step by step, as in graduated, marked by lines or in other ways to denote capacity.

+granular.+ Composed of grains or granulations.

+granuloma.+ A collection of epitheloid cells at an irritated point.

+gumma.+ A gummy tumor resulting from a peculiar caseation of a teritary syphilitic inflammatory deposit.

+H+

+habitat.+ The natural locality of an animal or a plant; impregnated; saturated with.

+hallux rigidus.+ First phalanx of the great toe is flexed at an angle of 30° with extension of the second phalanx.

+hallux valgus.+ Outward rotation of big toe beyond an angle of 15°.

+hallux varus.+ Pigeon toe.

+heloma.+ Same as corn or callus.

+heloma durum.+ Hard or indurated corn.

+heloma miliare.+ A millet-seed corn.

+heloma molle.+ Soft corn.

+heloma vasculare.+ A corn of the vascular variety.

+hema.+ Blood, as in hemoglobin, an iron compound in the red blood.

+hematoma.+ A tumor containing blood.

+hemorhage.+ A flow of blood.

+hemophelia.+ Abnormal tendency to hemorrhage.

+hemostatic.+ Capable of arresting hemorrhage.

+hereditary.+ Transmitted from parent to offspring.

+hernia.+ Rupture; protusion of a structure thro the wall which ordinarily contains it.

+herniotomy.+ Operation for the relief of hernia.

+hidros.+ Perspiration, hyperidrosis, excessive sweating.

+histology.+ Microscopic anatomy.

+hyascine.+ An alkaloid of hyoscyamus and stramonium.

+hydro.+ Water, hydrotherapy, treatment of disease by means of water.

+hydrarthrosis.+ A serous effusion in a joint.

+hyper.+ Above or over, hyperemia, the presence of an increased or overamount of blood in a part.

+hyperemia.+ Excessive amount of blood.

+hyperidrosis.+ Excessive sweating.

+hyperplasia.+ Overgrowth of a part due to a multiplication of its elements.

+hypertrophy.+ Abnormal, increased size of a part or of an organ.

+hypnotic.+ Causing sleep.

+hypo.+ Under, as in hypodermic, beneath the skin, or subcutaneous.

+hypodermatic (hypodermic).+ Subcutaneous, applied to injections underneath the skin.

+hypodermoclysis.+ The hypodermic injection of fluids to supply a lack of blood.

+hysteria.+ A functional neurosis with abnormal sensations, emotions or paroxysms.

+I+

+ic.+ Relating to, as in caloric, relating to temperature.

+ichthyol.+ A brownish oil; principally used in the form of ammonium ichthyol as an antiseptic.

+immersion.+ The plunging of a body into a liquid.

+immobilization.+ The act of rendering a part immobile (immovable).

+immunity.+ Freedom from risk of infection.

+incubation.+ The development of an infectious disease from the infection period to the appearance of the first symptoms.

+indolent.+ Inactive, sluggish.

+induration.+ Hardening as of tissues.

+ine.+ (Phar.) Alkaloid, as in morphine, an alkaloid.

+infection.+ Invasion by pathogenic microorganisms which act injuriously upon the tissues, causing disease.

+inflammation.+ A morbid condition characterized by hyperemia, pain, heat, swelling and disordered function.

+infra.+ (L. below). A prefix denoting below, as infracostal, below a rib.

+innervation.+ Distribution of the nerves in a part.

+inoculation.+ The introduction of a specific virus into the system.

+inorganic.+ Devoid of organized structure.

+in situ (Latin).+ In position.

+integument.+ The enveloping membrane of the body.

+intercellular.+ Between the cells.

+intermittant.+ Occurring at intervals.

+interosseous.+ Between bone tissue.

+interstices.+ Spaces, intervals, pores.

+interstitial.+ Lying or placed between.

+intra.+ (L. within). A prefix denoting within or inside, as intraneural, within a nerve.

+intravenous.+ Within a vein.

+inunction.+ Administering a drug in ointment form by rubbing into the skin.

+inversion.+ The reversion of the normal position of an organ, turning inward, inside out, etc.

+involucrum.+ An enveloping membrane.

+iodide.+ A compound of iodin with another element, as iodide of potassium.

+iodin (iodine).+ A non-metallic chemical element.

+iodoform.+ A lemon yellow crystalline powder; used as an antiseptic to wounds and sores.

+iritis.+ Inflammation of the iris, the anterior division of the vascular tunic of the eye.

+iron.+ A metallic element.

+irrigation.+ The washing out of a cavity or wounded surface with a stream of fluid.

+itis.+ Inflammation, as in pericarditis, inflammation of the pericardium.

+J+

+jaundice.+ A yellow tissue-staining from bile.

+jaw.+ One of the two bony structures of the mouth in which the teeth are set.

+jugular.+ Relating to the throat or neck.

+juice.+ Tissue fluid of a plant or animal.

+jute.+ Fiber used in surgical dressings.

+juxta.+ Prefix; meaning close to or next.

+K+

+kalium.+ Latin for potassium.

+kaolin.+ Fuller’s earth; used as a poultice with glycerin.

+karyokinesis.+ Indirect nuclear division, mitosis.

+keratin.+ A scleroprotein present in skin appendages, hair, nails, etc.

+keratitis.+ Inflammation of the cornea.

+kerato.+ A prefix denoting horny tissue or cells.

+keratodermia.+ Hypertrophy of horny layer of epidermis.

+keratosis.+ Circumscribed over-growths of horny layer of skin.

+kinetic.+ Relating to motion or to muscular movements.

+kneading.+ To work and press into a mass.

+knee.+ Articulation between femur and tibia covered in front by the patella.

+knee-jerk.+ Patellar reflex.

+L+

+lacerated.+ Torn.

+lacuna.+ A small gap or hollow space.

+lacuna, osseous.+ A space in the Haversian system occupied by bone-corpuscle.

+lacunar resorption.+ Absorption of lacunae.

+lamella.+ One of the plates forming the Haversian system of bone.

+lancet.+ A surgical knife with a two-edged blade.

+lancinating.+ A sharp, cutting pain.

+Lassar’s paste.+ An ointment containing salicylic acid, talcum and zinc oxide.

+laughing gas.+ Nitrous oxide gas.

+lead and opium wash.+ See Wash.

+leucemia.+ A disease of the blood marked by persistent leucocytosis.

+leucocyte.+ White blood corpuscle or a white cell.

+leucocytosis.+ An increase in the number of white cells in the blood.

+leukos.+ White, as in leucocyte, a white blood cell.

+ligament.+ A band or sheet of fibrous tissue connecting two or more bones, cartilages or other structures or serving as support for fasciae or muscle.

+ligature.+ A thread or the like tied about a blood vessel or other structure to constrict it.

+linimentum. Liniment.+ A medicament in alcohol, oil or water, applied by friction to the skin.

+l. aconiti et chloroformi.+ Anodyne application.

+l. ammoniae.+ Counter irritant.

+l. ammonii iodidi.+ Discutient.

+l. calcis.+ To mollify burns and scalds.

+l. camphorae.+ A mild counterirritant.

+l. chloroformi.+ Anodyne and rubefacient.

+l. crotonis.+ Counterirritant.

+l. hydrargyri.+ Anti-syphilitic.

+l. iodi.+ Discutient.

+l. opii.+ Anodyne.

+l. saponis.+ A base for other liniments.

+l. sinapis.+ Counterirritant.

+l. terebinthinae.+ Soothing application.

+lint.+ A soft absorbent material used in surgical dressings.

+lipoma.+ A fatty tumor.

+liquor.+ Solution of a nonvolatile substance.

+l. acidi chromici.+ Used, well diluted, as a wash in bromidrosis.

+l. alumini acetatis+ (Burows’ solution). For external use as an astringent and antiseptic.

+l. antisepticus.+ A mouthwash.

+l. bromi.+ Antiseptic.

+l. Burowii.+ Astringent and antiseptic (See l. alum. acet.)

+l. caoutchouc.+ For rubber skin.

+l. cresolis compositus.+ Antiseptic and disinfectant where vesicles form.

+l. ferri persulphatis.+ Styptic.

+l. ferrisub sulphatis.+ Monsel’s solution. Styptic.

+l. hydrargyri nitratis.+ Caustic application.

+l. iodi carbolatus.+ Antiseptic counterirritant.

+l. plumbi subacetatis.+ For bruises and sprains.

+l. sodii boratis compositus.+ Dobell’s solution. An alkaline antiseptic preparation.

+l. sodii ethylatis.+ Employed externally as a caustic.

+l. sodii silicatis.+ Used in surgery for applying splints.

+l. zinci chlorodi.+ Disinfectant and deodorant.

+listerine.+ Trade name of a solution containing boric acid, benzoic acid, thymol and other substances.

+Lister’s method.+ Antiseptic surgery.

+lith.+ Stone, as in lithology, the branch of medical science, relating to calculi or concretions.

+litter.+ A stretcher for carrying the sick or wounded.

