Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 107

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189

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iring mind was not satisfied with description; it must compare. The bodies of men as opposed to women, the parative study of different parts (e. g., the foot) in man animals and birds, the differences of structure at different , the protective intentions of nature, as shown by the es running along the sides of the fingers, instead of on front or back, all were studied or noted for study by him. observed the differences in the blood vessels in youth and

in age, and so foreshadowed the recognition of that disease which kills more people over fifty years of age than any other.

Had his accomplishments been less burdensome, had his genius been less universal, had he been permitted to make generally accessible to others what he knew himself, he might easily have shown himself to be as great an anatomist as Vesalius and still have had time to paint the Mona Lisa. Then the honor of founding modern anatomy would have belonged to Italy rather than to Belgium.

EMBRYOLOGY AND OBSTETRICS IN ANCIENT HEBREW LITERATURE .*

By DAVID I. MACHT, M. D.

le origin of life, the development of the human being, irth of the babe and the growth of the child have always pied a prominent place in the literature and religions of rimitive peoples, and in none a more important one than idaism, which considers the injunction " be fruitful and iply " (Gen. I, 28) as the first commandment of the lation, and the perpetuation of the race as the sacred of mankind, and which brands as crime and moral mur- ny interference with the normal development and growth e species from its very incipient stage to the time of its . It is therefore not surprising to find that embryology obstetrics receive more attention in the early Hebrew ngs, and more particularly in the Talmud and the Madra- , than any other medical subject.

ferences to the earliest stages of embryonic development ound as far back as the Bible. In Psalm CXXXIX, , we read :

being was not concealed from thee, when I was made in , when I was embroidered in the lowest parts of the earth. undeveloped substance did thy eyes see; and in thy book ill of them written down-the days which have been formed, yet not one of them was here.

1 in Job X, 10-12, we find the following :

›ld, like milk didst thou pour me out, and like cheese didst urdle me. With skin and flesh didst thou clothe me, and one and sinews didst thou cover me. Life and kindness hou grant me, and thy providence watched over my spirit.

general Hebrew name for the product of conception tri habbeten " or " fruit of the body." The earliest n the development of the embryo is termed " golem," e borrowed from the passage in the Psalm CXXXIX toted, and which literally translated means something less and rolled up "-an undeveloped substance. In ther development of the embryo various stages are dis- hed by the Hebrew sages and are designated by special

The first stage begins with the " golem " or unde- substance and extends through a period of forty-two

days or six weeks. The fœtus at the end of this period is known as "shefir merukkam," or embroidered membrane, clearly referring to the developing ovum with its membranes. The physician Samuel, in the second century (?) studied the embryo at this stage; and we are told that the eyes, nose and mouth can now be distinguished, the whole creature re- sembling a " grasshopper." In the Tractate Niddah 25 a, we read :

The wise men learned, what is a "shefir merukkam "? Its eyes are like unto the two dots of a fly and are separate from each other; its two nostrils are like unto the two points of a fly but merge into each other; its mouth is fine like unto a fine hair; and its hands and feet are still unfashioned.

A second stage is distinguished from the sixth week to the fourth month. The embryo is now called an " ubbar," a passive participle, meaning literally "something borne or carried." It is the ordinary Hebrew word for a "fœtus." So is the mother spoken of as " meubbereth," or one " loaded down "-gravid, and the period of gestation is known as "yemay-ha-ibbur," or the days "of being loaded down "- of gravidity. At this stage, we are told, one can recognize the fingers and toes, the hair and the nails, and also the genitalia (Niddah 25 a). The growth of the hair is an im- portant step in the development. We read " the work is not permanent, until the hair hath cropped out " (Niddah 25 b).

With the fourth month, we come to the third stage in the development. The fœtus is now no longer " like unto a grass- hopper," but looks like a human being, and is now spoken of as " welad," a child. This " welad " or child, on reaching the seventh month, is known as " welad shel kaymo," a " viable welad," or a child that can survive. The Hebrew scholars looked upon a seventh-month baby as capable of surviving. In the eighth month, the Aristotelian notion prevailed, that the chances were not so good as in the seventh.

A fully developed fœtus is known as " ben she-kallu chad- doshow," " a child whose months have been completed."

An abortion or miscarriage is known in Hebrew as a " nefel," or something dropped.

In regard to the maturation of the ovum, the ancient He- brews seem certainly to have recognized that for the develop-

! before the Johns Hopkins Hospital. Historical Society ar 12, 1910.

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JOHNS HOPKINS HOSPITAL BULLETIN.

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ment of the primitive germ there must be a union of male and female elements.

