M iffel Smitiii if pin. 
ANNUAL ADDRESS 
OF THE 
RETIRING PRESIDENT, 
W. W. DAWSON, M. D., CINCINNATI. 
1872. ANNUAL ADDRESS 
OF THE 
RETIRING PRESIDENT, 
W. W. DAWSON, M. D., CINCINNATI, 0. 
I propose to occupy this hour of your time with a few 
reflections upon the American Profession to-day in compar- 
ison to what it was twenty years ago; especially do I wish 
to contrast the teaching of the present with that of the past. 
Annual addresses, both state and national, are very much 
the same; so alike are they that the antiquarian in looking 
over them will imagine them written by the same hand— 
dictated by the same brain. They all eulogize the honor, 
the dignity, the divinity-kinship of the Profession, but 
deplore at the same time the want of a high esprit de corps 
among its members, the fearful ignorance of medical stu- 
dents, and the great defects of medical education. To hear 
these railers you would think we are in a most deplorable 
condition. 
As this has been so general, I think I will be excused 
from departing from a custom so long and so faithfully, if 
not profitably, observed. It may profit us to look at physi- 2 
Annual Address. 
cians as they are; at medical students as we see them scat- 
tered over the land teaching country schools; as we find 
them grouped in medical colleges; and at the manner and 
success of medical teaching. 
Physicians form a large body of men, everywhere needed 
everywhere present, in village, town and city. In charac- 
ter, standing and influence they are in advance of any other 
class. Here and.there an unworthy one is found, but the 
great mass of them are men of temperance, integrity and 
high moral worth. They lead in works of benevolence; 
they respond to the call of humanity ; they leap to the front 
when their country is in danger; they are identified with 
all efforts for the development of man’s physical, moral and 
mental nature. Among themselves an esprit de corps char- 
acterizes their intercourse, to which all other avocations and 
professions are strangers; an esprit de corps which, in its 
high tone, in its utility for protection and defense, in its 
ability to generate and maintain the kindliest relations be- 
tween its members, is a marvel and a wonder to the non- 
professional. 
Who are the medical students found yearly in our medi- 
cal colleges? They are young men gathered, in large pro- 
portion, from country school houses. Many of them have 
graduated at literary colleges; most of them have fair edu- 
cations, and in a very large number of cases the education 
is the result of individual effort. It is from this class of 
self-developed young men that have come the physicians of 
to-day, and from these physicians have arisen the men who 
give distinction to all departments of medicine. I say dis- Ohio State Medical Society. 
3 
tinction, for in many respects the physicians of America are 
the peers of their fellows in any land. 
It will not be inferred that I underrate in the student the 
advantages of a thorough classical education. What I mean 
to say is that the profession is in better condition than could 
be inferred from our annual orations on the defects of med- 
ical education, and what I hope to prove is that the real 
defects are gradually being remedied, and that in time, and 
in a very short time too, medicine here will be as well 
taught, and students will be of as high character as in any 
place on this globe. The marvel is that as much has been 
accomplished as has, when we look at the history of the 
country and the early surroundings of most medical men. 
Surmounting all difficulties, overcoming all obstacles, by 
hard study making up for the deficiencies of thorough early 
training, the American physician to-day stands abreast with 
the most distinguished; he brings his achievements, his 
successes, his improvements, and his discoveries and places 
them by the side of those gathered by the sons of more 
favored lands; these achievements, these discoveries, though 
probably not so numerous, are equally positive, equally mer- 
itorious, are, in fact, great contributions to medical science. 
The reforms insisted upon by those who dwell upon the 
defects of our system of medical education, consist of three 
recommendations: first, a higher standard for the Doctorate. 
Second, longer sessions. Third, graded studies. These are 
important suggestions, and fortunately for all parties, the 
faculties of medical colleges have generally been alive to 
them, and, as I have already said, I hope to show that the 
radical defects of medical education are gradually but stead- 4 
Annual Address. 
ily being remedied, that sessions are gradually being length- 
ened, that lectures with this increase of session necessarily 
become graded, and that the Doctorate yearly advances in 
worth, honor and dignity. This advance is as steady and 
faithful as it is desirable. 
