CHAPTER XX

+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.