"Three partners," we are told, " contribute to the develop- ment of man: the father and mother, and the Holy One, blessed be His name. The father soweth the white and the mother soweth the red; God giveth spirit and life " (Niddah 31). Of the male and female elements, it is the nuclei or " kernels," as the scholars put it, that are the essential parts. (Sabin III-Midrash Rabba. 3 M. 14.)

In regard to the order of development of various parts, the general opinion was that the head first developed, then the body, and other parts; but a few maintained that the center of development is the umbilicus, evidently bearing in mind the attachment of the cord with its nutrient vessels.

The position of the fœtus is briefly thus described: " In the first three months, the child is below (that is inside the pelvis) ; in the second three months it is in the middle (that is between the pubis and umbilicus) ; and in the last three months it is at the top or at the level of the umbilicus " (Niddah 30). This served well as a rough means of deter- mining the age of the fœtus. The position of the child inside the membranes was regarded as perfectly free, that being the function of the amniotic liquid.

" It floateth like a nut-shell on the waters, and moveth hither and thither at every touch " (Mid. R. 3 M. 14).

The child at full term is graphically described as follows, in a passage which has become classical and is often quoted by Hebrew writers :

Rabbi Simlai lectured: the babe in its mother's womb is like unto a rolled up scroll, with folded arms it lieth closely pressed together, its elbows resting on its hips, its heels against its buttocks, its head between its knees. Its mouth is closed; its navel open. It eats its mother's food, and sips its mother's drink; but it doth not excrete for fear of hurting. Now when the time hath come, that which is closed is op'ed, and what was open closeth, behold the child is born. (Niddah 30 b.)

When we now turn to obstetrics proper, we are struck by the wealth of anatomical terms. The following is a list of the terms applied to various parts of the organs of generation :

Uterus = rechem. Mons == kaf tappuach.

Vulva = erwah.

Rima pudendi == beth ha-sesarim (Niddah 66 b).

Vestibulum vaginæ == beth hizon (Niddah 41 b). Orificium urethræ = lul (Niddah 17 b).

Hymen = be-thulim.

Ostium vaginæ == beth shinnayim.

Vagina = beth teref, beth rechem (Niddah 64 a). Septum vesico-vaginale = karka prozdor. Canalis cervicis uteri = mokor (Niddah 41 a). Cavum uteri = cheder, beth herayon. Fætal membranes = shefir. Placenta = shilyoh.

Ovary and tube = shelil shel bezim (Bezah 7 a).

The diagnosis of pregnancy was made practically by the same signs as now. The signs of pregnancy are divided into . .: the positive signs and the presumptive signs. The

positive signs were regarded as coming from the fœtus. the perception of its movements, the palpation of its per. The chief presumptive signs were the suppression of mx." ation, the appearance of colostrum, changes in the size : consistency of the uterus, and various subjective sump .: A peculiar gait is spoken of, as characteristic of a pe. pregnancy. Some obscure passages in the treatise No. seem to refer to what may be taken as a molar pregnancy " hydatidiform mole," and there are certainly references" what may be regarded as extra uterine pregnancies.

The signs of former pregnancies, or of labor recently g: through, are cervical and other tears, and the prex Dior rests of placenta or membranes.

An intact hymen, though a presumptive evidence of : ginity, is not regarded as an absolute proof. Cases are . scribed of coitus with unruptured hymen (Chagiga Iba).

Menstruation plays such an important rôle in the fix life of the Jews, that a separate paper could be written 60 24 subject. Here we shall merely mention a few salient pz

The age of puberty is by Jewish law set for the male at ? completion of his thirteenth year, for the female at the c. of her twelfth year. In the Orient, as is well known, mensc: ation begins at an earlier age than in the Occident. And. of puberty were regarded the growth of pubic and ariky hair, development of the breasts, elasticity of the mamis pigmentation of the areola and various changes abou: genitalia.

The type of menstruation was studied especially in reg- to a determination of the time of its approach. The Jer required by law to separate himself from his wife a before the approach of her menses, and not to approach until after she has dipped in the ritual bath or " miker!" seven days after their cessation. Three types of menstroar were distinguished : In the first type, the periods retur : certain definite regular intervals of time; in the second top. the return is not so regular as to time, but is preceded various premonitory symptoms or signs, such as headsc: pains in the abdomen, backache, heaviness in the limbs, ;r- menstrual chills and fever, etc .; in the third type are ?. all the irregular cases.

Infantilism and under-development, with their consegues amenorrhœa and sterility are treated under a special head .: called Ai-lo-nith. In connection with amenorrhoea and die menorrhea I may mention their treatment by the emply ment of a reed or a stem, much like the stem-pessary ployed by modern gynecologists not so many years ago.

