22 TREATMENT OF MEDICAL EMERGENCIES. 6. Nasal hemorrhage frequently calls for the physician's aid. It occurs also in connection with typhoid fever and cirrhosis of the liver, but also in association with heart disease, and sometimes cannot be accounted for. The simplest measures for its relief are snuffing up cold water or solution of alum in water, a teaspoonful in eight ounces, injecting hot water into the nasal passages, and the use of ice externally. The dropping of a cold key down the back of the neck is a domestic remedy whose success is not without a rational explanation. The sudden impression of the cold key through a reflex action may cause a contraction of the blood-vessels, and then the hemorrhage ceases. Plugging the nares with a Bellocq's canula or other means should be practised when all else fails. The checking of nasal hemorrhage, or, indeed, of all hemorrhage, is aided by keeping the patient quiet in bed, and sometimes when there is a tendency to recurrences it is necessary to keep him on his back for several days. 7. Suffocation or asphyxia, for whose relief the physician is often called, is a term applied to the effects of suspended breathing, whether the result of interference with that function or of the introduction of the so-called irrespirable gases, by which are meant gases incapable of oxygenating the blood, although in the case of many there is added a specific poisonous effect. The former include such gases as hydrogen and nitrogen, the latter carbonic acid, carbonic oxide, chlorine, sulphuretted hydrogen, and chloroform vapor. Submersion in a liquid medium, as in drowning, acts similarly. In fact, it is for asphyxia due to such causes as the irrespirable gases and drowning that the physician is called. Sometimes it is on account of obstruction of the air-passages by foreign bodies, or, as in the case of the new-born infant, of pressure on the trachea and thorax. The phenomena first noted are those of forced respiration accompanied by forced lividity of the skin and mucous membranes. The increased effort at breathing is due to the circulation of nonoxygenated blood through the medulla oblongata, which is the respiratory centre, as well as through irritation of the peripheral branches of the vagi. These phenomena are succeeded by convulsions if the patient is not relieved, and finally the respiratory centre becomes paralyzed. This termination is, however, not only subsequent to the paralysis of the reflex convulsive centre (the spinal cord), but also to the brain lesions. Hence the patient remains conscious almost to the end, or, at least, until the convulsions set in. The successful treatment of asphyxia depends upon the fact that the heart continues to beat long after respiration ceases, and upon this fact, too, depends the wonderful capacity for resuscitation which exists in those apparently drowned or otherwise apparently dead from suffocation. The first indication is, of course, to supply oxygen, the want of which is responsible for all the symptoms. If there is obstruction of the air-passages by a foreign body, it must be removed, or tracheotomy must be performed. If the action of the muscles of respiration is interfered with, the interfering cause must be removed. If the patient is in an atmosphere of scanty oxygen or of irrespirable gases, he must be removed to fresh open air. In slighter degrees of asphyxia, such as are seen in the new-born infant, slapping the face with the bare hand or with a wet towel, or dashing cold water upon it will often have the effect of exciting the breathing act and of aërating the blood. If these measures are insufficient, then artificial respiration must be practised by some one of the usual methods, as that of Sylvester or Marshall Hall. In apparent drowning, faradization or galvanism of the phrenic nerve may be used, especially one pole being placed over the nerve as it crosses the scalenus muscle at the root of the neck, and the other at the epigastrium. Finally, disagreeable as it is, I am confident I have seen mouth to mouth insufflation in the new-born infant produce the first stimulus to inspiration which was the initial element in resuscitation. In the case of others, of course, as the apparently drowned, at any age, it is not to be relied on.-University Medical Magazine. 