Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 137

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

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Beyer and Wittneben ' examined the blood of 345 viduals with reference to the Much-Holzmann react" Their results are given in the following table:

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Digitized by

ical depressive insanity

50%* 31

psy

50%

74 19

psychoses

II.

tic diseases

25%

III.

10%

which they conclude that the reaction is of no differ- 1 diagnostic value. It appears to them rather as an ex- ion of certain changes in metabolism, which can occur he most different conditions, the exact mechanism of h, however, is unknown.

aenkel, Kathe and Bierotte' carried out the reaction in ases, 58 of which were various types of psychoses, 26 patients suffering from other than mental diseases. In er cent of the psychoses a positive reaction was obtained, er cent of the patients suffering from other diseases gave sitive reaction, while of eight normal individuals tested ave a negative reaction; from which they conclude, that reaction is not specific as claimed by the originators, but differentiate between healthy and diseased individuals. ' consider the reaction a quantitative rather than a itative one, since they found that all sera exert some in- ing action. Differences in the resistance of the corpuscles idividuals were noted and in some cases, a given serum, 1 tested again one set of corpuscles, gave a positive re- n and when tested against other corpuscles gave a negative ion.

difference was found between active and inactivated n. Controls were made to determine if the corpuscles hemolyzed by the serum alone in any case (isohemolysis). le authors consider that the Much-Holzmann reaction de- s upon the relation between activating and inhibiting ances present in the serum. These bodies probably : lecithin and cholesterin.

!ozieki' obtained the positive reaction, according to and Holzmann, in a number of different psychoses, as as in normal individuals and almost constantly in the of the newborn. He considers the reaction diagnosti- valueless and thinks that it depends upon the degree of ular activity.

multz' tested the reaction in 151 cases and obtained a ve result in 50 per cent of all cases of dementia precox naniacal depressive insanity. He also obtained positive s in a number of other psychoses and in some normal ils. A large number of his cases fell in the doubtful , due to the difficulty of making a clear reading. tz could not find that various factors such as age, sex, rature, pregnancy, general blood condition and state of ion were of any importance. The quantitative nature reaction is emphasized and he concludes that the reaction io diagnostic value. The relative amount of cholesterin

Geissler 10 examined 500 cases and points out that it is necessary to select the time for testing the serum according to the clinical state of the patient, as the reaction is generally negative in the intervals between attacks of maniacal de- pressive insanity and is more often present in those phases of dementia precox associated with periods of definite excitement or depression. Using these precautions he obtained a posi- tive reaction in all cases of dementia precox and maniacal depressive insanity, but found positive results in other types of psychoses, as well as in non-psychic diseases. Geissler did not confirm Much and Holzmann's claims as to the positive reactions in cases of epilepsy and in those having a family history of dementia precox and maniacal depressive insanity. Eisner and Kronfeld " found the reaction positive in 57.8 per cent of 19 cases of dementia precox and in 50 per cent of eight cases of maniacal depressive insanity. Although they found about the same percentage of positive reactions in other psy- choses and a somewhat smaller percentage of positive reactions in mentally sound individuals, they conclude that the reaction occurs with greater frequency in the psychoses as a class, than in other states. As to the diagnostic value, they cannot con- firm the work of Much and Holzmann.

Plaut " examined 21 cases in all and found a positive test in 38 per cent of the cases of maniacal depressive insanity, and in 20 per cent of the dementia precox group. He con- cludes that the reaction is of no diagnostic value as proposed.

Brueckner and Much," after the study of 200 more cases, conclude that although the reaction is of great theoretical sero- logic interest, it is not of use in the diagnosis of dementia precox and maniacal depressive insanity as originally claimed. They point out that before the reaction can be of use in psy- chiatry it will be necessary to determine the nature of the in- hibiting substances, the factors concerned in their appearance in the blood serum, and the apparent relation existing between their higher prevalence in mental diseases than in all, others examined so far. They offer no solution.

Rosanoff," after the examination of 185 persons, concluded that all human sera possess some power of inhibiting the hemolytic action of cobra-venom, but that the degree of in- hibition is not sufficiently raised or uniform in cases of de- mentia precox or maniacal depressive insanity to make the test of diagnostic value. A positive reaction was obtained in other psychoses and in normal individuals. The fact that so high a percentage of those suffering with dementia precox (57.9 per cent) gave a positive reaction, led Rosanoff to be- lieve that a positive test might add weight to the diag- nosis in certain doubtful cases, where there were other symp- tomatological factors leading to the conception of dementia precox. All 15 cases of maniacal depressive insanity gave negative results in Rosanoff's hands.

