Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 160

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

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Operation .- May 8, 1911. Through a high mid-line incision a lobe of the liver was exposed. The end of the lobe was cut off with scissors leaving a bleeding area 3 cm. x 6 mm. Over this surface was placed a flap of fascia lata and the bleeding was markedly checked. The fascia covered the end like a shallow cap, and was held in position by mattress sutures passing through the liver substance and through both sides of the fascia. These sutures were drawn as tight as desired and did not cut through the liver substance. The liver was dropped back and the wound was closed in the usual manner. Condition on leaving the table excellent. Per primam healing.

June 6. Death from pneumonia. Autopsy .- There was ad- hesion of the omentum to the fascia. When this was stripped off the fascia was seen covering the denuded area like a cap. It was slightly thickened but otherwise seemed normal.

Histology .- (Microscopic examination.) The sections showed normal staining, well-nourished fascia surrounding an area of liver substance. It was adherent to a considerable extent.

EXPERIMENT 60 .- Black and white fox terrier; about 1 year old. Operation .- June 5, 1911. The spleen was brought up through a left rectus incision, the edge was trimmed with scissors, and a flap of fascia was sutured over the denuded area so as to bind it. The fascia was held with mattress sutures which passed through the spleen and both edges of the fascia. There was considerable hemorrhage until the fascia was applied and the sutures tied. The spleen was dropped back and the wound was closed in the usual manner. Dry dressing. Condition on leav- ing the table excellent. Per primam healing.

July 3. Animal sacrificed. Autopsy .- The fascia was thick- ened and securely bound the edge of the spleen. It seemed well nourished and it could be separated from the spleen quite easily.

Histology .- (Microscopic examination.) Sections showed nor- mal staining fascia surrounding spleen tissue.

Comment .- In this group free flaps of fascia were suc- cessfully transplanted on the liver, kidney and spleen. It suggests that the fascia flaps might be used to support sutures in these organs, and also to bind raw post-operative surfaces (Fig. 11).

It is to be noted that the fascia when applied to a bleed-

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ing surface seemed to have a definite hemostatic effect which is comparable to the hemostatic action of bits of muscle, spoken of by Cushing.

The kidney might be suspended to the ribs or muscles in a sling of free fascia. These results are very promising.

(a)

(b)

FIG. 11 .- Experiment 25. (a) Fascia on a lobe of the liver. Operation, January 17, 1911. Specimen removed, January 26,

1911. The fascia was thickened but was adherent to the liver surface over most of its extent. Experiment 36. (b) Fascia on kidney cortex. Operation, February 21, 1911. Specimen removed, March 7, 1911. The fascia is closely adherent to the kidney sub- stance and blends with the capsule.

In both of these specimens, as in all the others, the fascia was well nourished.

Remarks .- In none of the animals have I noted a muscle hernia after the fascia was removed, but should it occur the

hernia could be repaired without difficulty. There parently no untoward effect after removal of the fas .. as far as the use of the limb is concerned.

In every instance the fascia retained its own strucz .: seemed well nourished. After removal from its bel . as tough and strong as when first transplanted.

The great strength of the fascia, and, in addiun : thinness and flexibility are to be noted. It can be, into a defect under considerable tension, and the sutura hold securely even when inserted close to the edges er of the flap.

The great supply of this material and the ease with it can be obtained are important points.

There is some difference in the measurements of frs fascia before and after removal. For example: A mai out flap of fascia lata measured 4.5 x 2.5 cm. before . and after removal it measured 3.3 x 2 cm. Andthey measured before removal 4.5 x 2.2 cm. and after ME 4 x 1.75 cm.

In several experiments fascia was drawn taut and sms around firm rubber tubes 0.8 to 1 cm. in diameter, u: 7 inserted in the subcutaneous tissue. These specimens:" removed after forty-nine and fifty-four days. The strukt the fascia could easily be seen. Microscopic examin showed normal staining fascia with no signs of degens :.

This is interesting as it shows that fascia will receive cient nourishment if only one surface is exposed to . tissue.

The type of so-called distemper prevalent in the last." this winter appeared to have some effect on the healing wounds and a number of them became infected. This .: seem due to a break in technic, as other animals opera .. the same morning (before and after these animals). ; identical technic, and not developing the distemper, di :. break down.

In several animals whose stitches had been removed : per primam healing the skin wound subsequently broke. after the development of distemper.