+locomotor ataxia (tabes dorsalis).+ Hardening of the posterior columns, ganglia, roots and peripheral nerves of the spinal cord.

+logos.+ Treatise, as in Pathology, a branch of medical science which treats of disease in all its relations.

+lotio.+ Latin for lotion or wash.

+l. hydrargyri flava.+ Yellow mercurial wash.

+l. hydrargyri nigra.+ Black mercurial wash. (Both of the above are used as applications to venereal sores).

+l. plumbi et opii.+ Lead and opium wash. Applied to sprains and bruises.

+luetic.+ Syphilitic.

+luetin test.+ A skin test for the diagnosis of syphilis.

+lumen.+ The space in the interior of a tubular structure, such as an artery.

+lunula.+ The opaque, whitish, semi-lunar area near the root of the nail.

+lymph.+ A clear yellow fluid found in the lymph spaces or lymphatic vessels of the body.

+lymphangioma.+ New formation of lymphatic vessels.

+lymphangitis.+ Inflammation of lymphatic vessels.

+lymphoma.+ A tumor of lymphoid tissue.

+lysis.+ Solution, as in analysis, the breaking up of a chemical compound into its simpler elements. Also the gradual subsidence of symptoms in a disease as distinguished from crisis.

+lysol.+ Trade name of a mixture of soaps and phenols; used as a disinfectant.

+M+

+macrococcus.+ A large unicellular microorganism.

+macros.+ Large, as in macroscopic, an object visible to the naked eye.

+macula.+ Spot, as in macular, relating to or marked by macules, or spotted.

+magnesium sulphate.+ Epsom salts; a purgative.

+malignant.+ Resistant to treatment and tending to grow.

+malleolus.+ A process of bone the shape of the head of a hammer.

+mania.+ Frenzy, as in megalomania, a delusion of grandeur.

+manifestation.+ Clear to the eye or to the mind.

+manus.+ Hand, as in manual, relating to or performed with the hands.

+marrow.+ The soft substance filling the medullary cavities and cancellous extremities of the long bones.

+massage.+ A scientific method of manipulating the body by rubbing, pinching, kneading, tapping, etc.

+matrix.+ The formative portion of a nail or of a tooth.

+measles.+ An acute exanthematous disease.

+medullary.+ Relating to the medulla or marrow.

+membrane.+ A layer of tissue covering a part or connecting two structures.

+mercury. Quicksilver.+

+metastasis.+ A change in the seat of disease.

+metatarsalgia.+ Pain in the metatarsus.

+metatarsophalangeal.+ Relating to the metatarsal bones and the phalanges.

+meter.+ Measure, as in meter, a measure of length, the equivalent of 39.3 inches.

+microbe.+ A minute one-celled microorganism.

+micrococcus.+ A genus of schizomycetes.

+microorganism.+ A minute living body.

+miliary.+ Like millet seeds, in size.

+molecular.+ Pertaining to molecules.

+molecule.+ The smallest possible unit of existence of any substance.

+morphine.+ The chief narcotic principle of opium.

+mortification.+ Death; gangrene.

+mucous.+ Relating to mucous as in mucous membrane.

+mucus.+ A clear viscid secretion of a mucous membrane, mucilagenous in character.

+mummification.+ Dry gangrene.

+myeloma.+ A tumor due to hyperplasia of the bone marrow.

+myoma.+ A muscular tumor.

+myxoma.+ A tumor of stellate or polyhedral cells in a matrix of mucin.

+N+

+naevus (nevus).+ A congenital mark or discolored patch of the skin.

+nail (unguis).+ The horny plate covering the distal end of the terminal phalanx of each finger and toe.

+naphthalan.+ A gelatinous mixture employed as a protective dressing in burns and in skin diseases.

+narcosis.+ Stupor or general anesthesia produced by some narcotic drug.

+nascent.+ Beginning; incipient.

+necrosis.+ Death of a circumscribed portion of tissue.

+neoplasm.+ A new growth; a tumor.

+neosalvarsan.+ A modified salvarsan: No. 914.

+nephritis.+ Inflammation of the kidney.

+nerve.+ A whitish cord made up of nerve fibres.

+neuralgia.+ Pain in a nerve.

+neurasthenia.+ Nerve exhaustion.

+neuritic.+ Relating to neuritis.

+neuritis.+ Nerve inflammation.

+neuroma.+ Nerve tumor.

+neuron.+ Nerve cell, as in neuritis, inflammation of a nerve.

+neutralize.+ To render ineffective.

+node.+ A knob; a circumscribed swelling.

+nostrum.+ A quack remedy.

+novocaine.+ A synthetic local anesthetic.

+noxious.+ Injurious; harmful.

+nucleus.+ The essential part of a typical cell and the controlling centre of its activity.

+O+

+obliteration.+ Extinction.

+official+ (in pharmacy). Authoritative; standard.

+oid.+ Like, as in lymphoid, resembling or like lymph.

+oil.+ A liquid of fatty consistency, insoluble in water and inflammable. Examples: camphorated oil, carbolic oil, carron oil, linseed oil, oil of turpentine, sweet oil, sesame oil, tar oil.

+ointment.+ A soft, fatty, medicated mixture.

+onychauxis.+ Enlargement of finger or of toe nails.

+onychia.+ Inflammation of the matrix with suppuration and shedding of the nail.

+onychocryptosis.+ Ingrowing toe-nail.

+onycholysis.+ Loosening or shedding of the nails.

+onychomalacia.+ Loss or absence of nail rigidity.

+onychomycosis.+ Any parasitic disease of the nails.

+onychophag.+ One whose habit it is to bite his finger-nails.

+onychophagy.+ Nail-biting.

+onychoptosis.+ Falling off of the nails.

+onychorrhexis.+ Abnormal brittleness of the nails.

+onyx.+ A finger nail or a toe nail.

+onyxis.+ Ingrowing toe-nail.

+opisthotonos.+ Spasmodic rigidity of the body in which the trunk is thrown backward and arched upward.

+oral.+ Relating to the mouth.

+organic.+ Pertaining to or having organs, exhibiting animal or vegetable characteristics.

+orthoform.+ A white, odorless, crystalline powder; employed as a local anesthetic and antiseptic in burns, ulcers, etc.

+orthopedics.+ That branch of surgery which treats of chronic diseases of the joints and spine and the correction of deformities. (See chiropodial orthopedics.)

+os (plural ossa).+ Bone.

+osis.+ Full of, as in tuberculosis, a specific disease caused by the presence of the bacillus tuberculosis.

+osseous.+ Bony.

+osmidrosis.+ Bromidrosis; the excretion of perspiration of a strong odor.

+ossification.+ The formation of bone.

+osteitis.+ Inflammation of bone.

+osteoclast.+ A polynuclear cell concerned in the absorption of bone.

+osteogenetic.+ The development and formation of bone.

+osteoma.+ A bony tumor.

+osteomalacia.+ Softening of the bone.

+osteomyelitis.+ Inflammation of the bone marrow or of both marrow and bone.

+ous.+ Full of, as in fibrous, full of or composed of fibres.

+oxygen.+ A gaseous element, the most widely distributed. Essential to animal and plant life; symbol O.

+ozone.+ A modified form of oxygen.

+P+

+pachylosis.+ Thick, dry and abnormal quality of skin which cracks into scales of irregular form.

+pack.+ The process of enveloping a patient in a wet sheet or blanket. Cold pack: in sheets wrung out of water; hot pack: in sheets wrung out of hot water; dry pack: in dry warmed blankets, etc.

+pachyacria.+ Bulbous thickening of the extremities of the fingers or toes.

+pachydermia.+ Thick skin; elephantiasis.

+palliative.+ Mitigating; lessening the severity.

+palm.+ The flat of the hand.

+palpation.+ Exploration with the hand.

+panidrosis.+ Sweating from all parts of the skin.

+papilla.+ Any small nipple-like process.

+papilloma.+ A growth of hypertrophied papillae of the skin.

+papule.+ A small circumscribed elevation of the skin, containing no fluid. A pimple.

+paralysis.+ Loss of power of voluntary movement in a muscle through injury or disease of nerve supply.

+parasite.+ An organism that inhabits another organism and obtains nourishment from it.

+paresis.+ General paralysis of the insane or dementia paralytics. A condition thought to be due to a chronic meningitis.

+paresthesia.+ An abnormal spontaneous sensation such as of numbness, burning, pricking, tingling, etc.

+parenchyma.+ The specific tissues of a gland or organ.

+paronychia.+ Felon, whitlow. Inflammation of the structures in the distal phalanx of the finger.

+patella.+ Kneecap.

+pathogenic.+ Causing disease.

+pathology.+ That branch of medicine which treats of disease and the changes in the tissues of the body caused by disease.

+pathy.+ Suffering, or disease as in Homeopathy—disease, the quality of being treated by likes.

+pedicure.+ One who attends the feet, cosmetically.

+per.+ Through, as in peripheral, away from the centre; the outer part of or surface.

+peri.+ A Greek prefix meaning around or about.