Pfoeringer and Landsberger " conclude that the cobra- venom reaction is not specific in the sense of Much and Holz- mann. They consider it the expression of general changes in metabolism, especially in oxidation processes, in which the

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280

JOHNS HOPKINS HOSPITAL BULLETIN.

red blood corpuscles play the most important rôle; at any rate, they do not consider this idea so hypothetical as the views of those who connect the reaction with processes in the central nervous system, which have to do with changes in the lecithin and cholesterin content of the blood.

Alt,16 without giving any of the details of the work upon which his conclusions were based, says, that in the 50 instances, in which the reaction was tried, he was unable to obtain re- sults which would in any way permit of conclusions in agree- ment with those of Much and Holzmann.

Omorokow " found that the Much-Holzmann reaction oc- curred more commonly in the psychoses as a class than it did in the surgical cases and mentally normal individuals ex- amined by him.

Nitsche, Shlimpert and Dunzelt 18 in 198 cases, of which 105 were dementia precox and 28 maniacal depressive insanity, found positive tests in 54.2 per cent of the former and 14.2 per cent of the latter. The duration of the disease, age, sex, drugs and nutritional state apparently exert no influence on the outcome of the reaction. Opposed to Geissler " they can find no interdependence between the results and the stage or clinical phase of the disease in question. The reaction is not considered as diagnostic of either dementia precox or maniacal depressive insanity.

Raubitschek and v. Dungern " in the discussion of the re- port by Much (loc. cit.) indicated that they could find no reg- ularity in the results of the test as applied and that they found positive results in a great number of conditions other than dementia precox and maniacal depressive insanity.

Stilling " investigated 50 cases of dementia precox, repeat- ing the work of Hirschl and Potzl and found the resistance of the corpuscles to hemolysis by cobra-venom increased in only 14 cases. Twenty-two cases gave a positive Much-Holz- mann reaction, when tested against corpuscles from cases of dementia precox.

The author is unable to confirm the results of either Hirschl and Potzl or Much and Holzmann.

Bonfiglio " at the end of his examination of 67 cases states that the reaction of Much and Holzmann is not specific for either maniacal depressive insanity or for dementia precox. In other details, his experience has been that of almost all others, who have repeated the work. In a second communica- tion " he gives a review of the literature which has appeared on this subject during the past several months.

From the foregoing summary of the literature it appears that no diagnostic significance can be attached to the Much- Holzmann reaction. Our own conclusions on this point are in accordance with those of the majority of investigators who have repeated Much and Holzmann's work. We have, how- ever, made certain additional observations which we think justify the publication of our results.

The points which we have tried to determine may be briefly stated as follows:

1. Does the serum from cases of dementia precox and maniacal depressive insanity inhibit cobra-venom hemolysis ?

2. Does a given serum always give the same reaction ver subjected to the Much-Holzmann test?

3. Is the result of the test influenced by the relation is tween the groups (as determined by the isoagglutinatie .. action) to which the serum and corpuscles belong?

4. Is there any difference between the action of fresh e inactivated serum on cobra-venom hemolysis?

5. Do corpuscles of different groups offer different dec- of resistance to hemolysis by cobra-venom?

6. Does serum favor or retard the hemolysis of human !: throcytes by cobra-venom ?

Technique .- In the first series of cases we followed ex. the technique given by Much and Holzmann. The cc venom was obtained for us from Drs. Flexner and No ... of the Rockefeller Institute of New York by Dr. H. J. k. ley. It consisted of a 1 per cent solution in 50 per cent erine. This stock solution was kept in the ice chest and t. it fresh dilutions were made for each series of tests.

From the first experiments it was evident that this nec had much greater hemolytic strength than that used by !. and Holzmann, so that after a few preliminary tests it t. found necessary to use a 1-25000 dilution instead of a 19 dilution as recommended by the originators. Later we furt. modified the technique in that we combined equal parts (. cc.) of cobra-venom solution, serum, and a 5 per cent stege sion of washed corpuscles, instead of 0.35 cc. serum, Qdi. cobra-venom solution and 0.5 cc. of a 10 per cent suspers of corpuscles. The modified technique gave better results our hands than that proposed by Much and Holzmann.

