Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 119

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

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In the 200 cases there were 66 (presumable or certified) subtentorial, including pontine, growths; and 38 of these

are included with the 123 cases in which the fields were es- amined. This leaves only 85 cases with cerebral (presumed or certified) lesions subjected to perimetry, and in 30 of them (36.5 per cent) the perimeter has shown what may be in- terpreted as a direct implication of the visual pathway.

Granting therefore the common occurrence of form and color defects from pressure involvement of the topic tracte and radiation in cerebral tumors proper, of what localizing valu: are these defects other than to place the lesion in the right it left hemisphere-a simple matter which is usually determin- able by other signs? We shall see, however, that the con- figuration of the homonymous defect is actually of consider- able help in determining the situation of the lesion, whether fore or aft and whether above or below the visual pathwar in the hemisphere obviously involved.

Our 42 cases of hemianopsia may be subdivided into three main groups: (1) those exhibiting a definite tendency ti- ward a complete binasal loss of vision with some preservativo of the temporal fields-the 12 cases of which we have already spoken; (2) those showing a fairly characteristic tendency toward a bitemporal blindness-6 cases; (3) those with an homonymous defect, whether vertically total, quadrantal er. what is far more common, but just as valuable for diagnosti purposes, a fragmentary homonymous constriction-24 case; and a few illustrations of superior hemianopsia must be in- cluded.

Modern decompressive measures for unlocalizable or in- accessible lesions give a definite prolongation not only to the life of the patient, but at the same time to the life of the tumor; and inasmuch as vision under these circumstances should be preserved (and will be unless procrastination has permitted an advanced secondary atrophy) the enlarging growth, if supratentorial, will, in all probability, in the cours of time encroach on the geniculo-calcarine pathway. Hence in the future if the perimeter is not neglected we shall dou't- less observe among our tumor cases a much larger percentage. of hemianopic defects than we have recognized in the past. When we realize the vertical breadth and the antero-posterior course of these fibers it is readily seen that every tumor of the cerebral hemispheres, with the exception of those situated in frontal or superior parietal regions, may at some time in the progress of its enlargement be expected to exert at least some pressure effect on the upper or on the lower portion of the radiation; and whether this shows itself as a beginning homonymous defect in the upper or in the lower part of the field may be of the utmost value from a localizing standpoint.

The hemianopsias which occur as the result of hæmorrhage or softening secondary to vascular disease, are apt to be a: sharply cut as they are abrupt in onset, but in the case of tumors the perimetric deviation is a slowly progressing one and is more or less complicated in many instances by the con- striction of the fields consequent upon the alterations second- ary to an accompanying choked disc. Hence it will be seen when we come to discuss the tumor hemianopsias that the clear-cut vertical meridians which are usually regarded 3% requisite to the diagnosis of this condition are conspicuously

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wwwpauy we case descriptions represents erely a "tendency toward " an hemianopic defect-sug- stive alterations in the field boundaries, in other words, nich are as clearly indicative of involvement of the right left pathway as though the defect were vertically complete. deed, these suggestive homonymous or bitemporal constric- ns may be registered by defects in the color fields alone, as Il be subsequently pointed out.

As the alterations which lead up to the typical hemianopic Id defects are progressive, it behooves us to recognize them their early stages, and the opportunities offered the operat-

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patients as their symptoms advance before operation and sub- side afterward, should give him especial facility in interpret- ing these states.

Summary .- In a series of 200 cases of brain tumor it has been possible in 123 cases to secure reliable perimetric charts. These have shown (1) normal fields in 27 cases; (2) simple color interlacing or inversion (dyschromatopsia) with more or less constriction, but without other field distortion in 53 cases, and (3) hemianopsia, or a tendency toward this defect, in 42 cases.