In proof of what I have said, let us look at our colleges, 
the time and manner of teaching, the qualifications of the 
young men who come to be taught, and who, in the end, 
receive the degree. In most of our colleges, in all I may 
say, the length of the session amounts to six months—form- 
erly it was but four, then it was increased to five—now, 
however, with a preliminary course in September, which a 
large portion of the class attends, the session is in reality six 
months long. In less than half a decade, the introductory 
in all colleges to the regular course will be delivered on the 
first Monday of September, and the valedictory on the cor- 
responding day in March. The times demand the advances 
—the colleges will undoubtedly make them. Already gra- 
dation in studies has been adopted by one leading college, 
and its example will be followed by others. The graded 
teaching as established at Harvard can be markedly im- 
proved upon. In many respects it is better than the old 
system of repetition, in some it is not so good, still it is a 
step in the advance, and as far forward as the circumstances 
would justify. 
If you compare the manner of teaching now with what it 
was forty years ago, or even twenty, the improvements will 
be as marked as they are hopefully inspiring. 
Take Anatomy, the basis of the whole structure; twenty 
years ago the Bones and Muscles occupied almost the whole Ohio State Medical Society. 
5 
course; these, with a few, and a very few, lectures on the 
Viscera, Arteries and Nerves, were all that were vouchsafed 
to the student. Now most schools have two professorships 
devoted to Anatomy—one to Anatomy proper, the other to 
Surgical Anatomy. 'Wilson inaugurated a new era in the 
teaching of this important branch ; he brought form out of 
chaos; he showed how to teach anatomy by teaching the 
relations of various parts to each other, and faithfully and 
profitably have the anatomists of the whole world followed 
his example. Now, when a student leaves his college, he 
knows more than the origin and insertion of a muscle; more 
than that an artery is a branch of the aorta; more than 
that the stomach is in the abdomen. lie is taught the situ- 
ation and topography of the organs; the relationship of the 
various parts. He knows where to cut to divide a muscle ; 
he knows where to seek for an artery. I do not overstate 
the fact when I say that the present intelligent and efficient 
manner of teaching anatomy, in comparison to the past, is 
as light to darkness. 
Think for a moment how Chemistry was taught twenty 
years ago, and how it is taught to-day. Then the whole 
ante-holiday part of the session was devoted to the fearful 
Imponderables. In the last half of the term, somewhat of 
Oxygen, Carbon, Nitrogen, Hydrogen, Alkalies, Acids and 
Salts was discussed. Medical Chemistry was not reached; 
the analysis of the secretions and excretions did not enter 
into the list of what was regarded as essential in a medical 
man’s education. Now, however, the graduate, if he has 
been diligent, is master of these subjects; at least he has 
been so instructed that he has all the elements of success. 6 
Annual Address. 
He is drilled in urinalysis; he knows how to examine spu- 
tum ; he can detect poisons and furnish the antidote for 
them ; in fact, he is, or has had the opportunity to be, thor- 
oughly competent to do all those things in Medical Chem- 
istry required in the intelligent practice of his profession. 
In Materia Mcdica, one of my Professors read from dingy, 
smoky manuscript that had seen service for twenty years. 
Once in a while—and a long while—a fresh scrap of white 
new paper could be seen interleaved with the yellow vete- 
rans. Now and then a specimen of plant or of earth or of 
mineral was presented. The dryness, the dullness, the want 
of interest in that course is not easily forgotten. In Ther- 
apy, the student was regaled with learned disquisitions on 
the fluids and solids, and the action of medicine upon them. 
If a man twenty years old in his profession will enter the 
room of the Professor of Materia Medica and Therapeutics 
of to-day, he will be struck with the change. By throwing 
out the hundreds of useless agents and confining himself to 
the essentially valuable, by an intelligent discussion of their 
qualities, uses and indications, by a philosophical estimate of 
their actions, by an accurate knowledge of the parts of the 
body upon which they exert their influence, the Professor 
makes this department one of the most interesting and cap- 
tivating to the student. 
Pharmacy is the legitimate offspring of an advancing, 
demanding spirit in the profession. Compare the elegant 
preparations of our pharmaceutist with the villainous com- 
pounds which were prescribed a few years ago; our patients, 
if not ourselves, have great cause for felicitation. 
Perhaps in no department has twenty years made such Ohio State Medical Society. 