+peridental.+ Surrounding a tooth or part of a tooth.

+periosteum.+ The fibrous membrane investing the surface of bones except at the point of tendinous and ligimentous attachment, and on the particular surfaces where cartilage is substituted.

+periostitis.+ Inflammation of the periosteum.

+periphery.+ The part of a body away from the centre; the outer part or surface, as of a bone or of a nerve.

+peritoneum.+ The sac lining the abdominal cavity and covering most of the viscera therein contained.

+perivascular.+ Surrounding a blood-vessel.

+peroxid.+ An oxid with the highest amount of oxygen.

+pes (pl. pedes).+ The foot.

+phagocyte.+ A cell possessing the property of ingesting bacteria or other foreign particles.

+phagocytosis.+ The destruction of microbes by the action of phagocytes.

+phalanx.+ One of the long bones of the fingers or toes.

+phenol.+ Carbolic acid.

+phlebitis.+ Inflammation of a vein.

+phlegmon.+ Acute suppurative inflammation of subcutaneous tissue.

+physiology.+ The science which deals with the functions of living things.

+picric acid.+ A combination of carbolic and nitric acids.

+pigment.+ An organic coloring matter.

+plantalgia.+ Pain on the sole of the foot.

+plantar.+ Relating to the sole of the foot.

+plaque.+ A flat patch or area on the skin or mucous membrane.

+plasia.+ Moulding, as in hypoplasia. defective development.

+plaster-of-Paris.+ Calcium sulphate.

+plastic.+ Capable of being moulded.

+plegia.+ Stroke, as in hemiplegia, paralysis of one side of the body and of the opposite side of the face.

+plethoric.+ Relating to overfilled blood-vessels.

+pleura.+ The serous membrane enveloping the lungs.

+plexus.+ A new network of nerves or veins.

+podagra.+ Gout, especially, typical gout in the great toe.

+podagral.+ Gouty, relating to or suffering from gout.

+podalic.+ Relating to the foot, as in podalgia, pain in the foot, podarthritis, inflammation of any of the tarsal or metatarsal joints.

+podiatrist.+ One who treats diseases and disorders of the feet.

+podobromidrosis.+ Fetid or foul smelling perspiration of the feet.

+pododynia.+ Pain in the foot or podalgia.

+podology.+ A treatise on the foot.

+poly.+ A Greek prefix for much or many, ex: polyphagia, excessive eating.

+poroma.+ Callus; exostosis.

+potassium.+ An alkaline metallic element. Among the salts of potassium are: potassium bichromate, employed externally as a caustic to syphilitic vegetations; potassium hydroxide, used as a strong penetrating caustic.

+poultice.+ A soft emulsion for external application.

+pous.+ Foot, as in podiatrist.

+pre.+ A prefix denoting anterior or before.

+predisposing.+ Inclining to, as a disease.

+prepatellar.+ In front of the patella.

+prognosis.+ A forecast of the result. In medicine, the prior determination of the outcome of a disease.

+proliferation.+ Cell-genesis, reproduction.

+pronation.+ The act of rotating the forearm in such a way that the palm of the hand looks backward when the arm is in the anatomic position, or downward when the arm is extended at a right angle with the body. (Stedman.)

+prophylactic.+ Preventing disease.

+protargol.+ A combination of silver with a proteid base.

+protean.+ Having the power to change form.

+protonuclein.+ A preparation from the lymphoid tissue of animals.

+protoplasm.+ Primitive organic cell matter.

+protuberance.+ A projecting part.

+pseudo.+ Prefix, signifying false.

+ptomain.+ A crystallizable nitrogenous basic substance, produced by bacteria in dead animal or vegetable matter.

+punctured.+ Wounded by a pointed instrument.

+purge.+ A cathartic.

+purulent.+ Having the character of pus.

+pus.+ A fluid product of inflammation.

+pustule.+ A soft purulent papule.

+putrefaction.+ Organic decomposition, decay.

+putrid.+ Manifesting putrefaction.

+pyemia.+ A condition in which pyogenic bacteria circulate in the blood, and form abscesses wherever they lodge.

+pyogenic.+ Developing or excreting pus.

+pyorrhea.+ A discharge of pus.

+pyorrhea alveolaris.+ Rigg’s disease; suppurative inflammation of the periosteum lining the teeth in their sockets.

+Q+

+q.h.+ Every hour, used in prescription writing.

+q.s.+ Sufficient quantity, used in prescription writing.

+quinine.+ An alkaloid of cinchona.

+quinine and urea hydrochlorate.+ Used as a local anesthetic.

+R+

+rachitic.+ Pertaining to rickets.

+rationale.+ Fundamental reason.

+Raynaud’s disease.+ Symmetrical gangrene of the extremities.

+recipe.+ “Take thou.” Used to precede directions in prescription writing.

+rectum.+ The terminal part of the digestive tube from the pelvic colon to the anus.

+refrigeration.+ The act of cooling or reducing fever.

+remittent.+ Characterized by temporary abatement of symptoms.

+resection.+ Removal of articular ends forming a joint; removing a segment of any part.

+retention.+ Holding back as of excretions and secretions.

+rhea.+ A flow, as in diarrhea, an abnormally frequent discharge of more or less fluid fecal matter from the bowels.

+rheumatism.+ An acute, probably infectious, condition; when articular, the joints are inflamed.

+rhigolene.+ A liquid obtained from petroleum distillation. Used as a local anesthetic.

+rickets.+ Disease of early childhood characterized by defective nutrition of the bony structures.

+Roentgen rays.+ (See X-ray.)

+rotated.+ Turned about or around on its own axis.

+S+

+sac.+ Pouch; bursa.

+saccharomyces.+ The yeast fungi.

+salicylate of mercury.+ A salt of mercury and salicylic acid.

+salvarsan.+ The Ehrlich-Hata anti-syphilitic preparation; known also as No. 606.

+saphenous vein.+ The ascending vein of the lower limb which empties into the femoral vein.

+saprophyte.+ A microorganism which normally grows on dead matter.

+sapremia.+ Intoxication due to absorption of dead saprophytes into the system.

+saprophytic.+ Pertaining to saprophytes.

+sarcoma.+ A malignant connective tissue tumor.

+scaphoid.+ One of the small bones of the wrist. One of the bones of the tarsus.

+scar.+ Mark of a wound.

+scarlet fever.+ Scarlatina. An acute exanthematous disease.

+schizomycetes.+ The fisson fungi microorganisms; bacteria; putrefaction; organic decomposition, decay.

+sclerosis.+ Induration and overgrowth of the connective tissue of an organ.

+scope.+ View, as in stethoscope, an instrument originally devised for aid in hearing the respiratory or c a r d i a c s o u n d s in the chest.

+scrotum.+ The sac containing the testicles.

+sebum.+ The fat excreted by the sebaceous glands of the skin.

+secare-sect.+ To cut, as in dissect, to cut apart or separate the tissues of the body in the study of anatomy.

+sedative.+ Calming, quieting.

+senile.+ Relating to old age.

+sensibility.+ The consciousness of sensation.

+sensory.+ Pertaining to sensation.

+sepsis.+ (See septicemia.)

+septicemia.+ An infection characterized by the presence of bacteria and their toxins in the blood.

+sequestrum.+ A fragment of necrosed bone.

+serous.+ Relating to, containing or producing serum.

+serum.+ A clear watery fluid moistening the surface of serous membranes or exudate resulting from inflammation of any of those membranes.

+shaft.+ The part of a long bone between its ends.

+shock.+ A sudden physical or mental disturbance.

+sinus.+ A hollow cavity recess, or pocket in the body tissues.

+skiagraph.+ A shadow. The production of photographs by means of Roentgen rays.

+skin.+ The membranous covering of the body.

+skiving.+ Splitting or paring materials for adjusting shields to surfaces on the foot.

+slough.+ Necrosed tissue separated from living structure.

+smallpox.+ Variola; an acute eruptive contagious disease.

+sodium chloride.+ Common table salt.

+sodium hydroxide.+ Caustic soda. Used for its caustic effects.

+sodium sulphate.+ Colorless crystals. Glauber’s salt; a purgative.

+sodium urate.+ The substance found in gouty nodes; chalk-stone.

+spasm.+ An involuntary convulsive muscular contraction.

+spirillum.+ A genus of spirillaceae containing rigid cells with polar tufts.

+spirochaeta pallida.+ The specific organism of syphilis.

+splint.+ An apparatus for fixating a joint.

+spontaneous.+ Occurring without external stimulation.

+spores.+ Reproductive bodies of cryptogams.

+stagnation.+ Cessation of motion.

+staphylococcus.+ A coccus; a genus of schizomycetes in which the cocci are irregularly clustered like a bunch of grapes.

+stasis.+ Standing, as in hemostasis, the arrest of the circulation in the blood vessels of a part.

+sterile.+ Barren, not fertile.

+sterilization.+ The destruction of germs.

+sternum.+ The breast-bone.

+stovaine.+ A local anesthetic; used largely to induce intraspinal anesthesia.

