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(11.) The arteries of those poisoned by lead, even in very early stages of the disease, may show all auscultatory phenomena of the arteries of patients with aortic regurgitation. (12.) The arteries give no pathognomonic sign of aortic insufficiency.
(To be concluded.)
RECORDS OF THE BOSTON SOCIETY OF MEDICAL SCIENCES
FROM MARCH TO MAY, 1878.
JAMES J. PUTNAM, M. D., SECRETARY.
TUESDAY, MARCH 24, 1878. — DR. WEBBER read an account of a case of section of the ulnar nerre just below the point where the branch supplying the abductor minimi digiti is given off. As a result of this injury it happened that when an attempt was made to extend the fingers they all, except the little finger, assumed the position characteristic of the “ bird's-claw” hand, and further, the first and second fingers remained parallel with each other, as usual. The little finger on the other hand was drawn, by the unbalanced action of the abductor, into a position nearly at right angles with the hand, while the ring finger stood half-way between the second and little fingers. The loss of electrical reaction affected the parts supplied by the injured portion of the nerve, but so far as could be told with so young a subject (a boy seven years of age) no part of the skin had lost its sensibility.
DR. AMORY asked as to the length of time required for recovery of a nerve from section, and said that after accidental division of one of his own digital nerves three years had elapsed before sensibility had become entirely restored.
In answer to Drs. Dwight and Bowditch, DR. WEBBER said that undoubtedly the assumption of the functions of injured nerves by others, which either anastomose with them or supply the same area of skin, was in part the cause of the persistence or quick return of sensibility to paralyzed parts of the skin, but besides these causes the education of the cerebral centres to appreciate slight impressions conveyed mechanically to neighboring nerves must be taken into account.
DR. Blake showed an object which had been found in the eye socket of a Peruvian mummy by an officer of the United States Coast Survey, and given to him. It was of yellowish color, flat on one side and sharply rounded on the other, and was believed, in accordance with the opinion of Professor Agassiz, given in regard to other similar specimens, to be a portion of the
of the cuttle-fish. It was not a unique but yet a very rare specimen. It had undoubtedly been introduced at the time of embalmment, but Dr. Blake had been unable to learn whether it is only in skulls of a certain type, of which two distinct kinds exist, that these bodies are found. The rounded side is always turned outwards. It is not possible that they are introduced before death, because the specimen at the Peabody Museum is so large that it must have been forced in with some difficulty.
Dr. Wadsworth showed a microscopic section of an epithelioma of the limbus corneæ, which had encroached slightly on the cornea, forming a rounded
tumor, perhaps a quarter of an inch in circumference. The surface, during life, had been smooth and unbroken ; its central portion rather pale, the rest congested. The case was interesting as indicating the possibility of curing the disease by operation, more than nine months having now elapsed since the removal, without recurrence; also because it was possible, under the microscope, to trace the diseased into the healthy tissue in both directions. He showed also a section of another small epithelioma of the eyelid (not involving its edge), with the history that more than a year before the operation for removal a minute tumor had been noticed which had seemed to be an enlarged sebaceous gland, with inspissated contents, forming a mass perhaps a line in diameter, and consisting (under the microscope) of granules and fatty matter. For two or three months there had been no further trouble; then attention began to be frequently called to the part by a feeling of slight pain or itching there, and in the course of a year this little tumor had developed so as to be three eighths of an inch in diameter and rather dense to the feel, and the surface uneven and nodulated. The microscope had revealed the usual appearances of epithelioma. Two and one half years had elapsed since the operation, without any sign of return.
DR. Dwight wished to put on record a case of partial transposition of the viscera, every part being in its normal place except the intestines. The ascending colon was on the left side and the sigmoid flexure on the right. Partial transpositions of this kind are very rare, while complete ones are not excessively so.
