Exceptional Instances Research Articles

Sophoclea IV

Since the time of Brunck there has been a more or less general acquiescence in his substitution of πνθώμεθα for πνθομεθα, inasmuch as there is no obvious reason to be alleged in support of the optative. Campbell, it is true, found the optative more in accord with the feeling of the blind and weary Oedipus; but who will listen to this nowadays? Therefore it is the more surprising that Radermacher should retain the optative as expressing the eager wish to attain the goal, basing himself on J. M. Stahl's Syntax of the Greek Verb, p. 482. For Stahl, who admits the existence of certain exceptional instances to be justified in this sense, expressly excludes from the category this passage as well as El. 57 and 760, and seeks to limit the scope of his pronouncement to the writings of Aristophanes, Xenophon and the Orators—a curious combination.

ETIOLOGY OF OROYA FEVER

Bartonella bacilliformis failed to induce lesions when merely rubbed on the surface of the intact skin of a chimpanzee, an ourang-utan, and numerous Macacus rhesus monkeys, although when applied to the scarified skin of the same animals it gave rise to extensive lesions. Application of infectious material to the scarified skin did not always induce verruga lesions, but intradermal inoculation almost invariably gave rise to nodule formation. The localization of Bartonella bacilliformis in the skin is not, in experimental animals, determined by mechanical factors, since scarification of the skin or intradermal injection of foreign substances in monkeys infected with Bartonella bacilliformis does not give rise to verruga formation. The degree of susceptibility of the skin tissues appears to be considerably diminished during the course of experimental infection with Bartonella bacilliformis. Inoculation of the scarified skin of infected animals gave uniformly negative results, and intradermal inoculation induced only a mild local reaction. In a few exceptional instances, however, of animals previously infected with the strain of Bartonella bacilliformis derived from a human verruga nodule, reinoculation with the same strain gave rise to unusually marked reactions. The evolution of the skin lesion induced in experimental animals by Bartonella bacilliformis may be divided into four stages, the period of incubation, the initial stage, the mature and vascular stage, and the regression. In the initial stage the lesion is a pure angioendothelioma, but in the stage of full development the histological picture is complicated by connective tissue proliferation and occasionally also by penetration of epidermis into the lesion. The demonstration of Bartonella bacilliformis in the endothelial cells distinguishes the lesion from others which simulate it. The cutaneous lesions known as verruga nodular, verruga mular, and verruga miliar have been reproduced in monkeys.

The Interpretation of Early Fetal Roentgenograms

In this communication we wish to discuss the interpretation of early fetal roentgenograms exclusive of those after pneumoperitoneum. In an article published in the Journal of the American Medical Association, July 7, 1923, we considered the importance of the roentgenogram showing the fetal skeleton as a positive sign of pregnancy. In the former we primarily considered the fetus from mid-pregnancy to term, while it is our desire at this time to emphasize the possibility of depicting the fetus as early as possible and to describe the findings thus obtained. The problem of producing a satisfactory film in the early period, one that has a real interpretive value from a roentgenographic as well as a diagnostic standpoint, is a vastly different one than at a later period of fetal development. It is our aim to show some definite evidence of fetal bony structure at the earliest possible moment, in order to make a positive diagnosis, and we are not especially concerned at this time with the position of the fetus. Quoting from our previous paper we regard the “roentgenogram of the fetal skeleton as the earliest demonstrable positive sign of pregnancy.” It has been stated by others that the fetal skeleton can regularly and constantly be depicted on films at three, three and one-half, or four months. As a result of considerable experience, and some experimentation in this period, we are compelled to take issue with this view. It has been in exceptional instances only that we have been able to visualize the fetal skeleton prior to mid-term. Even when a satisfactory film has been secured, one from which positive findings can be obtained, die entire skeletal structure usually cannot be clearly outlined. Only an extremity, a few vertebrae, the head or a part thereof may appear. When the head can be seen it is the occipital bone which is usually observed, and if other cranial bones are also visible, the occiput is always densest. When the fetus happens to lie transversely in the uterine cavity with its back presenting, almost the entire fetal skeleton may be observed on the film. The tilt of the pelvis, the relation of the sacrum to the skeletal shadows, gas and intestinal contents, pelvic contents, all or singly, may offer sufficient resistance to the passage of the rays through the pelvis, so that the resulting conglomeration of shadows wipes out the fetal skeletal shadows on the films. Adequate preparation of the patient to minimize intestinal contents is highly desirable, but frequently is impossible to control. The importance of the position of the patient can again well be emphasized at this time. The uterus, before mid-term, does not rise very high into the abdomen. If the roentgenogram is made in a straight antero-posterior or postero-anterior position, then the fundus which lies below the level of the iliac crests is covered by the shadow of the sacrum with its dense promontory and the fifth lumbar vertebra.