+stratum corneum.+ The horny or outer layer of the epidermis.

+streptococcus.+ A genus of schizomycetes in which the cocci are arranged in strings or in chains.

+strismus.+ Spasm.

+structure.+ The component formation features of a tissue.

+strychnine.+ An alkaloid of nux vomica.

+styptic.+ Having the property of checking hemorrhage.

+sub.+ A Latin prefix denoting, beneath, as subareolar, beneath the areola or minute area.

+subcutaneous.+ Under the skin.

+subcutin.+ A white crystalline powder used in saline solution as a local anesthetic.

+supinate.+ To turn the hand so that it is supine, i. e., with the palm outward. The opposite of pronation.

+suppository.+ A solid medicine, melting at body temperature, for introduction into the rectum or vagina.

+suppuration.+ The formation of pus.

+supra.+ A prefix denoting a position above.

+suture.+ An anatomic union between two bones; the surgical union of two surfaces by stitches.

+symptomatic.+ Relating to symptoms; indicative.

+symptomatology.+ The study of the symptoms of disease.

+synchronous.+ Occurring at the same time.

+syncope.+ Swooning or fainting.

+synovia.+ Tenacious, colorless, stringy alkaline fluid which lubricates a joint; in appearance like the white of eggs.

+synovial.+ Pertaining to synovia.

+synovitis. Inflammation of a synovial membrane.

+synthetic.+ Created from parts into a compound.

+syphilis.+ An infectious disease spread by inoculation thru sexual intercourse; also possible by contamination thru table utensils, towel, pipes, etc.

+systemic.+ Relating to a system.

+T+

+tabes dorsalis.+ Locomotor ataxia; posterior spinal sclerosis.

+talipes.+ Clubfoot.

+talipes calcaneus.+ The heel touching the ground and the foot generally in extreme dorsi-flexion.

+talipes cavus.+ Hollow foot. An increased curvature of the arch of the foot.

+talipes equinus.+ Club foot, the patient walking on his toes, and the foot in plantar flexion.

+talipes planus.+ Flat foot; a deformity marked by depression of the arch of the foot.

+talipes valgus.+ Eversion of the foot, the inner side of the foot resting on the ground.

+talipes varus.+ Inversion of the foot, the outer side of the sole of the foot touching the ground.

+tarsus.+ A bone of the posterior part of the foot.

+technic.+ Details of a procedure.

+tendo Achillis.+ The common tendon of the gastrocnemius and soleus muscles.

+tendon.+ A white, glistening fibrous tissue, affording attachment of muscles to bone.

+tenosynovitis.+ Inflammation of a tendon and its sheath.

+tenotomy.+ The surgical division of a tendon.

+terminal.+ Relating to the end, extremity or summit of any body.

+tetanus.+ Lock jaw. A very fatal disease due to the introduction of the bacillus tetanus into the tissues.

+therapy.+ Treatment, as hydrotherapy, treatment of diseases by means of water.

+therapeutics.+ The branch of medical science concerned with the application of remedies for the alleviation of pain and the treatment of disease.

+thermal.+ Pertaining to heat.

+thoracentesis.+ Tapping the thorax to release fluid from it.

+thrombin.+ The fibrin ferment.

+thrombosis.+ The formation of a thrombus.

+thrombus.+ A blood clot in a vessel producing an obstruction in the flow of the blood in the same.

+thymol.+ A phenol found in some volatile oils. Used as a deodorizer and as an antiseptic.

+tibia.+ The shin-bone.

+tincture.+ The pharmacy name of an alcoholic solution or extract of a nonvolatile vegetable substance.

+tissue.+ A collection of cells or derivatives of cells forming a definite structure.

+toma, or oma.+ Tumor in hematoma, a bloody tumor.

+tourniquet.+ An instrument or apparatus for arresting the flow of blood from a vessel in a limb by pressure.

+toxalbumins.+ Poisonous soluble albuminoids producing specific disease.

+toxemia.+ A poisoned state of the blood due to the absorption of poisons not of parasitic origin.

+toxicity.+ A state of being poisonous.

+toxicology.+ The science of poisons and their antidotes.

+toxins.+ Amorphous, nitrogenous poisons, formed by bacteria in both living tissues and dead substances.

+trabecula.+ Any one of the fibrous bands extending from the capsule into the interior of an organ.

+tracheotomy.+ The operation of opening into the trachea.

+traction.+ Drawing; pulling.

+tragopodia.+ Knock-knee.

+transfusion.+ The transfer of blood from one person to another.

+transplant.+ To transfer from one part to another as in plastic operations.

+trauma.+ A wound or injury.

+traumatic.+ Relating to or caused by a wound.

+trinitrin.+ Nitroglycerin.

+triturate.+ To reduce to fine powder; a finely divided powder.

+tropacocaine.+ An alkaloid from Java coca leaves, used as a local anesthetic.

+trophe (nourishment).+ Hypertrophy, overgrowth; atrophy, lack of nourishment.

+trophic.+ Relating to or dependent upon nutrition.

+trypsin.+ A proteolytic ferment of pancreatic fluid.

+tubercle.+ A circumscribed elevation on the skin, mucous membrane or surface of an organ; the lesion of tuberculosis.

+tuberosity.+ A small rounded elevation on a bony surface.

+tumor.+ A swelling or tumefaction.

+tylosis.+ Formation of a callosity.

+typhoid fever.+ An acute infectious disease caused by the bacillus typhosus.

+U+

+ulcer (ulcus).+ A lesion of a cutaneous or mucous surface usually attended by suppuration.

+ulceration.+ The process of ulcer formation.

+unguentum Crede.+ An ointment of colloidal silver, 15: distilled water, 5; white wax, 10; benzoinated lard, 70 parts. Used as an inunction.

+urates.+ Salts of uric acid.

+urea.+ An end-product of metabolism excreted in the urine.

+ureter.+ A tube carrying urine from the kidney to the bladder.

+urethra.+ A canal from the bladder thru which the urine is discharged.

+uria (urine).+ As in glycosuria, the excretion of sugar (glucose) in the urine.

+urology.+ The subject which has to do with urinary modifications in disease.

+V+

+vaccine.+ The modified virus of any disease, which, when inoculated, protects against the action of the unmodified virus.

+vaccination.+ The injection of a killed culture of a specific bacterium as a means of prophylaxis or cure of the disease caused by that microorganism.

+valgus.+ One who is bow-legged or has knock-knees.

+varix.+ An enlarged and tortuous vein, artery or lymphatic vessel.

+vasoconstrictor.+ An agent or a nerve which causes narrowing of the blood vessels.

+vasodilator.+ An agent or a nerve which causes dilatation of the blood vessels.

+vein.+ A blood-vessel carrying blood toward the heart.

+venous.+ Pertaining to a vein.

+verruca+ (pr. verrucae). Wart.

+vertebra.+ A bony segment of the spinal column.

+vesicle.+ A small blister or sac containing serum.

+villus (pl. villi).+ A minute projection from the surface, especially of a mucous membrane.

+viscus (viscera).+ An internal organ especially of the abdominal cavity.

+W+

+Wart.+ A circumscribed hypertrophy of the papillae of the corium covered by thickened epidermis.

+Wassermann’s test.+ A diagnostic test for syphilis, based upon the theory of complement fixation.

+wen.+ A sebaceous cyst, especially one occurring on the scalp.

+whitlow.+ See paronychia.

+X+

+xeroderma.+ Roughening of the skin from diminished secretion.

+X-rays.+ The ethereal waves or pulsations from a Crookes’ tube from the bombardment of the anode target with the cathode rays.

+Z+

+zinc chloride.+ A caustic sulphate. An astringent.

+zymotic.+ Relating to fermentation; noting an infectious disease.