7 
striking changes as in the teaching of Physiology. At that 
time, in most of our schools Physiology was appended to the 
chair of Anatomy, and positively received no attention at 
all. In some schools a seventh chair was added, called the 
Institutes of Medicine ; this embraced, or should have em- 
braced Physiology and Pathology. One of the schools 
which I attended had a Professor of the Institutes; he was 
called a “ Giant in Physiology.” This Giant spent a large 
portion of his time in teaching us Phrenology and Mesmer- 
ism; occasionally he relieved the tedium of these twin sci- 
ences by a lecture on Vital Forces. Another Professor in 
this department lectured from manuscript, from which he 
seldom raised his eyes. These Giants had both been edu- 
cated abroad, and taught Physiology as they had learned it. 
Now the student is taken into the laboratory and taught the 
functions of the body by experiment—by vivisection. The 
gastric fistula by which digestion can be watched and esti- 
mated, is now not an uncommon spectacle in our medical 
colleges. The functions of the nervous, lymphatic and 
glandular systems, the part which the great organs take in 
the animal economy are demonstrated with remarkable 
exactness. 
When we reflect on the manner and success of teaching 
the elementary branches, Anatomy, Chemistry, Physiology 
and Materia Medica of the present in comparison to what it 
was a quarter of a century ago, we can not but be struck 
with the hopeful contrast, and we must admit that with all 
the defects of our system of teaching that it is, all things 
considered, equal to any other department of science or let- 
ters in our new and developing country. 8 
Annual Address. 
This brings us to a review of the present manner of 
teaching the practical branches, the application of the ele- 
ments. And first, I may say that almost everywhere in our 
country, Didactic and Clinical instruction go hand in hand. 
The importance, the absolute necessity of the union, seems 
to be recognized by all. To Cincinnati belongs the honor 
of first uniting in this country a College and Hospital. Dr. 
Drake was the author of this system, and from this initia- 
tive have grown results of the most lasting benefit. Col- 
leges and hospitals are now most intimately associated, not 
usually made one and the same institution, as was projected 
by Dr. Drake, but so associated as to make the Clinics of 
the Hospital complementary to the Didactics of the College. 
But few schools are to be found without a College Dispen- 
sary at which students arc trained in diagnosis and treatment. 
The chair of Gynaecology has been added in most of our 
Colleges, thus rendering the instructions upon the diseases 
of women much more thorough and practical than was pos- 
sible under the old regime. The diseases of the uterus, its 
degenerations, malignant and non-malignant, its changes of 
position and shape, its intimate relations with and modifica- 
tions of its neighborhood, furnish subjects for a full course 
of lectures, the vital importance of which need not here be 
discussed. 
In the Practice of Medicine, the student is no longer sent 
away with theories and prescriptions; educated in the path- 
ology of disease, daily drilled in its diagnosis, he goes easily 
to the best remedies for its treatment. Physical Diagnosis 
is not old, but the last ten years has added very greatly to 
its exactness, to its reliability. The use and value of the Ohio State Medical Society. 
9 
Stethoscope is rendered familiar to the student, because at 
thei bedside lie is taught the interpretation of the sounds 
transmitted through it. He knows when he leaves his Alma 
Mater what this means at the base, and what that means at 
the apex. Thermometry, now so important an adjuvant in 
revealing the vital condition, is taught in the same practical 
manner. The Sphygmograph, a refinement in diagnosis, is 
presented if not estimated. I think it would be difficult to 
find a medical student of two years of age who could not 
tell you when and how to use the Induced Current, and in 
what cases the Continuous Current is applicable. In the 
application, if not in the literature of this great remedy, we 
are certainly not behind the most advanced. 
Added to the curriculum of study almost within the last 
ten years, we have the two departments of Ophthalmology 
and Otology. Of very great practical value in themselves, 
the thorough study of them often throws much light upon 
questions of general pathology. It would be difficult indeed 
to overestimate the advantages which the student now pos- 
sesses in investigating the diseases of the Eye and Ear. 
When we come to review the present with the past of 
Surgery, we may say that in America, Surgery has always 
been well taught, and the world knows how successfully it 
has been practiced. The achievements of American sur- 
geons furnish among the highest adornments of our history. 