THE QUANTITATIVE AMOUNT OF LIPOID MATERIAL IN THE KIDNEY AND ITS RELATION TO THE FUNCTIONAL RESPONSE IN EXPERIMENTAL NEPHRITIS

The presence of various forms of fatty materials, i. e., lipoids, in the kidney in acute nephritis is one of the most important histologic findings. The relation of these substances to the altered functions of the kidney and to the latter stages of chronic nephritis is not well known. An understanding of these relations would serve as stepping stones toward the solution of many problems which are of vital clinical importance. An experimental study of lipoid changes in nephritis in animals offers an approach which at present is not possible in dealing with early nephritis in man. It is only in exceptional instances that gross material can be obtained from a patient with early nephritis, since he either recovers or progresses on to a chronic condition. In producing kidney changes we have used uranium nitrate because the histology of this type of experimental nephritis has received a great amount of

EXPERIMENTAL SYPHILIS IN THE RABBIT

In a series of more than 200 rabbits in which generalized lesions were observed following local inoculation with Treponema pallidum, there were a number of animals in which characteristic lesions were noted upon mucous membranes or along mucocutaneous borders. These lesions were distributed with about equal frequency between the nose or nasolacrimal system and the eyelids on the one hand, and the genital and anal regions on the other. The lips and buccal mucosa appeared to be less subject to localized infections unless the papillomatous growths noted on the lips and under side of the tongue should prove to be in some way connected with such an infection. In many instances, the local reaction was initiated by an acute inflammatory process, and in the case of nasal and genital infections, a definite exudate was formed. The succeeding stages of the reaction consisted in an infiltration of the parts involved, together with a variable degree of proliferation of fixed tissue cells, leading eventually to necrosis and ulceration. The resulting lesions differed according to their location and the character of the reaction in the individual case. Localized infections of the nose occurred in several forms, first, as a rather diffuse affection of the nasal mucosa characterized by the presence of a mucopurulent exudate, second, as a more or less circumscribed process of infiltration with an especial predilection for the region of the anterior nares, and third, as a granulomatous process involving the alae in particular. Involvement of the nasal mucosa was very commonly associated with lacrimal overflow and with some degree of conjunctivitis. The lesions of the eyelids were usually small, elevated papules or lesions of an ulcerative character some of which were surrounded by a zone of infiltration. In exceptional instances, large granulomatous lesions occurred along the margins of the lower lids. Infection of the penis and sheath gave rise to conditions analogous to those of the nose. In one group of animals, there was a diffuse affection characterized by redness and swelling of the parts with a mucopurulent exudate, in another there were circumscribed or diffuse infiltrations, while in a third the lesions formed were indurated granulomatous masses. Secondary necrosis with erosion or ulceration was a common feature of all these conditions. Localized infections in the region of the anus differed from those in other localities chiefly in the absence of an exudative group of affections and in the frequency with which lesions of a papillomatous type occurred. Lesions of mucous membranes and mucocutaneous borders developed at periods of time varying from a few weeks to several months after inoculation. Most of them were rather enduring and in several instances persisted in an active condition for considerably more than a year.