CROSS REFERENCE INDEX

Abscess acute, 65 chronic, 66 symptoms, 66 treatment, 66

Acquired club foot, 191

Acquired flat foot, 178

Actinomycosis, 136 causes, 137 symptoms, 137 treatment, 137

Active hyperemia, 196 indications for therapeutic uses, 196

Actual cautery, 200 uses, 200

Acute abscess, 65 causes, 65 diagnosis, 65 symptoms, 66 treatment, 66

Acute rheumatism, 97 causes, 97 diagnosis, 97 symptoms, 97 treatment, 97

Acute synovitis, 86 causes, 86 diagnosis, 86 symptoms, 86 treatment, 86

Adhesive plaster, 215

Adrenaline, 211

Alcohol, 25

Alkaloids, 9

Alum, 210

Alypin, 251

Ameboid, 29

Ammoniated mercury, 212

Amyl nitrite, 45

Anaerobic bacteria, 8

Anesthesia, local, 229

Ankle joint, 165 dislocations, 172 backward, 172 forward, 172 injuries, 172 outward, 173 sprains, 176 diagnosis, 176 symptoms, 176 treatment, 177

Ankylosis, 94 fibrous, 94 bony, 94

Antiseptic method, 20

Antisepsis, 19

Antiseptics, 22

Appearance of varicose ulcers, 68

Appendicitis, 17

Application of skin grafts, 226

Aqueous solution of ichthyol, 208

Argyrol, 26

Aristol, 24

Arterial bleeding, 55

Arthritis, 88 acute, 88 causes, 89 chronic, 90 diagnosis, 90 symptoms, 91 treatment, 91 varieties, 89 Charcot, 98 gonorrhoeal, 95 gouty, 97 infective, 98 rheumatic, 97 septic, 90 syphilitic, 95 traumatic, 90 tubercular, 92

Arthrotomy, 173

Arterial hyperemia, 196 indications, 196 technic, 195

Arteriosclerosis, 117

Articular fractures, 159

Asepsis, agents, 19 drugs employed, 21 technic, 21

Aseptic methods, 21

Astragalus dislocation, 172

Astragalus fracture, 168

Astringent powders, 210 alum, 210 stearate of zinc, 210 zinc, 210

Asepsis in the management of wounds, 39

Atrophy of bone, 100 causes, 100 symptoms, 100 treatment, 100

Backward dislocations ankle, 172

Bacteria, 6 aerobic, 8 anerobic, 8 alkaloidal, 9 cultivation, 10 classification, 7 destruction, 12 effect of oxygen, 8 elimination, 11 facultative, 8 ferments, 10 habitat, 7 infection, 10 immunity, 12 temperature effect of, 8, 14 toxins, 9 pathogenic, 6 saprophytic, 6 surgical import, 15

Balsam of Peru, 210

Bandages, 215 elastic, 219 flannel, 215 French bandage of foot, 218 gauze, 214 ideal, 214 muslin, 214 plaster, 164 rubber, 214, 219 spica bandage of foot, 218 spica bandage of toe, 217 spiral bandage of toe, 217

Bandaging, 215 indications, 215 method, 216 technic, 216

Benign tumors, 114, 152 adenoma, 114 chondroma, 114 fibroma, 153 lipoma, 153 lymphoma, 154 myoma, 154 osteoma, 115

Bichloride solution, 22 strength, 22

Bicycle foot, 138 symptoms, 138 treatment, 138

Bier’s, arterial hyperemia, 196 indications, 196 technic, 195 venous hyperemia, 195

Bismuth subgallate, 210

Black mustard, 199

Blastomycotic ulcer, 79 diagnosis, 79 symptoms, 79 treatment, 79

Bleeding, 54 control of, 54

Blue ointment, 133, 212

Bone atrophy, 100 caries, 101 congenital defects, 99 hypertrophy, 101 necrosis, 102 osteitis, 105 osteomyelitis, 105 periostitis, 103 senile atrophy, 100 tumors, 114

Boric acid, 25 ointment, 212 powder, 210 solution, 208

Brandy, 47

Bromides, 48

Bunion, 84, 185

Burns, 56 causes, 56 degrees, 57, 58 pathology, 57, 58 symptoms, 59 treatment, 60 varieties, 57

Bursitis, 82 acute, 83 chronic, 83 diseases of the bursa, 82 symptoms, 83 treatment, 83

Burow’s solution, 208 formula, 208 indications, 35, 208 preparation, 208

Calomel, 210

Callosity, 141 causes, 141 definition, 141 symptoms, 141 treatment, 141, 142

Callous ulcers, 67 causes, 67 diagnosis, 67 symptoms, 68 treatment, 68

Cancer, 51

Carbolic acid, 13 dangers, 22 gangrene, 121 poisoning, 13 uses, 22

Caries, 101 symptoms, 101 treatment, 102

Cartilage, 88

Catgut, 46 uses, 46 varieties, 46

Cautery, 200 how applied, 200 when indicated, 200

Cells, 36

Cellulitis, 136 cause, 136 symptoms, 136 treatment, 136

Chancre, 131

Charcot’s disease, 98

Chauffeur’s foot, 138 cause, 138 symptoms, 138 treatment, 138

Chemical antiseptics uses, 13

Chemotaxis, 31

Chloroform liniment, 197

Chilblain, 63 symptoms, 63 treatment, 63

Chinese lady foot, 193

Chondromata, 154 symptoms, 154 treatment, 154

Chronic bursitis, 83 osteomyelitis, 110 periostitis, 104 syphilis, 132 synovitis, 87 tuberculosis, 134

Chyle, 5

Circulatory system, 3

Clavus, 142

Clawed toes, 183

Clinicial stages of burns, 57

Club foot, 188

Cocaine, 243 preparations, 243 strength of sols., 244 uses, 244

Cocoon dressing, 207 description, 207 indications, 207

Cold, 197 the effects of, 34, 62 treatment, 62

Cold compress, 197 indications, 197

Collodion dressings, 207 indications, 207

Comminuted fractures, 158 symptoms, 158 treatment, 158

Compound fractures, 161 diagnosis, 161 symptoms, 161 treatment, 161

Contusions, 41 symptoms, 42 treatment, 43

Contused wounds, 41 diagnosis, 42 symptoms, 42 treatment, 43

Contagious warts, 139

Congenital club foot, 188

Congenital defects of bone, 99

Congenital flat foot, 178

Counterirritants indications, 199

Copper sulphate, 210

Corn or clavus, 142 symptoms, 142 treatment, 142 varieties, 142

Corrosive sublimate, 46

Crede’s ointment, 26

Creolin, 23 strength of sol., 23 uses, 23

Cysts, 154 bone, 117 diagnosis, 154 sebaceous, 154 symptoms, 154 treatment, 155 varieties, 154

Dakin’s solution, 209 how prepared, 209 indications, 209 method of use, 209

Dead bone symptoms, 102 treatment, 102

Depressed fractures, 157

Demarcation in gangrene, 122

Dermatol, 210

Dermatitis, 135 symptoms, 135 treatment, 136

Diabetic gangrene, 120 ulcers, 75

Diapedesis, 31

Diaphysis of bone, 158

Digitalis, 45

Direction of the line of fracture, 157

Diseases of the arteries, 118 bones, 105 caries, 101 necrosis, 102 osteitis, 105 osteomyelitis, 105 periostitis, 105 joints, 170 lymphatics, 5 veins, 127

Dislocations, 170 ankle joint, 172 astragalus, 175 diagnosis, 171 metatarsal bones, 176 subastragaloid, 174 symptoms, 172 toes, 176 treatment, 171, 173

Drainage indications for, 46 methods of, 46

Dressings, 207 dry, 207 wet, 207

Dry dressings, 207 materials used, 207 indications for, 207

Early diagnosis of carcinoma, 153 syphilis, 130 tuberculosis, 133

Ecchymosis, 42

Electricity, 201 uses, 201

Electrolysis, 201 method of application, 141, 201

Elastic stocking application, 126 uses, 126

Elevated position for treatment of varicose veins, 126

Elongated veins significance, 126

Embolism, 119 causes, 119 diagnosis, 119 symptoms, 119 treatment, 119

Endarteritis obliterans, 120 symptoms, 120 treatment, 120

Enteroclysis, 45 indications, 45

Epitheliomatous ulcer, 79 causes, 79 diagnosis, 80 symptoms, 80 treatment, 80

Epiphysis of bone, 158

Erysipelas, 135 causes, 135 diagnosis, 135 symptoms, 135 treatment, 136

Escharotics, 210 indications, 210 methods of application, 210

Esmarch bandage, 214 where indicated, 215 technic, 219

Ethyl chloride, 252

Extirpation of tumors, 117 varicose veins, 126

Exuberant granulations, 68

Faradism, 201 indications for, 201 technic of, 201

Ferments, 9, 10

Fibromata, 114 diagnosis, 114 symptoms, 114 treatment, 114

Fibrous ankylosis, 94 causes, 94 treatment 94

First aid in accidents, 60 in fractures, 162

First degree of burns, 57 pathology, 57 symptoms, 57 treatment, 57

Firm bandaging technic, 216

Fission, 37

Fissure, 64 diagnosis, 64 treatment, 64

Fistula, 64 definition, 64 diagnosis, 64 treatment, 64

Flannel bandages, 214 method of application, 215 uses, 215

Flat foot, 178 acquired, 178 causes, 179 congenital, 178 diagnosis, 180 operation treatment, 183 pathology, 179 prognosis, 181 spastic, 180 rigid, 182 supports, 181 symptoms, 180 treatment, 181

Flat foot from child birth, 179 from excessive weight, 179 from prolonged fractures, 179

Flexed toes, 183 diagnosis, 184 symptoms, 184 treatment, 184

Fluctuation, 66

Forward dislocations, 172 at the ankle joint, 172 diagnosis, 172 symptoms, 173 treatment, 173

Formaldehyde, 14 uses, 23

Fractures, 156 astragalus, 168 causes, 159 classification, 156 comminuted, 158 complete, 156 complicated, 161 compound, 161 depressed, 157 diagnosis, 166 epiphyseal separations, 158 etiology, 159 fibula, 165 fissured, 157 fixation method, 165 greenstick, 156 impacted, 158 joint, 158 line of, 157 location, 158 number, 161 metatarsal, 169 multiple, 161 operative, 164 os calcis, 168 pathologic, 160 Pott’s, 165 recent, 162 reduction, 163 simple, 161 tarsal, 167 tibia, 165 treatment, 162, 166, 167 varieties, 157 violence, 160