In the instances where there was infection the transpl: fascia seemed particularly resistant to it, and retsina: structure after the breakdown of the surrounding tissus

Where there was tension on the fascia there was No. tively little thickening, but wherever the fascia was sa; laid on a tissue there was always thickening, and url= was held flat with sutures it had a tendency to bunch er: up.

Once or twice the fascia flap was accidentally alles:" partially dry out before it was transplanted, but, in s." this, it was moistened with salt solution and transpl .: The results were excellent and the fascia was nourishsi grew in its new position.

The question naturally arose as to the necessity of = planting the fascia immediately, and also whether fast.1. one animal could be successfully transplanted into anet's" Experimentally, both of these questions have been an:» satisfactorily.

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5 .- (Microphotograph, Zeiss. Obj. AA. Oc. 3.) Two layers ia filling defect left by removal of patella. Section cut . I to fascia bundles. The smooth dark staining layer at .tom of the plate is the portion toward the joint cavity.

FIG. 12 .- (Microphotograph, Zeiss. Obj. AA. Oc. 3.) Fascia preserved in cold storage wrapped in moist salt gauze for 35 days and then transplanted on the surface of a trachea. Opera- tion, March 14, 1911. Specimen removed, April 10, 1911. The section is cut across the fascia bundles. The fascia is normal in appearance and stains well.

FIG. 9 .- (Microphotograph, Zeiss. Obj. AA. Oc. 3.)

Longitudinal section of fascia covering a tracheal defect. The defect can be seen between the tracheal rings. On the right of the plate the fascia has become accidentally separated from the surface of the trachea during the preparation of the section. The mucous membrane can be seen covering the fascia.

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J. wur as long as seven days; in cold storage at 32º C. ped in gauze moistened with salt solution for thirty-five and in cold storage at 32° C. in normal salt solution fty-six days. (Fig. 12.)

am sure that the number of days given here does not the greatest time that fascia may be preserved by the ods spoken of, but I mention the periods as a sugges- that suitable fascia might be preserved until needed for al use.

scia kept in salt solution appeared edematous when first ved from the solution, but the edema disappeared when issue was pressed with dry gauze. The edema was en- in the superficial connective tissue which had not been ved. The fascia kept in moist salt gauze, on the other , was normal in appearance.

ance of puckering or drawing up of the surface under the fascia and at its edges, somewhat similar to the effect of ordinary collodion on the skin. On this area, from within the organ, this puckering was not to be found and the lumen was in no way encroached upon.

The hemostatic action of free fascia flaps is noteworthy.

Conclusions .- The foregoing experiments give an idea of the great possibilities of transplanting free flaps of fascia and many suggestions for the clinical use of this substance may be drawn from them.

I feel convinced that many of the difficult situations aris- ing during operations for the repair of weakened and defec- tive tissues or for the control of bleeding surfaces will be simplified by the use of free fascia flaps and shall report the results of its use in such cases, with a consideration of the literature, in a subsequent paper.

NOTES ON NEW BOOKS.

essive Medicine. Edited by HOBART AMORY HARE, M. D., etc., ssisted by LEIGHTON F. APPLEMAN, M. D., etc. Vol. II. June, 911. (Lea & Febiger: Philadelphia and New York, 1911.)

ey contributes the chapter on "Hernia," Gerster that on gery of the Abdomen, Exclusive of Hernia," Clark that on ecology," Stengel that on " Diseases of the Blood, Diathetic Metabolic Diseases; Diseases of the Thyroid Gland, Nutrition, the Lymphatic System "; and Jackson that on " Ophthal- sy." It is interesting in looking over these quarterly les to consider how much or how little of all the literature permanent value; and whether an annual volume of limited night not be of greater value; but Progressive Medicine is edited and satisfies a natural demand of the profession.

rtbook of Nervous Diseases. By WILLIAM ALDRED TURNER, [. D. (Edin.), and THOMAS GRAINGER STEWART, M. B. (Edin.) rice, $6. (Philadelphia: P. Blakiston's Sons & Co., 1910.)

s book contains 607 pages, including the index. It is well d, well illustrated, and well bound, opening well, but the al purple color of the binding is somewhat startling at