EXPERIMENTAL SYPHILIS IN THE RABBIT

A study was made of the infections produced in rabbits inoculated in the testicles with two strains of Treponema pallidum which had been carried in rabbits for several years. Infection resulted in all instances; the incubation period varied as a rule between 2 and 6 weeks and under properly chosen conditions could be reduced to approximately 3 weeks or less. The resulting infection pursued a typically cyclic or relapsing course which affected both the spirochetes and the associated lesions in the testicle. The spirochetes in the local lesions exhibited periodic changes less marked and less regular but identical in character with the changes which occur in the blood in cases of relapsing fever. The lesions in the testicle also showed periods of active development and quiescence or regression which followed closely upon the changes exhibited by the spirochetes. The specific reaction in the testicle showed considerable variation in the speed and sharpness with which successive phenomena occurred as well as in the character and extent of the processes themselves. These reactions were of two fundamental types. In one group of animals, the reaction was characterized by an intense cycle of acute exudation and infiltration with a lesser degree of proliferation, followed by crisis and subsequent recurrence of secondary cycles of proliferative reaction of a minor degree. In the other group of animals, the reaction was more chronic in character and consisted largely of infiltration and proliferation. The progress of the reaction was more gradual, and sharp alterations in its course were absent. The infection progressed by a succession of stages with slight and irregular remissions. In a third group of animals, the reaction was subacute, combining at the same time the processes of exudation, infiltration, and proliferation. The first cycle of reaction was fairly acute and terminated in a definite crisis with moderate regression which in turn was followed by recurrence and more or less pronounced secondary cycles of proliferation. In all cases of outspoken infection, there was diffuse involvement of testicle, tunic, epididymis, and cord, but as the infection progressed, the lesions underwent many transformations, so that a variety of lesions was formed from processes which in the beginning were of a common type. Eventually, the reaction became more irregular and the infection became centered in one or more foci which were commonly situated in the epididymis, tunics, scrotum, or mediastinum testis. These centers served as residual foci of infection. The duration of the testicular process was found to be very variable. In some animals, the entire reaction consisted of but a single sharp cycle, and the local infection was terminated by crisis within 4 to 6 weeks after inoculation. As a rule, the period of active infection was from 2 to 4 months, and quiescent or inactive lesions not infrequently lasted for from 4 to 6 months. In exceptional instances, local infection persisted for more than a year.

A NOTE ON THE PRODUCTION OF ANTIPNEUMOCOCCUS SERA

Horses immunized to Type I pneumococci developed serum, 0.1 cc. of which protected against 0.5 cc. of a virulent culture, 0.000001 cc. of which killed mice in less than 40 hours. Protective tests of serum from horses immunized to Type II organisms varied, 0.1 cc. protecting, however, in certain instances against 0.1 and 0.01 cc. of virulent homologous culture. Types I and II sera obtained in our experiments with culture sediment and whole culture did not vary markedly for a given type and corresponded closely in their protective titer with samples of sera received from The Rockefeller Institute Hospital. It is therefore evident that the following minimum standard of 0.1 cc. of serum to protect mice against at least 0.2 cc. of virulent cultures can and should be maintained when serum is to be used for the treatment of cases. By further study and comparison of these different methods of immunization it is hoped that sera of greater potency may be produced, but as yet this has only been accomplished in exceptional instances. A horse immunized with Type III (Pneumococcus mucosus) developed serum having a slight degree of protection for mice against the corresponding organisms. This serum was sufficiently potent, however, to cause prompt and complete agglutination when combined with fresh untreated homologous organisms, thus avoiding the preliminary treatment to remove the capsule which has previously been held necessary. As a diagnostic aid in the differentiation of pneumococcus strains, the serum has proved of distinct value.

A determining factor in the development of Roman Architecture

It is of course universally recognised that Roman architects differed from their Greek or Hellenistic predecessors largely in the practice of spanning considerable spaces with arches, vaults or domes, whereas the Greeks limited themselves usually to stone architraves or wooden beams, with exceptional instances of the use of arches and probably simple trusses, of moderate dimensions. I am not certain, however, that it has occurred to investigators to discuss the possible cause for this radical difference between the two “classical” schools of architecture, except perhaps by generalisations as to racial qualities, merely another form of stating the same fact, rather than an explanation of it, or by reflections on the reckless waste of material and labour generated under a despotism, a form of explanation that will not carry conviction to the judicious. The matter is however of sufficient interest to justify the enquiry as to whether a more definite and convincing cause cannot be assigned.