NOTES ON NEW BOOKS.

odern Treatment: The Management of Disease with Medicinal and Non-Medicinal Remedies. By Eminent American and English Authorities. Edited by HOBART AMORY HARE, M. D., Professor of Therapeutics and Materia Medica, Jefferson Med- ical College, Philadelphia, etc .; assisted by H. R. M. LANDIS, M. D., Medical Director to the Phipps Institute for Tubercu- losis and Physician to the White Haven Sanatorium. Two octavo volumes, 1800 pages, with numerous engravings and full page plates. Price per volume in cloth, $6.00. (Phila- delphia and New York: Lea & Febiger, Publishers, 1911.) Handbook of Practical Treatment. In three volumes. By 79 eminent specialists. Edited by JOHN H. MUSSER, M. D., Pro- fessor of Clinical Medicine, University of Pennsylvania; and A. O. J. Kelly, M. D., Assistant Professor of Medicine, Univer- sity of Pennsylvania. Volume 1: Octavo of 909 pages, illus- trated. Per volume, cloth, $6.00. (Philadelphia and London: W. B. Saunders Company, 1911.)

The appearance of these two works at practically the same ne by two of the leading medical publishing houses shows the irit of competition which exists in this business as well as in many other active ones. For the moment, Lea & Febiger have e advantage, since both their volumes have appeared, while but o of Saunders Company are as yet published. "Practical Treat- ent" will in the end be the larger work by nearly 900 pages, the first volumes of both publications are practically identical t only in size but in general appearance. The similarity be- een these two publications goes still further, as a few writers ve contributed to both systems. There is one rather striking ture in " Practical Treatment," the appearance of a number articles by surgeons, a feature which, on the whole, seems advised in such a work. The doctor in contradistinction to surgeon is usually the better therapeutist of the two, and in h works, which are not intended to take up surgical treat- it, it seems as if it would have been better to have all the icles written by doctors. Otherwise the list of contributors loth works is well selected, and in purchasing one or the other k there is little to choose. It is six of one, and half a dozen he other. In two such systems there can be but little differ- 3, when both are ably edited as in this case, except in the ingement of the articles, a perfectly minor point, for after whether the treatment of one set of diseases is in the first or nd volume is of no consequence, and such differences exist. idern " or "Practical " Treatment, call it which you will, is Jamentally the same in America; different practitioners will slightly varying methods of treatment, but from East to t or from North to South the well-trained doctors practice same methods generally. Some will not agree on a milk or pre liberal diet in typhoid fever, as to which is the best, or the values of hydro-, electro-, and mechanotherapy in vari-

ous diseases, but none the less the basis of all treatment is the same everywhere in this country at least, and the young prac- titioner will find the pros and cons for the varying treatments exposed in both systems. So both are to be recommended and both will be found serviceable guides. The articles are all written by well-known practitioners, and differences of opinion as ex- pressed in one or the other work will but serve to stimulate the reader to further thought on his own part.

Inebriety: A Clinical Treatise on the Etiology, Symptomatology, Neurosis, Psychosis and Treatment and the Medico-Legal Relations. By T. D. CROTHERS, M. D., Hartford, Conn. (Cin- cinnati, Ohio: Harvey Publishing Company, 1911.)

No one can overestimate the value to mankind of all honest efforts to solve the social, economical and moral problems which result from alcoholic excesses and addictions; and hence all books like the one under review deserve careful consideration at. the hands of the reviewer. The author of this volume has been actively interested for many years in the study and treatment of inebriety and should by experience and knowledge be well fitted to give to the profession much valuable knowledge. The scope of the work is ambitious and the author has collected his material with great industry. The work, however, is not a strictly scien- tific one, but is rather a popular treatise. The central thought in it seems to be that inebriety is at all times and under all cir- cumstances a physical disease and clinical facts and plausible theories seem to combine throughout the work to establish the truth of it. "Unfortunately the evidence to this effect has not always been gathered with the care which seems to meet the requirements of scientific accuracy. Clinical facts are loosely stated and broad generalizations are often made from inadequate premises. Take a single unimportant example which may be cited to show the attitude of the author. He says in speaking of the causes of inebriety: "The evidence from the history of many cases shows that excessive cigarette smoking is followed by inebriety." That excessive cigarette smoking, like many other excesses, is frequently a concomitant of inebriety, is not to be doubted, but it is nothing more than this. What evidence can be produced to establish any causal relation between cigarette smoking and inebriety? The same lack of scientific precision is noticeable in the author's clinical histories which for the most part are dogmatic statements, of conclusions which seem to have been reached oftentimes as the confirmation of previously ac- cepted theories rather than the presentation of clinical data.