The work is divided into nineteen parts, instead of ers, as follows: Anatomy and Physiology, Examination of ervous System in a Case of Nervous Disease, The Special 3, The Cranial Nerves, The Peripheral Nervous System, Diseases of the Brain, Diseases of the Membranes, Diseases : Spinal Cord, General Diseases of the Nervous System, totor and Trophic Diseases, Familial Diseases, Diseases sterised by Disorders of Muscular Function, Diseases of 'e Origin Characterised Chiefly by Disorders of Motion, ne and Periodic Headache, Hysteria, Neurasthenia,

isthenia, Epilepsy, and The Tics. It will be generally

that the above arrangement is an excellent one and ex- tion of the work proves it. The authors have so often their ability to do excellent work in the past that it goes it saying that they have kept up their reputation in this ambitious undertaking. We find but little to criticise and ' a trivial nature. Here and there it would perhaps have etter to have enlarged somewhat on certain statements have gone more into details but of a necessity brevity have been sacrificed. One statement we feel should be

modified and this appears in two forms, one on page 402, in speaking of the cerebro-spinal fluid, of progressive general paralysis: "The lymphocytes are greatly increased in number- to 150 or 200 or more [per] c. mm. of fluid-and the Wasserman reaction is present in 90 per cent or more of the cases (Mott)." And again on page 553 in discussing the diagnosis of neuras- thenia from the neurasthenic type of early paralytic dementia it states as follows: "This occurs chiefly in adult males who have had syphilis. Such cases may, or may not, present physical signs of organic disease, such as loss of the tendon jerks, or reflex pupillary immobility. If these signs are found in asso- ciation with neurasthenic symptoms, the onset of paralytic dementia may almost with certainty be diagnosed. The failure to obtain these signs of organic disease does not necessarily ex- clude the onset of paresis; therefore in those cases a lumbar puncture ought to be done and a cytological examination made of the cerebro-spinal fluid. If, on examination of the centrifuged deposit, the lymphocyte count shows 150 to 200 or more lympho- cytes, the diagnosis of general paralysis may be made with complete assurance. Although an increase of the lymphocytes is present in most cases of cerebrospinal syphilis, yet the count is rarely so high as in the parasyphilitic diseases." The first statement is not entirely clear as the word per is evidently omitted between " more " and " c. mm.," but in regard to both of them we believe that the number is entirely too high, that with such a high count other organic symptoms will undoubtedly be present, and that no competent observer would be willing to make a diagnosis of paresis on a high lymphocyte count alone, no matter how high it might be.

American Practice of Surgery. Editors: JOSEPH D. BRYANT, M. D., LL. D. ALBERT H. BUCK, M. D., vol. VIII. Profusely illustrated. (New York: William Wood and Co., 1911.)

With this volume this stupendous system of nearly 9000 pages comes to an end. Both editors and publishers can feel well satisfied with the work, which covers the entire field of surgery as completely, or even more so, than any other system in English. Those who use it will be able to find what they want in it, except that the index is very incomplete, which is a serious defect in such a work. This volume includes chapters on Introthoracic Surgery, Surgery of the Spleen, Surgical Diseases and Wounds

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of the Kidneys and Ureters, Surgery of the Pancreas, Surgery of the Liver, Gall-Bladder, and Biliary Passages, Surgical Dis- eases, Wounds and Malformations of the Urinary Bladder and the Prostate, Surgery of the Ovaries and Fallopian" Tubes, Sur- gery of the Uterus and its Ligaments, Extra-Uterine Pregnancy, and the Caesarian Section and its Substitutes. There are addi- tional sections on The Law in its Relation to the Practice of Surgery, and Administrative Surgical Work, the latter including surgical needs of hospitals, and military, naval and railroad ? surgery. There is finally an Appendix with a chapter on the i Relation of Blood-Pressure to Surgery, and a General Index.

Handbook of Treatment for Diseases of the Eye (Ophthalmic Therapeutics). By DR. CURT ; ADAM, Berlin. With a preface by PROF. VON MICHAEL, Berlin. Translated from the second German edition (1910) by William George Sym, M. D., etc., and E. M. Lithgow, M. B., etc. Illustrated. Price, $2.50. (New York: Rebman Company, 1911.)

This little book is devoted to the treatment of the diseases of the eye. While the propriety of separating the treatment from the description of the diseases may be questioned, yet it is sometimes very convenient, and it is possible some may like this book very much. ..

The treatment advocated for the various eye diseases is usually good, and will be found to give good results. The book states very definitely how to treat the various eye diseases, and if the instructions were even Afinde Mellowed the results would in almost every case be good and we suppose this means the book will be of value to some readers whose personal experience in such matters is small and who must necessarily follow some formal and definite plan in treating each disease. To all such readers we can commend this book as being about the best and safest of its class.