French bandage of the foot, 218

Frigorism (trench foot), 137 causes, 137 diagnosis, 137 symptoms, 137 treatment, 137

Frost Bite, 63

Furuncle, 66 causes, 66 symptoms, 66 treatment, 67

Galvanism, 201 indications, 201 method of application, 201

Galvano-cautery, 200 indications, 200 method of application, 200

Gauze aseptic, 44 iodoform, 24 uses, 44

Gangrene, 118 arteriosclerosis, 118 carbolic acid, 121 cold, 120 diabetic, 120 dry, 118 endarteritis obliterans, 120 embolism, 120 moist, 119, 122

Gelatin, uses, 219

Germs, 6 bacillus coli communis, 17 bacillus pyocyaneus, 15 bacillus tetani, 17 bacillus tuberculosis, 17 bacillus typhosis, 17 micrococcus gonorrhoeae, 16 spirochaeta pallida, 15 staphylococcus pyogenes aureus, 16 staphylococcus pyogenes albus, 16 staphylococcus pyogenes citreus, 16 streptococcus pyogenes, 16

Glycerine, uses, 219

Gonorrhoeal arthritis, 95 causes, 95 diagnosis, 95 symptoms, 96 treatment, 96

Gouty arthritis, 97

Granulations, 68

Green stick fracture, 156 symptoms, 156 treatment, 156

Gun shot wounds, 39 symptoms, 39 treatment, 39

Hematoma, 42 definition, 42 diagnosis, 42 symptoms, 42 treatment, 42

Hallux valgus, 185 causes, 185 operative measures, 187 pathology, 185 symptoms, 185 treatment, 186, 187

Hallux flexus, 183 symptoms, 183 treatment, 183

Hammer toe, 183 diagnosis, 183 symptoms, 183 treatment, 183

Heat, 14, 197 effects, 14, 34 dry, 14, 19 moist, 14, 20

Heloma, 142 definition, 142 causes, 142 diagnosis, 142 pathology, 142 radical cure, 144 pathology, 142 radical cure, 144 symptoms, 142 treatment, 143 varieties, 142

Hemoglobin, 42

Hemophilia, 51

Hemorrhage, 51 arterial, 51 capillary, 45, 51 causes, 51 control, 44, 52 in chiropody, 53 spontaneous, 51 venous, 51 treatment, 44, 52, 54

Hemostatics, 54

Hereditary syphilis, 130 diagnosis, 130 symptoms, 131 treatment, 132

High frequency current, 198 indications for, 198 method of application, 198

Horny tissue where found, 57 treatment, 58

Housemaid’s knee, 83

Hydrastine, uses, 211

Hydrochloride of cocaine indications for, 243

Hydrogen peroxide, 24, 211

Hyperemia, 194 arterial or active, 196 methods of application, 195 uses, 196 venous or passive, 195

Hypertrophy of bone, 101 causes, 101 symptoms, 101 treatment, 101

Hypertrophy of nails, 148 causes, 148 pathology, 149 symptoms, 149 treatment, 149, 150

Ichthyol ointment, 212 solution, 208 uses, 212

Immunity, 12 acquired, 12 inherited, 12 natural, 12 resistance to, 12 susceptibility to, 12

Impacted fractures, 158 causes, 158 diagnosis, 158 symptoms, 158 treatment, 158

Injuries to the ankle contusions, 41 dislocations, 172 fractures, 168 inflammations, 89 sprains, 176

Inflammation, 28 bone, 105 bursae, 82 causes, 28 definition, 28 emigration, 30 etiology, 28 exudation, 29 diapedesis, 31 pathology, 28 periosteum, 103 phenomena, 32 resolution, 32 serous membranes, 84 sloughing, 32 suppuration, 33 symptoms, 32 synovial membranes, 84 treatment, 34 varieties, 34

Incised wounds, 39 symptoms, 40 treatment, 44

Indolent ulcers causes, 67 diagnosis, 67 symptoms, 67 treatment, 67

Infective arthritis, 95 causes, 96 diagnosis, 96 symptoms, 96 treatment, 96

Ingrowing toe nail, 145 causes, 145 diagnosis, 145 operations, 148 symptoms, 145 treatment, 146, 147, 148 varieties, 148

Injuries of the bursae, 82 diagnosis, 82 symptoms, 82 treatment, 83

Injuries of the bone contusion, 41 dislocation, 170 fracture, 156

Interpretation of radiograms their diagnostic value, 203

Inunction of mercury, 133 indications, 133 preparation, 133 technic, 133

Iodin preparations, 24 uses, 24

Iodoform gauze, 24 ointment, 24 powder, 24 poisoning, 24

Joint fractures, 158 diagnosis, 158 symptoms, 158 treatment, 158

Knives method of sterilization, 21

Kreolin, 13

Lacerated wounds, 40 causes, 40 diagnosis, 40 symptoms, 40 treatment, 44

Lassar’s paste, 212 formula, 212 indications, 212

Lead and opium wash, 208 formula, 208 indications, 208

Leukocytosis, 26 definition, 26 interpretation, 26 value, 26

Ligaments injuries, 176

Ligatures, 46 uses, 46 varieties, 46

Ligation of varicose veins, 126 methods, 126 technic, 126

Lime water, 209

Liquor ferri subsulphatis (Monsel’s sol.), 211 formula, 211 method of application, 211 uses, 211

Liquor calcis, 209 formula, 209 uses, 209

Liquor plumbi subacetatis, 208 formula, 208 indications, 208

Local anesthesia, 229 advantages, 234 alypin, 251 cocaine, 243 drugs employed, 243 edemitization method, 242, 246 endermic method, 241, 245 essentials, 237 general principles, 233, 234, 237, 238 history, 229 methods of application, 241 nerve blocking, 242 physiologic effects, 232 preparation of instruments, 240 preparation of patient, 240 novocaine, 250 objections to, 236 quinine and urea hydrochloride, 249 Schleich’s sol., 246 stovaine, 251 strength of solutions, 244 technic, 241 toxicology, 247

Local treatment of arthritis, 91 bursitis, 83 periostitis, 103 osteomyelitis, 94 phlebitis, 128 synovitis, 87

Location of dislocations, 170 fractures, 156 sprains, 176 ulcers, 70

Locomotor ataxia, 75 causes, 75 diagnosis, 75 foot manifestations, 76, 77 treatment, 78

Longitudinal fractures diagnosis, 157 treatment, 157

Loose bandage objections to, 215

Lutein diagnostic value, 73 reaction, 73 technic, 73

Lymphatic system, 5

Lysol, uses, 23

Malposition in fractures, 164 treatment, 164

Malignant growths, 115, 152 carcinoma, 115, 152 diagnosis, 115 sarcoma, 115, 153 symptoms, 115 treatment, 115

Martin’s bandage, 195 indications, 195 how applied, 195

Massage, 201 indications, 44 technic, 202 varieties, 202

Mayo’s operation, 127 how performed, 127 when indicated, 127

Mechanical theory of tabes explanation of, 75

Mercury preparations, 133 uses, 132

Metatarsalgia, 184 diagnosis, 184 symptoms, 184 treatment, 184

Methods of disinfection, 20 immobilization of fractures, 165 fixation of fractures, 165

Microorganisms, 6 definition, 6 non-pathogenic, 6 varieties, 6

Moist gangrene, 119 causes, 118, 119 diagnosis, 119 symptoms, 119 treatment, 121 varieties, 119

Monsel’s sol., 211 formula, 211 indications, 211 uses, 211

Monochloracetic acid uses, 210

Morton’s disease, 184 causes, 184 diagnosis, 184 symptoms, 184 treatment, 184

Motorman’s foot, 138 causes, 138 diagnosis, 138 symptoms, 138 treatment, 138

Multiple varicose veins location, 125 treatment, 126

Muslin bandage uses, 214

Mustard uses of, 199

Muriate of cocaine, 214 how used, 214 when indicated, 214

Myeloma, 116 causes, 116 diagnosis, 116 symptoms, 116 treatment, 116

Nails, 150 diseases, 150 inflammation, 150 hypertrophy, 148 symptoms, 150 treatment, 150, 151

Necrosis, 102 definition, 102 causes, 102 diagnosis, 102 symptoms, 102 treatment, 102

Needle in foot, 40 diagnosis, 40 treatment, 40 value of X-ray, 40

Neosalvarsan (914), 133 how prepared, 133 indications, 133 technic, 133

Nerve theory cause for tabes, 75

Nerve pressure effect, 242

Nerve blocking in local anesthesia, 242

Nervous system, 3

Neuropathic joints, 98 diagnosis, 98 symptoms, 98 treatment, 98

Nicolaier’s bacillus, 17

Nitric acid uses, 210

Nitrate of silver, 25 different sols., 26 stick, 26 uses, 26, 210

Novocaine, 250 how prepared, 250 advantages, 250 indications, 250 uses, 250

Nucleus, 36

Number of fragments in fractures, 161

Number of ulcers on leg, 73

Obtaining a sounder scar, 227 in skin grafting, 228 in the treatment of ulcers, 222