With what pride we constantly refer to the triumphs of such 
men as McDowell, Dudley, Mott, Physic, Mussey and 
Blackman. Europe as well as America is filled with the 
renown of many of our leading living Surgeons. The 
Europeans read their books, discuss their papers, use the 10 
Annual Address. 
instruments of their invention, admire and adopt many of 
their original operations. The Foreign Surgeon when crit- 
icizing American surgery is generally just—sometimes un- 
just— occasionally ungenerous. The following paragraph 
from the recent valuable work on the “ Science and Prac- 
tice of Surgery,” by Frederick James Gant, belongs to the 
latter class. In discussing the history of Ovariotomy, he 
says: “ Extirpation of ovarian tumors, cystic or solid, is an 
operation of comparatively recent date suggested by Dr. 
Wm. Hunter, advocated by John Bell, and first practiced 
by Dr. McDowell in 1809, the latter an American pupil of 
John Bell. Ovariotomy is, therefore, unquestionably an 
operation of British origin, and it is to the labors of British 
surgeons that its subsequent progress is chiefly due.” Mr. 
Gant is somewhat more accurate than his neighbor, Mr. 
Butcher, of Dublin, who in a late article attributes to Mr. 
Lizars, of Scotland, the credit of having first performed the 
operation. Mr. Lizars cut into an obese woman in 1823, but 
found no ovarian disease, while Ephraim McDowell, of Dan- 
ville, Ky., performed Ovariotomy successfully in 1809. 
His patient lived for years after. How absurd and unjust 
in Mr. Gant to claim the honor of this great operation for 
British surgery when we remember that Great Britain never 
had a completed case until 1840, nor a successful one until 
1842, and especially as up to that time, the operation had 
been performed in America more than forty times. 
This pioneer operation of Ephraim McDowell may justly 
be regarded as the most daring feat in the history of surgery. 
Imagine his surroundings, in the “backwoods” of Ken- 
tucky—in 1809 it was indeed a backwoods, full yet of In- Ohio State Medical Society. 
11 
dians and wild animals—there, in that almost unbroken 
wilderness, with no counsel, no support, he not only con- 
ceived, but successfully performed that wonderful operation. 
Realize if you can the intrepid heart and force of brain of 
that early American surgeon as he made the first incision in 
that case, as he progressed in that operation—an operation 
hardly thought of, occasionally suggested, but never really 
advised. Picture if it be possible the surroundings of that 
man, and then you may have some idea of his great knowl- 
edge, his wonderful nerve and his unequaled self-reliance. 
Benjamin Dudly was as successful in Lithotomy as is Sir 
Henry Thompson to-day with his selected cases of Lithotrity. 
American surgeons have taught the world that Vesico- 
Vaginal Fistula is almost always remediable. They did not 
originate the operation, but they have shown how it can be 
successfully performed, and that, too, under the most un- 
promising complications. You will realize the truth of what 
I say when I tell you that a colleague of mine, during a 
recent visit to Europe, witnessed the treatment of a case of 
Vesico-Vaginal Fistula in an Irish Hospital by the daily 
application of Nitrate of Silver. The tide of surgical stu- 
dents might with profit be reversed. Such Hospital Sur- 
geons could learn something, could indeed learn much, by 
visiting this country. The relief of one case of Vcsico- 
Vaginal Fistula is worth a lifetime of labor, it is a 
diadem in the crown of a surgeon, and I am proud to .‘ay 
that most American Surgeons have a number of these jewels. 
Pulleys and Adjusters have given way to manipulation in 
the reduction of dislocations ; the key to this was furnished 
a few years ago by a New York surgeon. AVhat a revolu- 12 
Annual Address. 
tion in the treatment of fractures we have made by elastic 
extension and sand bags. The surgeons of all countries 
read Dr. Hamilton’s book on “Fractures and Dislocations.” 
They read it because it is the best book in any language. 
For the general practitioner what work can be compared to 
Gross’ System of Surgery. 
A new era has dawned in the treatment of joint diseases, 
especially disease of the hip, and it is doubtless true that 
the most valuable contributions are due to the learning and 
skill of New York surgeons. AY here except in this country 
elo you finel Morbus Coxarius so treated as to secure com- 
plete use of the limb and joint ? 
I might extend this list of American contributions to sur- 
gery very greatly, and with instances equally striking as 
those already presented, for it can not be denied that in sur- 
gery we have given as much as we have received. And 
here I may make the pertinent inquiry, if our system of 
medical education be so defective, why this great excellence 
in the men who have been educated by it? It is unusual 
to see such fruit from a tree that is all unsound. 