TUESDAY, APRIL 16, 1878. DR. GARLAND described some peculiar movements which he had recently observed in the pus cells of a specimen of urine which had been sent him for examination. The urine was of a pale straw color, showed an acid reaction, and had a specific gravity of 1011; it contained a large amount of albumen, and an abundant sediment which consisted of pus and blood cells, and epithelium from the vagina, lower urinary tract, and renal pelvis. There were no casts, but a large number of bacteria were moving about the field. The pus cells were making sluggish amaboid movements, and displaying numerous ameboid changes of contour. Some of the cells seemed enlarged by a protrusion on one side. This protruded portion was ordinarily clear and hyaline in appearance, but sometimes contained a few isolated granules, while the remainder of granular contents was grouped about the nuclei in the other parts of the cell. Strong illumination (by gas) of the hyaline portion made it evident that the granules which it contained were in active vibration. In spite of being violently agitated, however, the granules did not migrate from their positions. The addition of acetic acid and the beginning of alkaline fermentation stopped the movements. No similar movements could be detected in the granular masses which remained grouped about the nuclei in the other parts of the cell, and it was confined to two or three of the individual granules in the clear part. By the aid of careful focusing Dr. Garland was able to convince himself that the moving particles were inside the cell
, and that they were not bacteria, from which they differ in being much smaller and in showing much more active movements than the latter bodies.
Dr. Dwight suggested that the movements described were probably the same as the Brunonian movements of protoplasm.
DR. GARLAND thought this explanation a very probable one, but said it was unusual to observe such movements in the pus of urine, and suggested that they might have a clinical significance. Dr. Garland said further that in order to see the movements described it had been necessary to have a strong illumination and an acid urine.
TUESDAY, May 21, 1878. DR. WADSWORTH showed some photographs of sections of the retina in the foveal region.
DR. Bowditch showed a modification of Du Bois Raymond's unpolarisable electrode, of his own invention and construction. It was made of a plate of hard rubber about three inches long, one inch wide, and one quarter of an inch thick. Along the upper surface of this plate, near the median line, a number of small holes or pits had been bored, about oire quarter of an inch apart, from one end of the rubber strip to the other. Each one of these pits communicated by a little tunnel, one eighth of an inch or so in length, with a narrow trough which occupied the rest of the width of the strip of hard rubber from the pits outward, separated, however, from the pits themselves, on the surface, by the narrow bridge of rubber which closed in the tunnel from above. The pits were designed to hold the solution of zinc sulphate, the troughs to be filled with moistened clay. Across any desired number (six or eight, for example) of the troughs a frog's nerve could be laid, and could be excited electrically at any desired point by means of lead electrodes terminating in bits of zinc wire which could be dropped at will into any of the little pits containing the zinc solution. The apparatus had been in actual use, and had worked successfully.
DR. BLAKE read a paper, illustrated by diagrams and tracings of sound waves, on the phenomena of audition and the telephone, drawing comparison between the sound-conducting portions of the organ of hearing and the telephone.
The object of the experiments undertaken and described in this paper was to determine the loss of power appreciable in the telephonic transmission of the human voice by measurements of the excursions of the discs respectively of the transmitting and receiving telephones. This was done in two ways: first, by making tracings upon smoked glass with a fine plantinum point attached to the centre of the disc, the tracing being there measured under a microscope with micrometer eye-piece ; and, second, by inserting the telephone disc in a circuit, with a micrometer screw, between a single-cell bichromate-ofpotash battery and a delicate galvanometer. The measurements made in these two ways coincided very ne ly in their results, and showed a difference of movement in the receiving as compared with the transmitting disc, which may be stated as indicating a loss of power in transmission equal to 92.8 per cent.
In addition to these measurements a comparison of the vibrations in the air-chambers of the two telephones had been made by tapping the chambers and connecting them with two Koenig's manometric flames, whereby it was shown that the flame corresponding to the transmitting telephone exhibited the tongues characteristic of the vowel sounds sung into the telephone, while
the flame corresponding to the receiving telephone gave merely a slightly wavy line in the mirror.
The induced currents corresponding to the consonant sounds had also been tested by means of a short-coil Thompson reflecting galvanometer, and the deviations of the galvanometer had been found to correspond approximately to the logographic value of the consonants. The paper for which these experiments were undertaken had been read by request before the British Society of Telegraphic Engineers in London, at a regular meeting, May 8, 1878.
HALL'S DIFFERENTIAL DIAGNOSIS.