Oblique fractures, 157

Ointments, 212 balsam of Peru, 212 boric acid, 212 Crede, 26 ichthyol, 212 indications, 212 Lassar’s paste, 212 mercurial, 212 salicylic acid, 211 scarlet red, 213, 214 zinc oxide, 212

Oleate of mercury indications, 133

Onychia hypertrophy, 148 inflammation, 150 symptoms, 150 treatment, 151

Operations flat foot, 181 fractures, 164 hallux valgus, 187 osteitis, 94 necrosis of bone, 102 osteomyelitis, 94 periostitis, 103 varicose veins, 126

Ordinary saline sol., 208 how prepared, 208 indications, 208 methods of injection, 45

Orthoform uses, 210

Os calcis dislocations, 175 fracture, 168

Osteitis, 105 causes, 105 deformans, 113 diagnosis, 105 symptoms, 105 treatment, 105

Osteitis deformans, 113 causes, 113 diagnosis, 113 symptoms, 113 treatment, 113

Osteomalacia, 113 causes, 113 diagnosis, 113 onset, 113 symptoms, 113 treatment, 113

Osteomyelitis, 105 acute, 105 causes, 105 chronic, 110 diagnosis, 106 infective, 107 symptoms, 107 syphilitic, 111 tubercular, 109 treatment, 109, 114

Os trigonum location, 168

Oxygen, 26

Ozone, 26

Paget’s disease, 113 symptoms, 113 treatment, 113

Painful heel, 184 causes, 184 symptoms, 184 treatment, 184

Palliative treatment of veins, 126 bandaging, 126 Unna’s paste, 219

Parasiticides alcohol, 25 carbolic acid, 13 formaldehyde, 23 iodin, 24 heat, 34 mercury, 133

Passive hyperemia, 195 contraindications, 194 indications, 195 technic of application, 195

Pastes Lassar’s, 212 Unna’s, 219

Pathogenic bacteria, 6

Periostitis, 103 acute, 103 causes, 103 chronic, 104 diagnosis, 103 symptoms, 104 treatment, 103 varieties, 103

Perforating ulcer, 75 causes, 75 diagnosis, 75 symptoms, 75 treatment, 77

Peroxide of hydrogen uses, 14, 24, 211

Pes cavus, 193

Pes planus, 178 causes, 179 diagnosis, 180 symptoms, 180 treatment, 181 varieties, 179

Phagocytosis, 11, 31

Phenol gangrene from, 22 other name, 22 poisoning, 22 uses, 22

Phlebitis, 127 causes, 127 diagnosis, 127 preventive measures, 128 operations, 129 symptoms, 127 treatment, 128 varieties, 127

Phlegmon treatment, 195

Picric acid uses, 60

Plaster of Paris, 164 how applied, 164 indications, 164

Poisoned wounds, 39 symptoms, 39 treatment, 39

Poisoning by carbolic acid, 13

Potassium permanganate, 25

Powders, 210 aristol, 24, 210 alum, 210 boric acid, 210 dermatol, 210 calomel, 210 iodoform, 24, 210 orthoform, 210 protonuclein, 210 scarlet red, 210 stearate of zinc, 210 talcum, 210 zinc oxide, 210 indications, 210 uses, 210

Powdered white oxide of zinc uses, 219

Preparation of instruments for operations, 21

Preparation of field of operation, 20 dressings, 20 hands, 21 instruments, 21 skin, 21

Preparation of an ulcer for skin grafting, 222

Primary syphilis, 131 causes, 131 diagnosis, 131 symptoms, 131 treatment, 131 stage of, 131 incubation, 131

Protargol uses, 26

Protiodide of mercury dose, 133 uses, 133

Protonuclein, 14 as a powder for wounds, 210 as a tablet internally, 210

Ptomaines, 9 definition, 9 poisoning by, 9 symptoms, 9 treatment, 9

Punctured wounds, 40 symptoms, 40 treatment, 40

Pus causes, 33 symptoms, 33 treatment, 33

Pyemia, 47, 50 definition, 50 symptoms, 50 treatment, 50

Quinine and urea hydrochloride, 249 indications, 249

Radiograms value of, 205

Ray fungus other name, 136 symptoms, 137 treatment, 137

Raynaud’s disease, 119 diagnosis, 119 symptoms, 119, 121 traumatic, 124 treatment, 119, 123, 124 thrombosis, 120 varieties, 118

Reduction of fractures method of, 163

Red wash, 210 formula, 210 indications, 210

Results of skin grafting, 228

Repair of wounds, 36 by primary union, 37 by granulation tissue, 38 by second intention, etc., 37

Resolution significance of, 32

Reverdin’s method of skin grafting, 223 indications, 223 technic, 223

Rheumatic arthritis, 96 diagnosis, 97 symptoms, 97 treatment, 97

Rigid flat foot, 182 causes, 182 diagnosis, 182 symptoms, 182 treatment, 183

Rubber bandage, 214 indications, 215 technic, 219

Rubefacients, 199 indications, 199 method of use, 199

Rupture of tendo Achillis, 168 diagnosis, 168 symptoms, 168 treatment, 168

Salicylate of mercury, 133 indications, 133 method used, 133

Salvarsan (606), 133 how prepared, 133 indications, 133 technic, 133

Saprophytic bacteria, 6 definition, 6 symptoms, 6 treatment, 6

Sapremia, 49 definition, 49 symptoms, 49 treatment, 49

Sarcoma, 153 definition, 153 manifestations, 153 symptoms, 153 treatment, 153

Saturated sols. boric acid, 25 how prepared, 208 indications, 208

Scarlet red, 213 formula, 214 indications, 213 ointment, 213 powder, 210 symptoms of poisoning, 213 treatment, 214

Schede’s method of operating for varicose veins, 126

Schizomycetes, 6

Sebaceous cyst, 154 diagnosis, 154 symptoms, 154 treatment, 154

Secondary syphilis, 132 stages, 132 symptoms, 132 treatment, 132

Senility as a cause of disease, 100

Senile atrophy, 100 symptoms, 100 treatment, 100

Septic arthritis, 90

Septic phlebitis, 127 causes, 127 diagnosis, 127 symptoms, 127 treatment, 128

Septicemia, 48 causes, 48 definition, 48 symptoms, 48 treatment, 48

Sepsis, 18 causes, 18 diagnosis, 18 symptoms, 18 treatment, 18

Sequestra, 93

Serum therapy indications of, 50, 135 value of, 135

Skin grafting, 222 application of grafts, 226 after results, 228 indications, 222 methods, 223 technic, 224, 225

Sloughing, 34 causes, 34 symptoms, 34 treatment, 34

Silver nitrate, 14 solutions, 210 uses, 221

Sinus, 64 causes, 64 definition, 64 diagnosis, 64 symptoms, 64 treatment, 65

Sodium hydroxide uses, 141

Sodium sulphide, 149

Solutions, 208 boric acid, 208 black wash, 209 bichloride of mercury, 208 balsam Peru, 208 carbolic acid, 121 copper sulphate, 210 Dakins, 209 lead and opium wash, 208 monochloracetic acid, 210 nitric acid, 210 red wash, 210 salicylic acid, 25 saline, 26, 208 silver nitrate, 210 sterile water, 208 Thiersch’s, 208 white wash, 209 zinc sulphate, 210

Solvents, 211 salicylic acid, 211 sodium hydroxide, 212

Spastic flat foot, 180

Spica bandage, 217 of the foot, 218 of the toes, 217

Spina bifida, 76

Spiral bandage of the great toe, 217 technic of application, 217

Special forms of inflammation erysipelas, 135 gonorrhoea, 95 syphilis, 130 tuberculosis, 133 tetanus, 134

Spontaneous hemorrhage, 51 causes, 51 treatment, 52

Spiral fractures, 157 diagnosis, 157 symptoms, 157 treatment, 157

Sprains, 176 definition, 176 diagnosis, 177 symptoms, 176 treatment, 177

Static electricity indications, 201

Staphylococcus pyogenes albus, 16 aureus, 16 citreus, 16

Sterilization, 12 methods, 20 of the dressings, 20 of the feet, 22 of the hands, 21 of the instruments, 21

Stovaine preparations, 251 uses, 45

Streptococcus pyogenes, 16

Strychnine, 45 preparations, 45 uses, 45

Styptics, 211 definition of, 211 adrenaline, 211 hydrastine, 211 iodin, 211 Monsel’s sol., 211 peroxide of hydrogen, 211 alum, 211 copper, 211 nitrate of silver, 211, 220

Stockings, 216 elastic, 216 rubber, 216 uses, 216

Sugar in the urine, 120 significance, 120 treatment, 120

Subastragaloid dislocations causes, 174 diagnosis, 174 symptoms, 174 treatment, 174