24 THE NORTH CAROLINA MEDICAL JOURNAL. A MONTHLY JOURNAL OF MEDICINE AND SURGERY, PUBLISHED IN WILMINGTON, N. C. THOMAS F. WOOD, M. D., Wilmington, N. C., GEO. GILLETT THOMAS, M. D., Editors. Original communications are solicited from all parts of the country, and especially from the medical profession of THE CAROLINAS. Articles requiring illustrations can be promptly supplied by previous arrangement with the Editors. Any subscriber can have a specimen number sent free of cost to a friend whose attention he desires to call to the JOURNAL, by sending the address to this Office. Prompt remittances from subscribers are absolutely necessary to enable us to maintain our work with vigor and acceptability. All remittances must be made payable to THOMAS F. WOOD, M.D., P. O. Drawer 791, Wilmington, N. C. THE STUDY OF ANATOMY NEGLECTED-RESULTS OF THE ANATOMY EXAMINATIONS FOR THE YEARS 1887, 1888 and 1889-A LIST OF QUESTIONS IN ANATOMY FOR 1889. We have before us a very interesting letter from Dr. P. L. Murphy, the Examiner in Anatomy of the present Board of Medical Examiners, a part of which we are at liberty to use, and we do it. principally to show how much neglect there is in teaching anatomy to medical students in some of the schools. In 1887 forty-six men applied for license. Of this number 33 obtained license, 13 failed, 14 passed on anatomy; that is to say 14 answered, by estimation, 70 per cent. or more of the questions asked, 32 fell below 70 per cent. In 1888 there were 51 applicants, 36 obtained license and 15 failed; 35 failed on anatomy and 16 passed. In 1889 there were 50 applicants, 37 obtained license, 13 failed; 31 failed on anatomy and 19 passed. The above is expressed in the following table: It will be seen by the above that just one-third of the applicants passed their examination, and Dr. Murphy says that there was only one who passed in anatomy and failed to get his license. He points out, though, that there has been an improvement in the number who passed in this branch, being, in 1887, a little less than a third, and in 1889 a little more. He seems to be impressed with the idea, and we agree with him, that, as a general statement, the applicants who are well-grounded in anatomy are also better prepared on other subjects, and that the increasing thoroughness at the medical schools is showing itself in this direction. It is only a beginning, however, and we are of the impression that the increased ratio of better preparation on anatomy in 1889, was due to the considerable number of University of Virginia men. The questions given below are for three separate years, and the value of each question was printed below it; this we omit: Examination on Anatomy before the North Carolina State Board of Medical Examiners. First Year. Ques. 1. Describe the inferior maxilla. Ques. 2. Describe elbow joint; name and give attachments of the ligaments of the joint. Ques. 3. Name the muscles of shoulder; their origin, insertion and action. Ques. 4. Describe the popliteal artery; its relation and branches. Ques. 5. Describe the spermatic veins, and indicate the difference, if any, between the right and left. Ques. 6. What nerves form the lumbar plexus? Give the position, relations, etc., of this plexus and the course and distribution of the genito-crural nerve. Ques. 7. Ques. 9. Describe the annular anterior ligament (of wrist). Describe the crystalline lens and its capsule. Describe the lungs-their position, size, shape, lobes, etc., and also the structure of the lungs. Ques. 10. Give the boundaries of the perineum. Ques. 1. Second Year. Describe the lower extremity of humerus and the upper extremities of radius and ulna. Ques. 2. Name and give attachments of the ligaments of shoulder joint. Ques. 3. Name and give origin and insertion of the five muscles of anterior femoral region. Ques. 4. Describe the arch of aorta (ascending and transverse), its relations and branches. Ques. 5. Describe the coats of arteries. Of veins. Ques. 6. Give origin, course, relation, branches and distribution of great sciatic nerve. Ques. 7. Name and describe the lining membrane of the thorax. Ques. 8. Describe the stomach-its size, position, divisions, relations and its coats-and give structure of the coats. Ques. 9. ducts. Ques. 10. Name and give position of salivary glands and their Describe the maleurethra-its divisions and the other points of interest mentioned by anatomists and surgeons. Third Year. Ques. 1. Describe the zygomatic process of temporal bone including the glenoid fossa. Ques. 2. Name and describe the ligament of the hip-joint. |