Considerable difficulty was experienced in reading the sults of the test, as we got all grades of hemolysis from for slight up to complete, no matter how we varied the pra, tions of serum, corpuscles, and venom (the differences wet ) great in tests with normal serum as in those with serum t: cases of dementia precox or maniacal depressive insanityi. e that in our series a considerable number of cases fall inte 2 group giving doubtful reactions.

.We made no effort to collect a large series of cases, bet the other hand repeated the test a number of times with sex. from the same cases on different days, and frequently pot parallel series, using corpuscles from a different person in e !: series.

We have tested the serum of 49 individuals with the f lowing results :

TABLE I.

Number

Condition

Positive Negative Dock reactions reactions resetre

Cases

21 Dementia precox

Maniacal depressive insanity. 2

8 General paresis

16 Sundry other psychoses.

10 Diseases other than mental

and normal 2

A number of the above cases were tested on two, three ..

and five occasions, but without any reference to psychic s=". The results for a few of these cases, chosen at random fn". considerable number of cases in which repeated tests ".

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y wustaut for a given individual, varying sometimes from otful to positive or from doubtful to negative, but only :, Case 6, from negative to positive.

TABLE II.

Oct. 19th Oct. 27th Nov. 5th Nov. 8th Nov. 17th June 25th

Case imber

1909

1910

+ +1

+1 +1 +1 +

performing the " psycho-reaction " Much and Holzmann nmend that the serum be tested against several different of corpuscles rather than against a single set.

has been shown = " that individuals may be divided into groups according to the isoagglutinative action of the n and corpuscles. Isohemolysins have long been known cist normally in human serum and recently it has been n " that the serum of every individual possesses an anti- lysin which will protect not only his own corpuscles isohemolysis, but also those of any member of the p to which he belongs.

occurred to us that perhaps human serum might have such protective action as the above against cobra-venom lysis ; that is, that a given serum might protect its own iscles and others belonging to the same group from lysis by cobra-venom, and that a positive Much-Holz- 1 reaction (inhibition of hemolysis) might occur when erum tested came from a member of the same group as to which the individual belonged whose corpuscles were in the test, and that a negative reaction (hemolysis) t result, when the serum and corpuscles came from dif- t groups.

further thought that negative reactions might result in cases from the well known isohemolytic action of cer- era.

order to determine these two points we always deter- . the group to which the serum belonged and also tested if it possessed an isohemolysin for any of the cor- s used, and in a considerable number of cases we set up el series of tubes so that each serum was tested against cles from several different groups. A single series will to illustrate the results.

h regard to the groups to which the serum and cor- belonged, reference to Table III shows that, except ry minor variations in degree, the hemolysis proceeds ' well when the corpuscles and serum belong to the roup as when they are from different groups. Further- corpuscles in the presence of their own serum are hemo- y cobra-venom to the same extent as in the presence im from another individual, provided the latter con- o isohemolysin for the corpuscles in question.

the Much-Holzmann reaction, we encountered but few sera in our series which were hemolytic for the corpuscles used, but as far as our observations go, they tend to show that if a given serum is tested against several sets of corpuscles and is

TABLE ITI.

Showing the Relation Between the Groups to Which the Serum and Corpus- cles Belong and Contrasting the Action of Active and Inactive Serum.

2 hours at 87º C.

22 hours in ice chest

Venom

Serum. No. Gr.

Corps. Gr.

Serum active

Serum inactive

Serum active

Serum inactive

0.25cc.

II III

gK gK

fvl.

III

fvL

III IV

fvL

fvL fyl.

III

gK IVH

K K

24 IV

L L

: :

25 IV

III

fvA fvH

kK kK kK

III IV

fvH

fvL

fvL fvL fyL

27 II

fvH

fvL fvL

KK kK

III IV

29 IV

III IV

III

kK kK kK

: : :

III

fvL fv L

fvL fv L fvL

fvL L

fvL fvL fvL

III

fvH

III

fvH

kK kK kK

ILI

fvL fvL fvL

The grade of hemolysis is estimated by the color of the supernatant fluid and the amount of sediment in the tube. H == no hemolysis. kK = small sediment.

fvH = trace hemolysis.

fvL = almost complete solution. L = complete solution.