Supports for flat foot, 181 indications, 181 uses, 181 varieties, 181

Suppurative phlebitis, 127 causes, 127 symptoms, 127 treatment, 127

Sunlight value, 27

Sutures, 46 uses, 46 varieties, 46

Symptoms of abscess, 66 actinomycosis, 136 arthritis, 91 blastomycotic ulcer, 79 burns, 58 bursitis, 83 callosity, 141 callous ulcers, 68 carbolic acid poisoning, 13 caries, 101 cellulitis, 136 chilblain, 63 contusions, 42 cysts, 154 dermatitis, 135 diabetic gangrene, 120 dislocations, 120 embolism, 119 erysipelas, 135 fibromata, 114 fistula, 64 flexed toes, 184 fractures, 156 frigorism, 137 furuncle, 66 gangrene, 118 gonorrhoeal arthritis, 95 gunshot wounds, 39 heloma, 142, 143 hematoma, 42 hallux flexus, 183 hallux valgus, 185 hemorrhage, 52 hypertrophy of bone, 101 incised wounds, 40 inflammation, 32 ingrowing toe nail, 145 joint fractures, 158 locomotor ataxia, 75 malignant growths, 152 moist gangrene, 119 Morton’s disease, 184 motorman’s foot, 138 myeloma, 116 necrosis, 102 neuropathic joints, 98 onychia, 150 osteitis, 105 osteoma, 115 osteomalacia, 113 osteomyelitis, 113 Paget’s disease, 113 painful heel, 184 periostitis, 104 perforating ulcer, 76 pes planus, 180 phlebitis, 127 primary syphilis, 131 pus, 33 pyemia, 50 Raynaud’s disease, 119 rigid flat foot, 183 rupture of tendo Achillis, 168 sapremia, 149 sebaceous cyst, 154 secondary syphilis, 132 septic phlebitis, 127 septicemia, 48 sinus, 64 sprains, 176 synovitis, 86 syphilis, 130 syphilitic ulcers, 72 talipes (various forms), 189 tetanus, 135 thrombosis, 118 ulcers (various forms), 70 verruca, 139 wounds (different), 44

Synovitis, 86 acute, 86 causes, 86 chronic, 87 symptoms, 87 treatment, 87

Syphilis, 130 acquired, 130 causes, 130 gummata, 132 hereditary, 130 periods of symptoms, 131 primary, 131 secondary, 132

symptoms, 132 transmission, 130 treatment, 132, 133

Syphilitic arthritis, 95

Syphilitic ulcers, 72 causes, 72 differential diagnosis, 73 symptoms, 72 treatment, 74

Syringomyelitis, 76

Talipes, 188 acquired, 192 causes, 188 congenital, 188 diagnosis, 190 pathology, 189 prognosis, 190 symptoms, 189 treatment, 190 various forms, 192, 193

Tenotomy, 191

Tertiary syphilis, 133 causes, 133 diagnosis, 133 symptoms, 133 treatment, 134

Terminations of inflammation, 32 chronic, 33 necrosis, 32 resolution, 32 suppuration, 33

Tetanus, 134 causes, 134 diagnosis, 135 symptoms, 135 treatment, 135

Tetanus antitoxin, 135 indications, 135 value, 135

Thiersch’s skin grafting, 223 indications, 223 method, 224

Thrombus definition, 118

Thrombosis diagnosis, 118 symptoms, 119 treatment, 119

Tourniquet, 53

Toxalbumins definition, 9

Toxemia, 47

Toxins, 9 definition, 9 products, 9

Traumatic arthritis, 90 symptoms, 90 treatment, 90

Treatment of abscess, 66 arthritis, acute, 91 arthritis, chronic, 91 arthritis, septic, 91 arthritis, traumatic, 91 actinomycotic ulcer, 79 blastomycotic ulcer, 79 burns, 60 bursitis, 83 callosity, 142 callous ulcers, 88 carbolic acid gangrene, 121 carbolic acid poisoning, 13 caries, 102 cellulitis, 136 chilblain, 63 contusions, 43 cysts, 154 dermatitis, 136 diabetic gangrene, 120 dislocation of the ankle, 172 dislocation of the astragalus, 175 embolism, 119 erysipelas, 136 fibromata, 114 fistula, 64 flexed toes, 184 fracture of the astragalus, 168 fracture of the fibula, 165 fracture of the os calcis, 168 fracture of the metatarsal bones, 169 fracture of the tarsal bones, 167 fracture of the tibia, 165 frigorism, 127 furuncle, 67 gangrene, 123 gonorrhoeal arthritis, 95 gunshot wounds, 39 hematoma, 42 hallux flexus, 183 hallux valgus, 187 hammer toe, 183 heloma (all forms), 143 hemorrhage, 54 hypertrophy of bone, 101 incised wounds, 44 inflammation, 34 ingrowing toe nail, 147 joint fractures, 158 locomotor ataxia, 75 malignant growths, 152 moist gangrene, 121 Morton’s disease, 184 motorman’s foot, 138 myeloma, 116 necrosis, 102 neuropathic joints, 98 onychia, 151 osteitis, 105 osteomalacia, 113 osteomyelitis, 105 tubercular bone, 109 syphilitic bone, 111 Paget’s disease, 113 painful heel, 184 periostitis, 103 perforating ulcer, 77 pes planus, 181 pes valgus, 192 pes varus, 193 phlebitis, 195 phlegmon, 195 primary syphilis, 131 pus, 33 pyemia, 50 Raynaud’s disease, 119 rigid flat foot, 183 rupture of tendo Achillis, 168 sapremia, 149 sebaceous cyst, 154 secondary syphilis, 132 septic phlebitis, 127 septicemia, 48 sinus, 65 sprains, 176 synovitis, 86 syphilis, 130 syphilitic ulcers, 74 talipes (various forms), 190 tetanus, 135 thrombosis, 119 tubercular arthritis, 94 ulcers actinomycotic, 136 callous, 68 epitheliomatous, 79 diabetic, 75 perforating, 75 syphilitic, 72 tubercular, 74 varicose, 68 verruca various forms, 139 wounds, 44 aseptic, 39 contused, 40 incised, 41 infected, 39 gunshot, 39 lacerated, 44 poisoned, 44 septic, 44

Trench foot, 137 causes, 137 diagnosis, 137 symptoms, 137 treatment, 138

Trendelenburg method for enlarged veins, 126

Treponema pallidum, 15, 130

Trichloracetic acid uses, 210

True subastragaloid dislocations, 174 diagnosis, 174 symptoms, 174 treatment, 173

Tuberculosis, 133 cause, 133 diagnosis, 133 symptoms, 134 treatment, 134

Tubercular abscess, 109 symptoms, 109 treatment, 110

Tubercular arthritis, 92 diagnosis, 93 symptoms, 92 treatment, 94

Tuberculosis of bone, 109 causes, 109 diagnosis, 109 symptoms, 109 treatment, 110

Tubercular ulcer, 74 diagnosis, 74 symptoms, 74 treatment, 74

Tumors, 152

Tumors of bone, 114 fibromata, 114 carcinoma, 115 chondromata, 114 diagnosis, 115 myeloma, 116 osteoma, 115 sarcoma, 115 symptoms, 116 treatment, 117

Thymol iodide, 210 other name, 24 uses, 210

Turpentine, 199

Ulcers actinomycotic, 136 blastomycotic, 79 causes, 67 callous, 67 definition, 67 differential diagnosis, 70 epitheliomatous, 79 diabetic, 75 perforating, 75 symptoms, 72 syphilitic, 72 treatment, 73 tubercular, 74 varicose, 68

Unna’s paste, 219 consistency, 219 how applied, 220 indications for use, 219 method of preparation, 219

Unrolled bandage, 216 disadvantages, 216

Varicose ulcer, 68 cause, 69 differential diagnosis, 70 symptoms, 68 treatment, 71

Varicose veins, 125 bandages used, 126 operative measures, 126 palliative means, 126 resection of internal saphenous, 126 support, 126

Varix, 68, 126

Verruca, 139 etiology, 139 diagnosis, 139 symptoms, 139 treatment, 139, 140 varieties, 139

Vaseline uses, 212

Violet ray, 198

Wart, verruca, papilloma, 139 causes, 139 symptoms, 139 treatment, 140

Wash black, 209 lead and opium, 208 red, 210 white, 209 consistency, 209 uses, 209

Webbed toes, 99 causes, 99 symptoms, 99 treatment, 99

Wet dressings, 207 indications, 207 varieties, 208

Wounds aseptic, 39 classification, 39 contused, 40 gunshot, 39 incised, 39, 41 lacerated, 40 poisoned, 39 punctured, 40 prognosis, 40 symptoms, 44 treatment, 44

X ray uses, 202, 203, 205

Zinc chloride, 24

Zinc oxide adhesive plaster uses, 215

Zinc sulphate, 210 in solution, 210 stick, 211 uses, 211