The Principles and Practice of Bandaging. By GWILYM G. DAVIS, M. D., etc. Third Edition, Revised. Illustrated. Price, $1. (Philadelphia: P. Blakiston's Son & Co., 1911.)

This work, which originally appeared in 1891, has been largely rewritten and the illustrations have been redrawn, so that it is practically a new book. As it exists to-day it is a first-rate guide for beginners as the author intends it to be. The draw- ings and text are both clear, so that a student should have little difficulty in mastering these principles. The author has divided his work into three parts: The Roller Bandages, The Tailed Bandages or Slings, and the Handkerchief Bandages. This arrangement with an abundance of illustrations makes it easy to acquire the practice of bandaging. The compactness and general excellence of this small manual will make it welcome to students.

Fractures and Their Treatment. By J. HOGARTH PRINGLE, M. B. (Ed.), F. R. C. S. (Eng.), Glasgow. Price, $5.50. (London: Henry Frowde and Hodder & Stoughton, 1910.) Oxford Medical Publications.

This book deals first with the general facts in relation to fractures. The usual causes, mechanisms, classification, and general diagnostic signs are discussed in the earlier chapters. Following this is a consideration of the process of repair, and of associated lesions of soft parts and joints. Fractures of particu- lar bones are then described, with the methods of treatment, the anatomical sequence of the skeleton being pursued. The final chapter is devoted to the relation of fractures to the Work-

men's Compensation Acts of England. At the end of de are presented several tables, compiled from various i authorities, indicating the amount of depreciation in efficiency after certain injuries. The book is well it's and contains a good bibliography, the references to special and being grouped together. The literary style of the worte the usual clearness and purity of British authors. The com of the subject-matter is far from being complete, the to. of most of the particular fractures being limited to a sre of general and well-known facts.

One wonders why such a book was written. There se reason for this expenditure of time and labor on a sx already so fully and frequently treated, in every for. text-book articles to special volumes, unless there be sm- light to shed of importance enough to justify the task illumination, if present, escaped the reviewer. The best especial fault except the deadly one of being commonpas unnecessary. The writer must have sensed the protek such criticism. In the preface he states that the Ins Workmen's Compensation Laws have made of fractures !!! paratively new subject, and further says that he was das to write the book because no special work on the sober been published in England for a very considerable time. last reason does not exist in this country, and one feels legal aspect of fractures was a prime motive in the corn of the book, that this phase of the subject has been gives disproportionately small amount of attention. H. B. :

Medical Guide and Monograph Series. Golden Rules of Pe! : By JOHN ZAHERSKY, M. D., etc. With an Introdnt : C. W. SAUNDERS, M. D. Price, $2.50. (St. Lovir: Mosby Company, 1911.)

Although there is nothing on the title page to indice. this book has appeared before, the author has written :" " Preface to the Second Edition," which proves that bis have been welcome to certain members of the profession. book has been carefully prepared and contains precepsi are serviceable to the student. One might apply, howsie aphorism to "Golden Rules " of this and other bramt- science " that all is not gold that glistens." The success c.A. works is rather a sad reflection on the mental attitude doctor who finds them useful. If he knows his sciences should do he will not need them; and unless he ker: science " Golden Rules " are but a snare and delusion.

A Monograph of the Anopheline Mosquitoes of India. By : JAMES, M. D., etc., and W. GLEN LESTON, M. D., etc. Edition. Rewritten and enlarged. (Calcutta: Ti: Spink & Co., 1911.)

Although this treatise is intended mainly for workers in yet there is so much valuable information in it in nay mosquitoes, that all students interested in the transmis contagious diseases, especially yellow fever and malaria prize it highly. Its most beautiful and copious illustrent of immeasurable help in appreciating the differences ber the genera. The book is divided into two parts. Partic three chapters: 1, A general account of mosquitoes. : collecting, mounting and examination of anopheline mos,- and their larvæ; 3, The classification and identifier. Indian anophelines. Part II contains the description of t genera. Drs. James and Liston are to be most wart .: gratulated on their admirable piece of work.

The Johns Hopkins Hospital Bulletins are issued monthly. They are printed by the LORD BALTIMORE PRESS, Baltimore. Buberph" a year (foreign postage, 60 cents), may be addressed to the publishers, THE JOHNS HOPKINS PRESS, BALTIMORE; single copies si mall for twenty-five cents each. Single copies may also be procured from the BALTIMORE NEWS CO., Baltimore.

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Entered as Second-Class Matter at the Baltimore, Maryland, Postoffice.

‹II .- No. 249.]

BALTIMORE, NOVEMBER, 1911.