The annual examination for the degree of Doctor of Med- 
icine in most of our colleges is now made by written ques- 
tions and written answers; thus a better knowledge of the 
student’s ability is obtained than by a thesis written in his 
own room, with books and his room-mate or some medical 
friend to draught upon. The plan is essentially the same as 
that adopted in Great Britain in the examination for De- 
grees, License, for Hospital Interne, and entrance into the 
Army, Navy or India service. And now let us look for a 
moment at the questions presented in this country and in Ohio State Medical Society. 
13 
Europe. For comparison, I take those given by the Staff 
of the Cincinnati Hospital at the last_ examination for In- 
ternes, and those adopted by the Faculty of one of our Col- 
leges at a recent examination [for the Degree. I use the 
questions of these two institutions because I happen to be in 
possession of them—I have no doubt, however, but that 
they are fair types of those used in most of our colleges and 
hospitals. 
Questions submitted to the Candidates for the position of Interne in Cin- 
cinnati Hospital, 1872. 
Obstetrics.—1. Name the positive signs of pregnancy. 2. What 
presentations are unnatural, requiring interference? 3. Where the 
face presents, what relation must its long diameter sustain to the 
inferior strait for safe delivery? 4. How is assistance to be rendered 
when the presentation is distending the perineum? 5. Where and 
how soon should the funis be tied after the expulsion of the foetus? 
6. What are the signs of placenta previa? 7. Name the displace- 
ments of the uterus. 8. Name the symptoms of prolapsus uteri. 9. 
How would you treat dysmenorrhoea ? 10. How would you treat 
amenorrhoea ? 
Ophthalmology.—1. How would you treat foreign bodies lodged 
in the cornea? 2. Give a differential diagnosis of simple conjunc- 
tivitis and iritis. 3. What is accommodation, and how is it effected ? 
4. What is the difference between presbyopia and hypermetropia. 5. 
What nerves supply the muscles of the eyelids and eyeball ? 6. Give 
the diagnosis, course and treatment of ulceration of the cornea. 7. 
Give the diagnosis and symptoms of cataract. 8. Describe the treat- 
ment of diphtheritic conjunctivitis in its three stages. 9. Give the 
diagnosis and treatment of acute granulations. 10. Describe the dif- 
ferent methods of operating for entropion of the lids. 
Surgery.—1. In strangulated hernia what difference in the direc- 
tion of the division of the strictures is necessary to avoid the internal 
epigastric artery in cases where that stricture is at the internal ring, 
and in others where the stricture is at the external ring ? 2. What is 
the condition of the skin in eczema, the pathological products of that 
disease, and its chief symptoms? 3. Name the common forms of gan- 
grene ? 4. What effects may be obtained from poultices, and mention 14 
Annual Address. 
some of the conditions indicating their use? 5. What lesion of the 
alimentary canal is apt to occur in cases of burn? 6. At what point 
is the clavicle most frequently fractured? state the symptoms indica- 
ting such injury, and what are the chief indications in the treatment? 
7. At what portion of the urethra is stricture most frequent? 8. 
State the chief characteristics of the initial lesion or sore of syphilis, 
and those of the soft sore or chancroid respectively. 9. What is 
Hunter’s method of ligature of arteries for aneurism, and the prin- 
ciple on which it is based. 10. Mention different means for the arrest 
of hemorrhage. 
Practice of Medicine.—1. What is your method of taking the 
clinical history of a patient ? 2. How do you distinguish between 
pleuritic effusion and consolidation of the lung from pneumonia? 3. 
Give the diagnosis and treatment of pericarditis. 4. What patho- 
logical conditions may produce dropsy ? 5. How would you proceed 
to investigate a specimen of urine? 6. On what different patholog- 
ical conditions may Bright’s disease depend? 7. What conditions 
may produce hemiphlegia ? 8. What is the difference between dysen- 
tery and diarrhoea? 9. What causes may produce obstinate consti- 
pation ? 10. Give the symptoms and treatment of delirium tremens. 
Pathology.—1. OHgin of pus corpuseles. 2. Pathology of throm- 
bosis. 3. Pathology of embolism. 4. Minute anatomy of healing by 
granulations. 5. Pathology of miliary tubercle. 6. Pathological 
characters of a malignant as distinguished from a benignant tumor. 
7. Morbid anatomy and pathology of cerebral hemorrhage. 8. Path- 
ology of cardiac hypertrophy. 9. Pathology of aneurism. 10. Mor- 
bid products in pleurisy and the manner in which they are disposed of. 