Dr. Hall's Synopsis of the Diseases of the Larynx, Lungs, and Heart has been elaborated by the American editor into a work on the differential diagnosis of all the more important general and local diseases. He judiciously states that “preference has been given to American over European authorities, as every year adds confirmation to the opinion, now widely received, that diseased conditions assume very different aspects under different climatic and sociological surroundings.” The physical signs and the symptoms of the various affections are arranged in tabular form for convenient reference, and the facility thus afforded for comparison and discrimination enables this manual to supply a want often experienced in more elaborate treatises.
CLAPP'S AUSCULTATION AND PERCUSSION.?
This is a very carefully prepared tabular view of the physical signs obtained by auscultation and percussion, especially as interpreted by those clinical teachers of whom Dr. Flint is a notable example. Whatever criticism can be made upon the views expressed in this little manual pertains also to this class of writers as a whole. For instance, Dr. Clapp adopts the low-pitched blowing respiration described by Walshe, Flint, and others as pathognomonic of a cavity, to which the majority of auscultators would not assent. Prolonged expiration is made diagnostic of pulmonary emphysema, whereas most physicians would attribute its presence to a coexisting diminution of calibre in the bronchial tubes. The crepitant râle is said to be “almost pathognomonic of pneumonia,” no allusion being made to its occurrence in pulmonary ædema and after pulmonary hæmorrhage. The old idea of Laennec in regard to ægophony is retained.
In brief, it may be said that the views of the modern German school are seldom adopted.
Differential Diagnosis : A Manual of the Comparutive Semeiology of the more Important Diseases. By F. de Havilland Hall, M. D., Assistant Physician to the Westminster Hospital, London. American Edition, with extensive additions. Philadelphia : D. S. Brin
: A Tabular Handbook of Auscultation and Percussion for Students and Physicians. By HERBERT C. CLAPP, A. M., M. D., Instructor in Auscultation and Percussion in the Bos ton University, etc. Boston: Houghton, Osgood & Co. 1879. Pp. 97, 8vo.
We will only repeat, what was said in the beginning of our notice, that this little manual shows evidence of a great amount of care and labor in its compilation, there being hardly an error in it when viewed from the stand-point mentioned above. An index would improve a second edition.
HEALTH, LUNACY, AND CHARITY. A Bill in conformity with the suggestions of Governor Talbot has been printed for the use of the committee of the legislature on public charitable institutions, to whom was referred the important questions of satisfying a supposed popular clamor for retrenchment, of reorganizing successfully the Board of State Charities, and of devising legislation to place the committal to asylums and care of the insane under state supervision.
The bill abolishes the State Board of Health, the Board of State Charities, and the trustees, inspectors, and advisory boards of the reformatory institutions and almshouse. It provides for the appointment of nine persons by the governor (who wishes to have them independent of party, sex, and sect), to constitute an unpaid State Board of Health, Lunacy, and Charity; to possess the pow- . ers of the two abolished boards; to examine insane people, and discharge them from asylums, if they see fit; and, in case of dangerous epidemics, to have coördinate powers with local boards of health. They may appoint and fix the salaries of their executive officers, no one of whom is to be a member of the board. The reformatory institutions are to be placed under a board of inspectors, who, as well as the trustees of the insane asylums, may be directed by the general board whenever the governor sees fit.
Although we do not share the distrust of our asylums for the insane and their management, it seems to us clear that a judicious supervision of the inmates of them by the State would be of advantage to the medical superintendents, to society, and to the insane; but this could be done by the board of charities or health, or by the two together, as well as by a new board, and at no greater expense. The reorganization of the department of charities we
. cannot now take time to discuss. It is recommended by their own officers, and something should be done, but we hope not in a short-sighted nor in a too Butler-fearing way. The interests at stake are too great to allow the saving of a few thousand dollars to cripple one of the most important departments at the State House. For the board of health the new plan, although intended to do so, does not promise any additional prospect of usefulness, unless it be that it is desirable to have them inspect our public institutions, and that could be done in a better way. They have nothing to gain by being consolidated, and a chance of losing everything if they must give up their present harmonious organization, enter the arena of politics, and run the risk of going to the ground, as the board of charities has done, thereby bringing sanitary science into disrepute. Looking at the matter from the stand-point of the medical profession, we think it would be much better than that to abolish the board outright, for another would soon be demanded by the State.
After so many years' experience in “boards,” it is surprising that so much