The duration of normal gestation was given by the Ta- mudists as 271 days, or 9 months of 30 days each. Th"> may, however, be variations, and a pregnancy of 12 moz:) duration is cited (Niddah 27 a and Jebamoth 80b). A :: mnemonic the length of pregnancy is expressed by the Helt :: word for pregnancy-HERAYON. In Hebrew, & Latin, numbers are expressed by the letters of the alpha :: and the numerical value of the Hebrew word for pregnan." is 5 + 200 + 10 + 6 + 50 or 271 days.

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among the ancient Hebrews than nowadays. "Ere the lwife cometh in unto them they are delivered " (Exodus I, . Severe labor pains were regarded as signs of divine th and punishment, and the prophets often employ this re of speech in their utterances.

"our cases of dystocia or difficult labor are mentioned in Bible. The first is that of Rebecca giving birth to her is (Genesis XXV, 24). The second is that of Thamar nesis XXXVIII, 27), also giving birth to twins. The d is the birth of Benjamin (Genesis XXXV, 17) in which mother Rachel succumbed. The fourth is the case of the of Phineas (I Samuel, IV, 19) of which we read :

nd his daughter-in-law, the wife of Phineas was with child, : to be delivered; and when she heard the tidings concerning the ark of God had been taken, and that her father-in-law her husband were dead, she sank down and gave birth; for pains came suddenly upon her.

Tomen in labor were attended by midwives, called "meyal- 1" or birth helpers, " chachomoth " or wise woman, and ayoth " or life bringers. Physicians assisting in confine- it are not mentioned in the Bible but are referred to in Talmud.

'he birth took place on a special kind of couch or stool- " mashber." The midwife delivered the child and cut cord, bathed the infant (Ezekiel XVI, 4), rubbed it with and wrapped it in swaddling clothes (Job XXXVIII, 91). n case of asphyxiation the Talmudists recommend strok- the cord gently towards the infant before cutting it, and xtreme cases trying resuscitation by direct inflation of the nt's lungs (Sabbath, 130 and 150).

[ultiple pregnancies are frequently mentioned. Twins ? common, and in Egypt we are told the Hebrew women : birth to sextuplets (Midrash Shemoth, and Rashi Exodus ).

uperfecundation and superfœtation are both mentioned in Talmud and are of medico-legal importance. The Tal- ists held that a superfecundation occurring within forty

after the first conception may lead to normal twins; 'eas after forty days one of the twins will thrive at the nse of the other. After the third month superfecundation ot take place. We read (Berachoth, 60) : "From the day until after the 3rd month, one shall pray that there no 'sandol ' (fœtus papyraceous or compressus) ; that nay not conceive a second child and so interfere with evelopment of the first."

th reference to superfœtation the law prohibits the mar- of a widow or a divorced woman who is pregnant until the birth of the child (Jebamoth, 36 b-42 a; Sota, 26 a). word or two as to malformations and monstrosities. a number of malformations and monstrosities are men- I in the Talmud. We read of a fœtus with a human Ind animal body, of a monster with a single eye, of an alos, of various malformations of the head, of partial lion of viscera, etc. Of special importance are various

iviluis of nemapurodites. Iliese give rise to legal complica- tions in cases where certain duties are limited to one sex only. A separate chapter in the Mishna under the title Androgynes is devoted to this subject.

Finally, a word in regard to obstetrical operations. Three kinds of operations are mentioned in the Talmud. The first was a destructive one-embryotomy, which consisted in the cutting up of the dead fœtus and extracting it piecemeal. The other two aimed at the saving of both mother and child. One was called " kariyath habbeten " or the cutting open of the abdomen, and was nothing more or less than the classical Caesarian section. The other operation called " yozay dofan " or delivery through the side, also aimed at the saving of both mother and child, but its exact character is a matter of dis- pute among Hebrew archaeologists.

Before concluding, a word as to the Hebrew ideas on heredity and the recently much agitated so-called new but really old subject of eugenics. Freedom of will is, of course, the foundation of the Jewish as well as of all religions. " All is in the hands of God, except the fear of God," is a famous Hebrew saying. Man makes himself! And yet, the Hebrew sages recognize too well the importance of heredity. The sins of the parents are but too often visited on their children and their children's children unto the third and fourth genera- tion, and that both morally and physically, hence a well- known Talmudic saying (Baba Mezia, 75 a) : "Seest thou a wise man, whose son is wise, and whose son's sons have been brought up in the ways of wisdom-from their house wisdom shall not depart."