As to the author's contention that inebriety is solely a physical disease, many queries suggest themselves. If it is a disease, has it a definite course, well-recognized symptoms and an established method of treatment? The causes of inebriety differ with in- dividual cases. The pathological appearances after death are

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not invariable. Many inebriates go down to early death in spite of all efforts to arrest the course of the malady. Others, as the author points out, get well spontaneously; " the craze for alcohol at times dies out of itself from causes unknown," as he expresses it. Inebriety seems a condition characterized by a depressed state of the nervous system due to drink and to other causes often physical, mental or moral, sometimes to all of them com- bined. The author's remarks on treatment seem judicious and well-calculated to assist the physician who seeks knowledge upon this point. The chapters entitled " Inebriety as Noted in Ancient Civilization " and " Medico-Legal Questions" are of much interest.

Diseases of the Anus, Rectum and Sigmoid, for the use of Stu- dents and General Practitioners. By SAMUEL T. EARLE, Pro- fessor Emeritus of Diseases of the Rectum in the Baltimore Medical College, etc. (Philadelphia and London: J. B. Lip- pincott Co., 1911.)

Following the custom usual to text-books of this type, Dr. Earle devotes the first chapter of his work to a review of the chief facts concerning the anatomy and physiology of his chosen field. Then a very practical presentation of general technical .questions-methods of examination, anæesthetics, equipment, etc .- is given. The first abnormal condition discussed is that .ever obtruding subject, constipation; and its forms, causes and symptoms are considered at length. From the limitations of the author's subject, the operative treatment of constipation directed at the intestinal tract oral to the sigmoid receives no attention. It is of interest to note that Earle attaches less importance -to lesions of Houston's valves, as a cause of constipation, than certain other proctologists are inclined to attribute to such conditions.

Diseases of an inflammatory nature, embracing such frequently encountered conditions as ulcerations, perirectal abscesses and fistulæ, of course constitute an important division of the subject- matter of such a book, and this general group is handled in a manner sufficiently full, and yet free from the tedious reitera- tion so often inflicted on the reader. A reflection of the present interest in sigmoiditis and diverticulitis is found in the author's treatment of these subjects. Here and elsewhere in the book, apt and frequent citations from original sources are a noticeably valuable characteristic. Congenital anomalies, fissure, stricture, and pruritus ani, are each the subject of a chapter in which the accepted facts are set forth in a readable way. One naturally does not turn to.such a book, specifically addressed to students and general practitioners, for contributions to the advancement of the subject, but rather for a resume of the present consensus of opinion; nevertheless to many readers, especially to surgeons, perhaps the chief interest of the book lies in the chapter on hemorrhoids, where Earle's own method of operating is described.

Conditions demanding larger surgical procedures, such as pro- lapsus of the rectum, new growths, and extensive injuries, re- ceive the emphasis to which their importance entitles them, and the text is reinforced by numerous good illustrations. Through- out the book, the writer manifests his interest in the pathology of the various lesions, and numerous illustrations of gross and microscopic specimens are given. The last two chapters, devoted respectively to diseases of the coccyx and Herschsprung's disease, while not strictly within the scope of the work, are so closely allied to it that they require no apology, but distinctly add to the completeness of the volume.

In the preface, Dr. Earle says: "The maladies discussed are very common and very stubborn. My chief care has been to include the most recent and effective methods of cure, and to give

these comprehensively and succinctly." In this purpose the writer has distinctly succeeded, as the generally accepted fars and theories are well presented, and; there, is a noteworthy ab- sence of the repetition of commonplace case-reports and. details of technique so frequently encountered. At the wisk, of seeming captious, one might wish for a more definite ring of authority a some places, and another minor point for criticism is afforde! by occasional involved sentence-construction which somewhat obscures the meaning. On the whole, however, the book fulfils the purpose for which it was conceived very well., A touch o. personal interest to the Johns Hopkins Medical School men lies in the dedication of the book to Dr. Councilman and the citatixe of opinions of Dr. Welch, with both of whom Dr. Farle worke! as a post-graduate in pathology.

Differential Diagnosis. Presented through an Analysis of 345 cases. By RICHARD C. CABOT, M.D., Assistant Professor of Clinical Medicine, Harvard Medical School. 753 pages, Ilios- trated. Price, $5.50. (Philadelphia and London: W. B. Saunders Company, 1911.)