The following questions, ten in each department, were submitted to the 
graduating class of 1872 in the Medical College of Ohio. 
Anatomy.— 1. Give a general description of the skeleton. 2. 
Describe the os femoris. 3. What are the essential components of an 
entirely movable joint? 4. Describe the elbow joint. 5. Describe 
the heart. 6. Give its position. 6. Describe the larynx. 8. De- 
scribe the trachea, bronchi and bronchia. 9. What are the envelop- 
ing membranes of the cerobro-spinal axis? 10. What are the great 
divisions of the encephalic mass, and their relation ? 
Surgical Anatomy.—1. What is the best place for ligating the 
common carotid artery, and what are its relations at that part ? 2. 
Popliteral artery, where found and relations? 3. What are the ana- 
tomical objections to ligating the first and second portions of the sub- Ohio State Medical Society. 
15 
clavian artery ? 4. Scarpa’s triangle, boundaries and important parts 
contained. 5. By what muscles is the inner border of the foot ele- 
vated? 6. Fractures in upper third of radius, in what position best 
treated and why ? 7. What are the parts divided in the lateral ope- 
ration of lithotomy ? 8. Surgical anatomy of the shoulder joint. 
9. Surgical anatomy of the elbow joint. 10. Surgical anatomy of the 
hip joint. 
Physiology.—1. The digestive juice with the widest range of 
action, and its chief ingredients? 2. Trace fat through the system. 
3. The cause or causes of circulation in the veins? 4. Capillary cir- 
culation, continuous or intermittent, in either case why? 5. Chief 
use of the red blood corpuscles? 6. Uses of sweat? 7. The imme- 
diate and subsequent effect of wounding the cerebellum ? 8. The 
diurnal range of temperature and the variations compatible with 
health? 9. The necessary quantity of air in cubic feet for twenty- 
four hours? 10. Describe a spermatozoid. 
Chemistry.—1. Enumerate the general properties of acids and 
bases. 2. Give the composition, formula, and mode of preparation of 
hydrochloric acid. 3. Describe the tests for arsenic. 4. What is the 
antidote to arsenic and how prepared. 5. Describe normal urine. 
6. How is urea obtained from urine? 7. How are chlorine, sulphuric 
acid, potassium and sodium detected in urine? 8. Describe the tests 
for sugar in urine. 9. How would you determine whether a deposit 
consists of urates, phosphates, oxalate of lime or uric acid ? 10. How 
would you discover blood in urine ? 
Surgery'.—1. What are the various processes by which fractured 
bones unite ? ' 2. What are tne means you would use for strangulated 
hernia before resorting to an operation, and, failing in these, what are 
the operations recommended, and the advantages of each? 3. In 
what injuries of the ankle joint is deformity inevitable? 4. What 
are the stages of hip-joint disease, and the treatment of each stage ? 
5. How would you treat wounds of the stomach ? 6. What are the 
indications for amputation? 7. Describe the various methods of acu- 
pressure. 8. Differentiate between intra and extra-capsular fracture 
of the neck of the femur. 9. Differentiate between abscess, encepha- 
loid, aneurism, hernia and adenoma. 10. Name the principal disease 
which affects bones. 
Practice.—State the prominent facts in the clinical history of 
malarial fevers. 2. What is the cause, course and termination of 
hepatic abscess? 3. What are the symptoms and dangers of desquam- 
ative nephritis? 4. Diagnosis between real and feigned epilepsy. 5. 16 
Annual Address. 
How treat habitual constipation ? 6. What are the physical signs of 
pericarditis? 7. Diagnosis between peritonitis and enteritis. 8. How 
distinguish fixed neuralgia from inflammatory pain ? 9. Give the 
dry and moist rales; what do they indicate ? 10. How would you 
treat cardiac hypertrophy ? 
Gynaecology.—1. Describe the uterus; location, size, weight, di- 
vision, structures. 2. In what particular does tbe neck of the worn 
differ from the body of the womb ? 3. Describe ovulation and men- 
struation. 4. What circumstance would enable you (if possible) to 
determine the difference between specific and non-specific vaginitis? 