The corpuscles used in the above series were from cases Nos. 32, 33, 34.

found to be hemolytic for one set but not for the others, this serum may give a positive Much-Holzmann reaction when tested against the corpuscles for which it is not hemolytic and a negative reaction when tested against the corpuscles for which it is hemolytic.

In several series of experiments we contrasted the effect of active serum and serum inactivated at 56° C. for 30 min- utes, on cobra-venom hemolysis. Table III gives one such series and shows that there was only a slight and inconstant difference between the two.

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III

fvH

MMM MMM

L L

fvL

III

gK gK

fvL

fvH

gK = large sediment. K = sediment.

fvH

gK gR

kk kR

to be bo

III

fvH

fvL fvL

fvL

fvL fvL fv L

: : :

fvH

MMM

fvL

282

JOHNS HOPKINS HOSPITAL BULLETIN.

[So .:

We could discover no difference in the resistance of cor- puscles of different groups to hemolysis by cobra-venom and our experiments to determine if serum favored or retarded cobra-venom hemolysis gave inconstant results with different sera.

SUMMARY.

1. We concur in the prevalent conclusion that the Much- Holzmann reaction has no diagnostic significance.

2. The influence which a given serum has on cobra-venom hemolysis is fairly constant.

3. The relation between the groups to which the serum and corpuscles belong has no influence on the result of the Much- Holzmann reaction provided the serum contains no isohemo- lysin for the corpuscles used.

4. There is practically no difference in the effect of active and inactivated serum on cobra-venom hemolysis.

5. Corpuscles from normal individuals belonging to differ- ent groups vary in their resistance to cobra-venom hemolysis to a very slight extent.

6. The action of different sera in favoring or retarding cobra-venom hemolysis is inconstant.

LITERATURE.

1. Much & Holzmann (München. med. Wchnschr., 1909, LVI, 1001).

2. Much (München. med. Wchnschr., 1909, LVI, 2550).

3. Bauer (München. med. Wchnschr., 1909, LVI, 1367).

4. Huebner & Selter (Deutsche med. Wchnschr., 1909, Iki 1183).

5. Hirschl & Pötzl (Wien. klin. Wchnschr., 1909, XXII, 45

6. Beyer & Wittneben (München. med. Wchnschr., 190, 57 1464).

7. Fraenkel, Kathe & Bierotte (Munchen. med. Webnsehr. LVI, 1461).

8. Zalozieki (München. med. Wchnschr., 1909. LVI, 160%).

9. Schultz (München. med. Wchnschr., 1909, LVI, 1528).

10. Geissler (München. med. Wchnschr., 1909, LVI, 1591).

11. Eisner & Kronfeld (München. med. Wchnachr., 199 5 1527).

12. Plaut (München. med. Wchnschr., 1909, LVI, 1531).

13. Brueckner & Much (Berl. klin. Wehnschr., 1909, XLVI. 35

14. Rosanoff (Arch. int. med., 1909, IV, 405).

15. Pfoeringer u. Landsberger (Berl. klin. Wchnschr., 190. 37 1642).

16. Alt (Psychiat. neurol. Wchnschr., 1909, XI, 103).

17. Omorokow (Ref. in München. med. Wchnschr., 1909, LT. 2177).

18. Nitsche, Shlimpert & Dunzelt (München. med. Wetas" 1909, LVI, 2101).

19. Raubitschek & v. Dungern (Ref. in München. med. WebRac 1909, LVI, 2550).

20. Stilling (München. med. Wchnschr., 1909, LVI, 2630).

21. Bonfiglio (Il Policlin. Roma, 1909, XVI, sez. prat. 1062). 22. Bonfiglio (Riv. sperim. di freniat., 1909, XXXV, 468).

23. Jan Jansky (Klinicky Sbornik, No. 2, 1907). Ref. Jahresty für Neurol. & Psychiat., 1907.

24. Moss (Johns Hopkins Hosp. Bull., 1910, XXI, 228.

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CONTENTS.