[Price, 25 Cents

CONTENTS.

PAGE

al Paintings of Velasquez. (Illustrated.) JOHN W. CHURCHMAN, M. D. 383

Glycosuria. I. Ether Glycosuria.

JOHN H. KING, M. D., B. S. CHAFFEE, D. B. ANDERSON nd L. H. REDELINGS 388

Notes on Jaundice in Pneumonia.

By FLETCHER MCPHEDRAN, M. B. 408

Abdominal Lipectomy. Report of Two Cases. (Illustrated.) By W. F. SHALLENBERGER, M. D. . 410

In Memoriam. Dr. Christian Archibald Herter .

411

Notes on New Books .

412

THE MEDICAL PAINTINGS OF VELASQUEZ .*

By JOHN W. CHURCHMAN, M. D., Late Resident Surgeon, The Johns Hopkins Hospital.

is nothing whatever to show that Velasquez felt any r interest in the tasks of science or in its achieve- He certainly exhibited no feeling for medicine as a 1, or as one of the humanities. The approach of art e has often been more obvious. Other men, like , have made important contributions to each. Not ike Keats and Sainte-Beuve-have known, by de- : the one for the other, the problems and interests Yet Velasquez' mind was of the type which enjoys ssionate observation of facts; and in this sense his view was at least a new one in art. Vision meant not what it had meant for his predecessors; it meant e of the five senses keenly developed and used with- or favor. Such sympathy with the method of espite any indifference to its content, it is not far- · describe as intellectual kinship. In this man, art te drew near; and the gap between them was further by the fact that the actual phenomena which fell uez' way chanced to be the ones with which medi- self concerned.

as Velasquez' fascination by oddness and deformity

; the meeting of the Johns Hopkins Hospital Historical 10, 1911.

of mind and body were, he was by no means unique in his choice of material which happens to have a medical interest. He was, indeed, quite unique in the extent to which his choice was of this character; but the field of medicine he shares with many other painters. There was Jan Steen, for example, in the Netherlands. Yet sunlight and shadow could hardly pre- sent a sharper contrast than did these two men; nor could bar-room, where the one idled away his days, and king's-court, where the other lived out his career. In almost every detail and circumstance of outward life and mental outlook what the one man was the other was not. The Dutchman brought to medical life the methods of pictorial art; his interest in medicine was casual and anecdotal. Velasquez was interested neither in episodes nor in events. He apprehended and con- stantly maintained the purely objective attitude.

The pictures of Velasquez which possess unusual medical interest, belong to the Dwarf and Jester Group.1 With three exceptions, they were painted in the last ten years of his life and represent, therefore, his mature work. The earliest of them is the Geographer of the Rouen Gallery. (Fig. 1.)

1 The two mendicants (Menippus and Aesop) and the Berlin del Borro (of somewhat doubtful authenticity), though allied to this group, should be separately considered.

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A Protest Against the Indiscriminate Use of the Organic Com- pounds of Silver in Ophthalmic Practice. By SAMUEL THEOBALD, M. D. . 407

, of Occlusion of the Various Hepatic Vessels Upon the (Illustrated.)

M. C. WINTERNITZ, M. D. . 396

ing of Experimental Pathology and Pathological Physi- to Large Classes. RICHARD M. PEARCE M. D. 404

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The subject of this portrait is probably the same person as the one represented in the striking Pablillos de Valladolid (Fig. 2). The Bouffon Pernia (Fig. 3) and the Don Juan of Austria (Fig. 4) complete the Buffoon Group.

The Dwarf pictures fall into two groups according to the predominance of portraiture or pathology. In the first group Velasquez has immortalized those of his dwarfed every-day companions whose deficiencies were only physical. Here be- long the El Primo (Fig. 5), the Don Sebastian de Morra (Fig. 6), the Don Antonio d'Ingles (Fig. 7), and the Don Carlos and his Dwarf (Fig. 8). The Don Carlos in the Riding School in the Westminster Collection, includes, in the background two court dwarfs; and mention should be made of the portraits of two fragile, stunted, royal children (Philip Prosper, Royal Gallery, Vienna, and Don Carlos, Wallace Collection, London).

More striking is the group in which the monstrous pre- dominates. These are the pictures it is hardest to imagine a painter producing; yet Velasquez seems to have painted these prodigies " with care and pleasure, just as he would have painted a pretty woman-without a thought." One recalls Charles Morice's remark about Cézanne " A potato is as significant for him as a human face."

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Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 160

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

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