The use of groups of cases, each group presenting a distinc: symptom, as cough, fever, localized pain, chill, coma, convulsions. weakness, etc., as a basis for a work on differential diagnosis is a new and clever one of the author, and is bound to be mos: serviceable to many students. It is similar to a clinical confer- ence, where the instructor has gathered a number of patients together who show a more or less common condition, and thes differentiated their troubles to his hearers. Those who will die this book intelligently, and before reading the discussion of the cases presented, will try to analyze them for themselves, and then compare their own diagnoses with those of the author, will put themselves through an excellent training. They should first read the introductory pages to each symptom and thus have an anatomical and physiological ground to build upon. There may be errors, as the writer suggests, in his work, but it will only be a brilliant student who will find them, and others will make te mistake in accepting the diagnosis of the author. The work is t: be heartily commended as a fresh and attractive method of teach ing, and its success will be watched with much interest.

The Blues (Splanchnic Neurasthenia). Causes and Cure. By ALBERT ABRAMS, M. D., etc. Illustrated. Fourth Edition Revised and Enlarged. Price, $1.50. (New York: E. B. Treat & Co., 1911.)

The only difference between this edition and the preceding c3: lies in a brief note amplifying the treatment for this conditica The author believes that concussion of certain of the spinoce processes will reduce congestion in the abdominal organs, and & cure " the blues." It would be most fortunate for the human race were this mental condition always due to a physical condition s easily alleviated!

Collected Papers by the Staff of St. Mary's Hospital, Mayo Clin .. Rochester, Minnesota, 1905-1909. Octavo of 668 pages, illas trated. $5.50 net. (Philadelphia and London: W. B. NOst- ders Company, 1911.)

All of these papers have appeared in various medical journal and gathered together in a handsome volume, there is much c: interest in them. Most doctors, who have not been to Rochester think of the " Mayo Clinic " as being the two brothers Mayo, bu: in the list of contributors to this volume there are fourters names-an indication of what a large clinic exists under the name, and the extent of the work carried on there.

The Johns Hopkins Hospital Bulletins are issued monthly. They are printed by the LORD BALTIMORE PRESS, Baltimore. Subscriptions,

wear (foreign postage, 50 cents), may be addressed to the publishers. THE JOHNS HOPKINS PRESS, BALTIMORE ; single copies will be so" mail ' .- "ty-five cents each. Single copies may also be procured from the BALTIMORE NEWS CO .. Baltimore.

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ol. XXII .- No. 244.]

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CONTENTS.

PAGE

e Changes in the Circulation in Aortic Insufficiency. (Illus- trated.)

By WILLIAM G. MACCALLUM, M. D.

197

Further Note on the Clinical Use of Scarlet Red and its Compo- nent Amidoazotoluol, in Stimulating the Epitheliation of Gran- ulating Surfaces. (Illustrated.)

By JOHN STAIGE DAVIS, M. D. 210

1 Certain Limitations in Interpreting Thyroid Histology. By DAVID MARINE, M. D., and C. H. LENHART, M. D. . 217

Pneumococcus Peritonitis. With Report of a Case. By HARVEY B. STONE, M. D. 219

An Anomalous Duct Belonging to the Urinary Tract. (Illustrated.) By PAUL G. WOOLLEY, M. D. and HERBERT A. BROWN, M. D. 221

Acute Cholecystitis with Large Amounts of Calcium Soap in the Gall-Bladder. (Illustrated.) By JOHN W. CHURCHMAN, M. D. 223

Notes on New Books .

224

THE CHANGES IN THE CIRCULATION IN AORTIC INSUFFICIENCY.

By WILLIAM G. MACCALLUM, M. D., Professor of Pathology, Columbia University.

(From the Department of Pathology, Columbia University, New York.)