5. Mention the most common diseases of the uterus in the order of 
their frequency. 6. Name the various substances that may be ex* 
pelled from the female pelvic organs. 7. Give the probable and posi- 
tive evidences of the existence of uterine cancer. 8. Mention the 
forms of dysmenorhcea and differential diagnosis. 9. What are the 
conditions capable of producing amenorrhcea? 10. What are the dis- 
eases which may produce pelvic abscess? 
Obstetrics.—1. Give positive signs and duration of pregnancy. 
2. Give diameter of pelvis at brim and outlet. 3. Give diameters of 
foetal head. 4. Describe the anterior and posterior lateral inclined 
planes, and their relations to the mechanism of labor. 5. Give the 
four cranial presentations, with the diagnosis of the first. G. Man- 
agement of natural labor. 7. Under what circumstances would you 
turn, and how? 8. Cause, symptoms and treatment of unavoidable 
hemorrhage. 9. Cause and treatment of post-partum hemorrhage. 
10. Symptoms and treatment of puerperal convulsions. 
Ophthalmology.—1. Name the bones that form the orbit. 2. 
Name the muscles found in the orbit, giving the nerves that innerv- 
ate them. 3. Giving a case of internal squint, how could you tell 
whether it was paralytic or not? 4. Give the condition of the lids in 
ptosis and facial paralysis, with the muscles and nerves involved. 5. 
Give the structure of the eye from before backwards. 6. Give the 
points of differential diagnosis in the various conjunctival inflamma- 
tions. 7. Differential diagnosis of iridal and corneal inflammation, 
with the general plan of treatment in the latter and the particular of 
the former? 8. Of what does the lachrymal apparatus consist, and 
what may interfere with the carrying off of the tears? 9. What is a 
cataract, and what is its treatment? 10. What are the two methods 
of examining the eye with artificial light? 
Materia Medica.—1. Why is cod liver oil the best form in which 
to administer a fat? 2. Describe the effects of arsenic on the primary Ohio State Medical Society. 
17 
assimilation. 3. Name the preparations of arsenic, and the dose of 
each. 4. Give the composition of opium. 5. What is the treatment 
of opium narcosis? G. What practical test for the purity of chloro- 
form may be made at the bedside? 7. In danger from chloroform nar- 
cosis what methods of resuscitation are proper? 8. What is the dis- 
tinction between Galvanism and Faradism ? 9. To what class of cases 
are these two forms of electricity especially applicable ? 10. Write a 
prescription for a purgative pill. 
Questions at the examination of Candidates for the Enylisli Indian 
Medical Service. 
Ax atomy axd Physiology—1. Give a general description of the 
spinal column, and of the course of its ossification. 2. Describe the 
mode of development of a vertebra in general, indicating the excep- 
tional cases, (exclusive of the sacrum and coccyx.) 3. Enumerate 
the various muscles and describe their respective functions, by which 
the deformity witnessed in the following fractures is probably caused : 
1st, Fracture of the neck of the femur; 2d, Fracture of the lower 
end of the femur immediately above the condyles; 3d, Fracture of 
the lower end of the radius, (Collis’s fracture.) 4. Describe the arch 
of the aorta, the relations of its various positions, and the dissection 
necessary to examine it; mention also the principal variations in the 
positions of its branches. 5. Describe the parts contained in the 
space bounded in front by the posterior border of the sterno mastoid, 
behind by the anterior border of the trapezius, and below by the 
clavicle. 6. Give a general account of the lymphatic and lacteal 
system, including the minute structure of the lymphatic vessels and 
glands. 7. Describe the physiological effects of the division of the 
vagi nerves. 8. Mention the parts in other vertebrate animals which 
are homologous with the human hand or parts of it. 
Surgery.—1. Describe the states named respectively “shock” and 
“ reaction ” as seen in such a case as that of a crushed limb. 2. Enu- 
merate the chief varieties of inflammation of the testicle, and state 
the distinctive characters of each. 3. Give an account of secondary 
hemorrhages such as may occur after amputations, and of the best 
modes of treating them. 4. What ill consequences may follow dis- 
secting wounds, and what are the best means of treatment, preventive 
and curative ? 5. What are the chief means by which in the treat- 
ment of hernia the taxis may be assisted, and in what conditions is 
each of them most useful? 6. Describe the process of repair of a 
tendon after subcutaneous section. 7. Describe the several diseases 18 
Annual Address. 