And that is indeed the natural explanation of the numerous Hebrew laws and customs pertaining to marriage and marital relations. The Jewish law does not shrink from the problems of social hygiene, but takes them up and analyzes and dis- cusses them with exactly the same minuteness and exactness as the laws pertaining to the observance of the Sabbath and holidays, the dietary laws, the agrarian laws, the laws per- taining to the giving of charity. The body is not the sordid instrument of sin to be curbed and subjected, stunted and worn out by penitence and castigation; nay, it is the sacred abode of the spirit, and all its normal physiological functions are regarded as wholesome and intended for good. So is the procreative faculty, when subserving its true purpose-the rearing of a sturdy race of servitors to God. With such an end in view it is a sacred duty.

The Torah or the law thus frees us from the fetters of materialism, yet guards against the barrenness of an ascetic life, and consecrating all our activities to an exalted, noble end, uplifts mankind above mere dust. The ordinances con- cerning menstruation, the rigid laws enjoining periodic sepa- ration and purification in married life have all this end in view-to use the means, only as means, not for themselves, but for the furtherance of higher, nobler ends. No wonder, then, one ancient Hebrew sage styles them as ordinances of such momentous, far-reaching importance, compared with which astronomy and geometry are only "after-courses " in the School of Wisdom.

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JOHNS HOPKINS HOSPITAL BULLETIN.

What the results of such a conduct are is not for me here to proclaim.

That, history has shown; that, history still shows; and that, so long as Jew is loyal to his heritage, history will continue to demonstrate.

Kislev, 5671. December, 1910.

LITERATURE.

1. Jewish Encyclopedia.

2. Hamburger: Real-Enzyklopedie des Judentums.

3. Talmud-Babylonian. Ed. Wilna.

4. Midrash Rabba.

5. Joseph Bergel: Die Medizin der Talmudisten. Leipzig, li .:

6. A. H. Israels: Tentamen Medico Historicum Gynecologie: 1895.

7. R. J. Wunderbar: Biblisch Talmudische Medizin, 1850-180:

ON DISSEMINATED CASEATING TUBERCULOSIS OF THE LIVER.

By WILLIAM SYDNEY THAYER, M. D., Associate Physician, The Johns Hopkins Hospital, Baltimore.

Focal tuberculosis of the liver is a condition rarely giving rise to recognizable clinical phenomena. Those instances which are detected during life are, for the most part, large, solitary, conglomerate tubercles or tubercular abscesses. Dis- seminated caseating tuberculosis, while not uncommon, espe- cially in children with intestinal and mesenteric lesions, is not often recognized intra vitam.

Rolleston 1 says: "There are very seldom any definite symptoms pointing to the liver."

Brown ' says: " Complications of the liver have more path- ological than clinical importance."

Hale-White' describes the condition purely from an ana- tomical standpoint and says: "This form of tubercular dis- ease does not give rise to any clinical symptoms, as there is no damage to a sufficient number of ducts to cause jaundice."

Ebstein ' says: "But also in these very rare cases (large conglomerate tubercles), tuberculosis of the liver has a purely anatomical interest."

The recent observation by the writer of an instance of tuber- culosis of the liver where, during life, the hepatic changes stood in the foreground of the clinical picture would seem to justify a brief note.

M. B. (Med. No. 22216), a colored woman of 49, was admitted to the hospital on February 11, 1908, complaining of pain in the right lumbar region and in the back. Her family history was un- important, excepting that her husband had died of tuberculosis 26 years ago. She had had measles in childhood; had been married 28 years: had had two children, one of whom died of tuberculosis. In July, 1902, a hystero-myomectomy was per- formed for sub-mucous myoma of the uterus, tubo-ovarian abscess and follicular salpingitis.

About five years ago, she had begun to suffer from rather ill- described pain in the left side which had continued. She had had a slight cough with occasional blood-streaked expectoration and increasing dyspnea on exertion; night sweats for two years, constipation. About two months ago, there was slight jaundice of the conjunctive, lasting about a week.

On physical examination the thorax was clear, except for a few

1 Diseases of the Liver, etc., Phila., N. Y., London, 8º, 1905, 342. : Osler's Modern Medicine, Vol. III, p. 320.

3 Allbutt's and Rolleston's System of Medicine, Vol. IV, Pt. I, p. 199.

* Ebstein-Schwalbe. Handbuch der praktischen Medizin, 2 Aufl., Stuttg., 1905. B 1

scattered sibilant râles. The abdomen was full and on de: bimanual palpation there was an indefinite sense of fluctu .: in the right flank, although the percussion note was tymparis even in the flanks. The border of the liver was not palpable.