GYMNASTICS AND MASSAGE IN THE TREATMENT OF NERVOUS DISEASES

Perhaps the greatest field for gymnastics and massage is in the domain of nervous diseases, because the problem here is generally one of nutrition and restoration of muscular function. Every specialist in these diseases should, in my opinion, have a practical training in these branches of mechanotherapy, because otherwise he cannot intelligently direct such treatment, and a considerable portion of it should be performed with his own hands. I shll not here discuss the technic further than to call attention to a few points and procedures. Nearly all patients with nervous disease suffer from digestive troubles, constipation and poor nutrition, and in abdominal massage which should be performed by the physician, or an experienced masseur or masseuse in exceptional instances, we have, to my mind, the most valuable single remedial agent for these conditions. ABDOMINAL AND GENERA MASSAGE Abdominal massage should be performed through a single covering; for instance, the

Isolation of Trypanosomes from accompanying Bacteria

In general, it may be said that bacteria once introduced into a culture of trypanosomes tend to outgrow and check the development of the flagellates. In exceptional instances, however, the bacteria thus introduced exert little of no interference and may be even apparently beneficial. While in the former case the trypanosomes soon die out, in the latter instance the mixed cultures may be kept for six months or longer.

GALLSTONES IN THE COMMON-DUCT.

Gallstones in the common duct have been found once in every five cases operated on by Robson, and once in every seven cases of the Mayos. It is estimated that 67 per cent. occur in the duodenal end, 15 per cent. in the hepatic end, and 18 per cent. in the middle of the choledochus. They vary in size usually from a split pea to a nut-meg, although exceptional instances of much larger stones have been recorded. They are usually solitary, though more than one are frequently found. They sometimes may remain many years. Moynihan speaks of one case removed after 9 years. They usually cause death in from 6 to 12 months from cholemia if the obstruction is complete and unrelieved. I have seen death ensue in 6 weeks from cholemia and infection, with intense jaundice and delirium, in spite of operation, which was only undertaken as a last

ABDOMINAL VS. VAGINAL HYSTERECTOMY FOR UTERINE CARCINOMA.

The choice of route for hysterectomy must be selected for each case. It is my desire to present a concise resume of the reasons for each, and the advantages they offer in the cases to which they are applicable. The views laid down are those of the general surgeon, and are based on an experience in this work that justifies, I think, an opinion. It has been claimed that vaginal hysterectomy is an operation that requires special training and attention to detail and technique which can only be acquired by the specialist. I can not, however, allow this statement to go unchallenged, for I believe that the general surgeon, with his larger field and constant application to detailed technique, is equally well, if not better, equipped to perform every operation of gynecology than is the specialist himself. Who to-day, but in exceptional instances, would dream of amputating a carcinomatous mammary

XXXII.—On the Manganese Oxides and Manganese Nodules in Marine Deposits

During the “Challenger” Deep-Sea Exploring Expedition a great many peculiar-looking manganese nodules or concretions were dredged from the floor of the ocean at great depths, chiefly in the Red Clay areas of the Pacific, but also in less abundance in the Red Clays of the Atlantic. In the other varieties of Deep-Sea deposits these nodules were much less abundant than in the Red Clays.In still more recent soundings, both American and British ships have discovered in many regions of the Pacific and Indian Oceans a dark-brown coloured deposit containing a large amount of manganese dioxide, similar in character to the Red Clays from which the “Challenger” procured the largest hauls of manganese nodules. There is then every reason for supposing that manganese deposits and nodules are very widely distributed over the ocean's bed, especially in deep water at great distances from land. It was only occasionally that manganese nodules were present in any abundance in a Globigerina Ooze, and in these exceptional instances there was always much volcanic debris associated with the deposit. In the Blue Muds surrounding continental shores manganese nodules were rarely observed; still, on some rocks and boulders dredged from terrigenous deposits, a coating of manganese dioxide was observed on that portion of the stone which had projected above the surface of the mud.