of the eye that are connected with syphilis and gonorrhoea. 8. A 
man fifty-three years old, while under treatment for slight stricture of 
the urethra, was exposed to cold, damp weather; the next day had a 
severe rigor,'followed by heat and sweating, and completely lost the 
power of passing urine. On each of the next two days he had simi- 
lar rigors, and on the third day he was not only still unable to pass 
urine, but had constant straining and extreme pain in his endeavors 
to do so. During three days more these symptoms continued, with 
rigors, and there were gradually added to them pain in the perineum 
and about the arna, tenderness on deep pressure in front of the anus, 
and heavy forcing pain referred to the lower part of the rectum. The 
bladder was regularly emptied with a catheter and was not painful on 
pressure ; the urine was generally healthy. Diagnose this case and 
give treatment. 
Questions submitted to Candidates at the primary examination for the 
Diploma of Membership of the Royal College of Surgeons, London. 
Anatomy and Physiology.—1. Describe the boundaries of the 
posterior mediastinum and its contents in their relative position. 2. 
Describe the structure of veins, and the forces by which the venous 
circulation is carried on. 3. Describe the ligaments of the hip joint, 
and mention the muscles in contact with its capsule. 4. Give an 
account of any experiments with which you are acquainted illustrat- 
ing the influence of the pneumogastric nerve upon the action of the 
heart. 5. Describe the ligaments connecting with the clavicle, and 
mention the parts that pass beneath it in their relative positions. 6. 
Describe the ciliaris muscle and its action. 
Surgery and Practice of Medicine.—1. How would you dis- 
tinguish, surgically, chronic induration of the breast from scirrhus? 
What are the microscopic appearances by which each is characterized ? 
2. Describe the operation of excision of the elbow joint, and state 
under what circumstances it may be required. 3. What treatment 
would be required in a case of incised wound of the cornea, with pro- 
trusion of the iris? Mention the consequences which may ensue, and 
the proper mode of dealing with them. 4. What are the causes 
which may impede the union of a fracture of a long bone? Describe 
the mode of treatment which might be resorted to in order to pro- 
mote the union of an united fracture. 5. Describe the deligation of 
the right carotid artery in the first part of its course, giving the exact 
relations of the parts concerned in the operation. 6. Mention the 
different forms of mevus and appropriate modes of treatment. 7. De- Ohio State Medical Society. 
19 
scribe a case of paralysis of the facial nerve, and mention the causes 
upon which it may depend, and the treatment you would adopt for 
its relief. 8. What are the circumstances which would induce you to 
have a recourse to thoracentesis in a case of effusion in the pleural sac, 
state how you would perform the operation, and the changes that 
would follow it. 9. Write prescriptions in Latin in full, and direc- 
tions in English for a diuretic mixture and a purgative powder, and 
give composition and doses cf the following preparations: Pulvis 
Jalapse Composita; Mixtura Ferri Composita; Tinctura Camphora 
Composita ; Liquor Morphia Hydrochlor. 
In the exhibition of these questions I trust I have not 
been tedious. I have ventured upon them for herein lies 
the argument, we see by them that our schools and hospi- 
tals take as wide a range and ask as difficult questions as is 
done by examining bodies elsewhere. These questions show 
the extent of teaching, and it will not be contended that a 
young man who answers seventy per cent, of them is not 
well educated. The lesson of this whole matter is, that the 
Profession in this country is not in as bad condition as 
would be inferred from these periodical complainers. 
In Medical Literature America certainly stands well; our 
books are read in all countries. In Surgery, Medicine, 
Therapeutics, Physiology, Chemistry, Obstetrics, Gynaecol- 
ogy, our authors have won well-merited fame. Our Medi- 
cal journals are yearly by their merits challenging recogni- 
tion. It is said that they contain much trash; this is true, 
but it is equally true of foreign periodicals. It is not all 
wheat within the lids of any medical work, unadulterated 
wisdom is not found in medical journals; I do say, how- 
ever, that brains predominate in our medical literature. 
Thus by the steady advance in the manner and efficacy of 
teaching, by the yearly improvement in the preliminary edu 20 
Annual Address. 
cation of students, by the increase in the length of the lec- 
ture term, and what is still better than all, by an enthusi- 
astic love of the profession, our Medical Colleges will 
annually send out a class of young men from whom may 
be expected the best of things; many of them will take 
high rank, and distinguish themselves in fields where dis- 
tinction is the result of true worth.