In the case of lesions of the aortic valves, which cause them be insufficient, there occur certain well known symptoms hich are perhaps more characteristic than those following Ly other valvular lesion, and have been very minutely studied. articularly striking are the collapsing pulse and the diastolic urmur with the hypertrophy of the heart, and especially of e left ventricle which follows. Ordinarily these things have en explained as being due to the regurgitation into the left atricle of a portion of the blood thrown out at each systole, d this explanation has generally been regarded as satis- tory until recently when H. A. Stewart1 in a study of this dition brought forward the problem as to the real cause the fall of pressure therein and the significance of the po- on of the dicrotic notch in the pulse curve. 1

Of course when the heart has become hypertrophied, differ- conditions may prevail, and so, too, when other lesions of heart or of the arteries exist, the simple impairment of the ulation resulting from the lesion of the aortic valves is ured. It is necessary, therefore, to study the effects of ic insufficiency produced in a normal animal, and this can ly be done, as in the work of Stewart, by tearing a segment he valve with the valvulotome described in an earlier 2

tewart: Experimental and Clinical Investigations in Aortic Fficiency. Arch. Int. M., January, 1908.

acCallum: Johns Hopkins Hosp. Bull., August, 1906. .T

Stewart confirmed the statement of Mackenzie, Broadbent and others that the dicrotic notch holds a position very low in the descending arm of the pulse wave, when there is aortic in- sufficiency, whereas it is normally above the middle of this slope. Since the dicrotic notch is normally found to be synchronous with the end of the systole, and since the dicrotic notch in aortic insufficiency occupies a position approaching the trough of the pulse wave, he concludes that the collapse occurs for the most part during the latter part of the systole. There can therefore be no regurgitation during that time and the collapse must be due to widening of the arteries and ready escape of the blood. A similar position is occupied by the dicrotic notch in the pulse of low arterial pressure. If the pressure is raised by compressing the aorta or by giving adrenalin, or, if from the existence of arteriosclerosis, the pressure is high, the dicrotic notch even in aortic insufficiency assumes a higher position and the pulse is no longer regarded as collapsing.

Further, since the diastolic arterial pressure is found to fall on the tearing of the aortic valve, while the systolic pressure is maintained, he argues that there must have been an at- tendant vasodilatation. Since the pulse pressure has been increased because of the fall in diastolic pressure, it can only have resulted from peripheral dilation.

Such a dilation of the peripheral vessels must constitute a protective adaptation which instantly comes into play upon

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the tearing of the valve and must be brought about by vaso- motor influences. Since this seemed at first sight hard to accept in place of the time honored explanation on the basis of regurgitation, I have examined it more closely. In order to approach these conditions I have devised an arrangement of the circulation, which I find, on looking over the literature, is somewhat like that used by Martin,' Howell and Donaldson," excepting in that it does not interfere with the nervous con- nections of the heart, and is, on the whole, more manageable. I have also found the description of a somewhat similar device by Lohmann ' in a recent journal.

It is as follows, the aim being to eliminate as far as possible the influence of the vasomotors and to determine directly the output of the aorta in relation to that of the ventricle. In devising a method which will give us the output of the heart under controlled conditions of peripheral pressure we must begin, I suppose, with the idea that such results may not cor- respond absolutely with those in the normal intact animal, but that when carefully measured before and after the insufficiency is produced, they will give us a clear idea of the changes which depend upon the insufficiency. This is all that one can claim for the results which follow, although as a matter of fact it seems perfectly easy to reproduce under such conditions a state of the circulation indistinguishable from that of the normal animal.

The method used will be made clear by the accompanying diagram (Fig. 1.) In order to eliminate the effect upon the heart of a peripheral resistance such as is offered by the systemic arteries, liable to constant change and difficult to measure and change at will, the aorta is cut through at the 'arch and con- nected with a canula and a long rubber tube with a curved glass outlet of the same caliber. This outlet can be set at any height upon the graduated vertical rods. A cistern supported at the same height and movable with the outflow nozzle, con- tains defibrinated blood usually mixed with Ringer's solution, which, after passing through a coil immersed in warm water. runs through a second canula into the distal portion of the aorta. Naturally, the first blood which escapes will clot and is not emptied into the cistern until it has been defibrinated ; but after a short time all the blood in use has become defibrinated and the outflow nozzle may be turned so as to empty directly into the cistern. Then the circulation will go on indefinitely, differing from the normal in that it drops through the open air at one point and there may be caught and measured, and in that the variable peripheral arterial pressure is replaced by an outflow level which may be precisely controlled by merely moving the supporting clamp up and down on the graduated standard. Any necessary manometers may be attached later- ally to the rubber tube which represents the aorta. A plethys- mograph constructed after the manner of Henderson's but made in a more suitable shape, and of glass so that the heart can be seen, is put upon the heart and connected with a tam-

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Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 119

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

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