Blood count:

R. B. C. 4,136,000

W. B. C. 6,120

Hb. 49%

Differential count:

Small mononuclears 7%

Large mononuclears 3

Transitionals 0.5

Polymorphonuclear neutrophiles 87

Polymorphonuclear eosinophiles 0.5

Unclassified 1

Stool: semi-fluid, light yellowish-brown. On standing, ±: upper third was fluid, the lower two-thirds, a brown and grantle: material. No parasites or eggs in the sediment; few cholestert crystals.

The urine was increased in quantity and contained a trace !! albumin and a good deal of pus and, considering the resistans in the right flank, it was thought well to catheterize the ureter: The patient, however, refused. An X-ray plate of the right side was taken which was broken in developing. By this time, the suspicion that the resistance in the right side might depend upaz a renal mass having passed away, no further X-ray examination was made.

The temperature during the patient's stay in the hospital wii irregular, ranging from normal or a point slightly sub-norms. often to 103º F., sometimes to a point above this. It was get- erally of an hectic character.

The urine continued increased in quantity, the specific gravity ranging from 1.002 to 1.010. Albumin was sometimes absent but often present in a slight trace, and occasional hyaline at. granular casts were found in the sediment.

The blood pressure ranged from 120 to 158 mm. Hg. while the patient was in bed and resting.

March 22. Blood count:

3,636,000

R. B. C ..

W. B. C. 6,420

Hb. 70%

March 29. Blood count:

R. B. C.

3,776,000

W. B. C. 6,840

Hb. 639

On April 1, the author noted that the abdomen was held $ rigidly that palpation was difficult. There was, however, a dix

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The patient was discharged at her own request, on April 4, 908, with a diagnosis of chronic nephritis and possibly tuber- ulous peritonitis. The fever still continued.

Ti She returned to the hospital on August 10, 1908 (Med. No. DE: 12989). On this occasion, she had complained for about a month of swelling of the legs, feet, and abdomen, of tenderness in the Eight upper abdominal quadrant, and of fever and night sweats. There had been a slight cough, but little expectoration; there was corstipation. There was slight puffiness of the eyelids, ind moderate œdema of the ankles and legs. Slight enlarge- UHf nent of posterior cervical, axillary, epitrochlear and inguinal glands. The lungs showed a few crackling râles at both bases. The abdomen was full, measuring 88 cm. in the umbilical line. t was tender on palpation and had rather a doughy feel; evident movable dulness.

On August 29, Dr. Futcher observed that the liver was distinctly .Helt 10 cm. below the costal margin in the mamillary line and 8.5

Hanging tvill do to 102 F. On physical examination, she was moderately well nourished, but had obviously lost considerable weight. There was slight dulness at both bases with numerous moist crackling rales. The heart was in no way remarkable. The abdomen dome shaped, much distended. The edge of the liver was seen to descend with inspiration, and the edge firm and irregular, was easily felt to the right of the median line. The surface of the liver felt rough though no large masses were to be felt. The flatness extended from the 5th rib to a point 11 cm. below the costal margin in the right mammillary line and 12 cm. below the tip of the xyphoid process. Dulness on the left side shifted with position.

Blood count:

R. B. C.

3,444,000

W. B. C.

4,600

Hb.

63%

The stools, repeatedly examined, were semi-solid and fluid, showing a certain amount of mucus, evidences of occult blood

S. Hayes

DISSEMINATED CASEATING TUBERCULOSIS OF THE LIVER, WITH CAVITY FORMATION, IN AN ADULT.

.m. below the xyphoid; 3 cm. above the umbilicus in the median ine. There was no special abdominal tenderness and no masses vere to be felt. There appeared to be slight impairment on per- ussion at the right apex with harsh breath sounds and a few medium moist rales at the end of inspiration. The temperature ras irregularly continuous and remittent.

The urine was of rather low specific gravity and showed a race of albumen and hyaline and granular casts. The diagnosis n this occasion was again "Chronic nephritis; tuberculous peri- onitis ( ?) ; enteroptosis."

The patient returned again on March 12, 1909 (Med. No. 3828). According to her statement, she had remained in fairly pod condition until about four or five weeks before admission hen she began to complain of diarrhea, weakness and loss of petite. There had been a little blood and mucus in the stools id later, some loss of control over the sphincter. There had en no abdominal pain: no cough; no shortness of breath. Two onths before she had been troubled for a time by sweating at ght. On entrance the temperature was normal but soon rose, maining irregular and remittent while she was in the hospital,

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Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 107

Author: Jacob Anthony Kimmell Publication date: 1910 Publisher: Number of Pages: 1189

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189