PAGE

psis of Studies on Peritoneal Adhesions with a Contribu- a to the Treatment of Denuded Bowel Surfaces. (Illus- ted.)

y EDWARD H. RICHARDSON, M. D. 283

' Carcinoma of the Pleura. (Illustrated.) y T. P. SPRUNT, M. D. .

289

of a Case of Puerperal Infection with Isolation from the trus of B. Influenza and a New Method for Making Blood ar for its Cultivation.

y WILLIAM THALHIMER, M. D ..

293

ucocytosis of High Grade in Broncho-pneumonia in a Child. y CHARLES R. AUSTRIAN, M. D. . 296

The Viability of Parasitic Ova in Two Per Cent Formalin, with Especial Reference to Ascaris Lumbricoides. By ROGER S. MORRIS, M. D. . 299

Anterior Poliomyelitis-Note

300

The Starnook-A New Device for the Rest-Cure in the Open Air and for Outdoor Sleeping. (Illustrated.) By S. ADOLPHUS KNOPF, M. D. 801

The Haven of Health-A Review. (Illustrated.)

By W. H. BERGTOLD, M. D.

303

Notes on New Books .

311

Books Received

. 314

A SYNOPSIS OF STUDIES ON PERITONEAL ADHESIONS WITH A CONTRIBUTION TO THE TREATMENT OF DENUDED BOWEL SURFACES.

By EDWARD H. RICHARDSON, M. D., Instructor in Gynecology, Johns Hopkins University.

3 scarcely necessary nowadays in a consideration of verative peritoneal adhesions to include convincing to the reality, scope and importance of this surgical 1. All of us know how frequently troublesome ad- occur as a mortifying post-operative complication, our best hospitals and at the hands of our most skil- geons. Impressed by several striking instances of this er which have come under my observation during the v years, I was led recently to undertake a systematic f the entire available literature upon this subject, in f possible, to arrive at some definite conclusions re- the pathology, the etiology, the prevention and the nt of peritoneal adhesions. In a later publication I present a complete analytical study of this voluminous , with detailed references to the original contribu- on which I have based the opinions about to be ex-

It is my purpose in this communication simply to a brief synopsis of this work in connection with a on of a new method of treating denuded bowel

At the outset it is well to recall certain familiar character- istics of the peritoneum itself which have an important bear- ing upon this subject.

We are apt to forget the enormous area of this serous mem- brane, which has been estimated to be only slightly less than that of the skin.

Again, its remarkable absorptive power is sufficiently strik- ing to have actuated a large number of investigators to under- take elaborate and laborious researches to determine its mechanism. As a result of this work we now know that fluids and soluble substances are, for the most part, absorbed by the blood vessels, while solid particles such as coloring matter in suspension, bacteria, oil globules, etc .- are taken up by the lymphatics. Furthermore, that the lymphatic ab- sorption is most active in the upper part of the abdomen, especially on the under surface of the diaphragm, and in the omentum, while in the pelvis it is sluggish-a fact now com- monly taken advantage of by surgeons in the use of the Fowler's, or sitting, posture in the treatment of peritoneal infections.

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JOHNS HOPKINS HOSPITAL BULLETIN.

It seems definitely established too that the very sensitive epithelial covering of the peritoneum is continuous, and not perforated by numerous stomata, or direct channels of com- munication between the peritoneal cavity and the lymphatic vessels, as was until quite recently taught. Closely allied with its absorptive power is its well-known ability to success- fully cope with an astonishing amount of infection without itself being seriously or permanently damaged.

Then, too, it is important to remember that different por- tions of the peritoneum vary very greatly in sensitiveness to pain; in a general way the visceral portion being insensitive, while perhaps no tissue in the body exhibits quite the same exquisite sensitiveness to pain as do the parietal layers of this serous membrane.

Finally, one of its most striking characteristics is the rapidity with which it can form adhesions-a piece of gauze introduced into the abdomen during the course of an operation becoming quite snugly fixed to the visceral surfaces within a period of twenty minutes a fact that is daily taken prac- tical advantage of by surgeons in the disposition of protective gauzes during operations upon infected areas, and which adds materially to the sense of security afforded by gauze pads alone. This characteristic is also very intimately in- volved in the whole question of peritoneal drainage, and constitutes further one of nature's admirable methods of pro- tection against peritoneal insult, as exemplified in the wall- ing-off of an appendix abscess.

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Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 137

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

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