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.
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 namedanesthiferous. 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.
Cocaineoccurs 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 ofthe 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:
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 purposeexcept 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 chemicalsubstances 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 solutionsrequire 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:
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 ofethyl 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 oflimited 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.
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.
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.
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.Bbacillus.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.Ccalcareous.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.
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.
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.
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.
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.Ddactyl.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.
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.
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.
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.Ffacet.A small plane, articulating surface.facient.To make, as in rubefacient, to make red.
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.
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.Ggangrene.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.Hhabitat.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.
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.
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.
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.