Cases of Masturbation (Masturbatic Insanity)

There are exceptions to the rule that all male masturbators are shy with regard to the female sex, and at all times. It is true that the majority are so in the earlier periods of their vice, and as long as definitive mental disease has not set in. In some cases where such disease has become established, a sudden transformation from bashfulness to brazen effrontery, and from timidity to bold, insulting and lascivious demeanour, is noticed. These patients exaggerate the characteristic, so happily drawn by Oliver Goldsmith in “She Stoops to Conquer,” of a certain class of men who are heroes before barmaids and cowards before refined females. In exceptional instances, the masturbatic lunatic is as brutally indecent to those of a higher as to those of a lower station. Godding relates a case of this kind in graphic language in his “Two Hard Cases.”

On The Relations of The Fig and The Caprifig 1

THE relations of the fig and the caprifig, or the cultivated varieties of fig and the wild form of the Mediterranean region, have been variously explained by different writers, including those recent ones whose works are cited below. Intimately connected with this question is the process of caprification, so often and so circumstantially described by ancient and modern authors, amongst the later of whom we may mention Gasparrini. Graf Solms-Laubach's essay is an elaborate work of upwards of one hundred quarto pages, embodying the results of much research. Not the least interesting part is that treating of caprification, or perhaps we might say the manner in which fertilisation is effected. The author regards the cultivated edible varieties of fig as constituting one race, and the wild caprifig as another race of one and the same species; and the former as having developed from the latter under the influences of cultivation. Gasparrini, on the contrary, described them as distinct genera. Dr. Fritz Müller takes an altogether different view. He says it appears to him far more likely that the fig and caprifig represent, as Linnæus supposed, different forms, the male and the female, belonging together, and not proceeding the one from the other, but which developed side by side, before any cultivation, through natural selection. An examination of the facts adduced by Solms-Laubach himself seems to point to the correctness of Müller's view. But we will set them forth as briefly as possible, leaving the reader to judge for himself. The responsibility of their accuracy rests with the author whom we are quoting. It may be well to explain, in the first place, the nature of the fruit of the fig, as it is something more than a seed-vessel of one flower. The fleshy part is a thickened hollow receptacle, closed, except a very narrow aperture at the top, and containing numerous minute flowers crowded together all over the inside of the cavity. Both the fig and caprifig produce three more or less distinct crops of fruit in the course of the year. Each of these crops of fig and caprifig bears a distinctive name; but the three crops of the former do not all reach maturity. In this country only one crop ripens. The varieties of the fig in Naples, whether cultivated or wild, produce fruit at least twice a year, and different varieties exhibit diverse phenomena in the degree of development and maturation of the several crops. In the fig the tissue of the receptacle or infiorescence is fleshy, and the perianth and pedicels of the individual flowers it contains thicken and abound in a sugary juice; whilst the fruit of the caprifig remains hard and milky up to maturity, or only imperfectly softens just at last without any secretion of sugar, and then shrivels and dries up. As long ago as 1770, Colin Milne1 recorded the fact that the varieties of fig cultivated in England contained only female flowers; and Graf Solms found that male flowers were almost invariably altogether wanting in the varieties cultivated in Naples, and in the very rare exceptional instances in which they were present they were imperfectly developed and abnormal, the anthers being commonly replaced by leafy organs. On the other hand the inflorescence of the caprifig, as observed in Naples, usually contained both male and female flowers, the latter covering the greater part of the surface of the cavity, and the former restricted to a zone, variable in breadth, in the neighbourhood of the apical aperture. It is, moreover, noteworthy that the inflorescence exhibits proterogynous dichogamy in a marked degree. At the time when the female flowers are in a receptive condition the male flowers are still in a very early stage of development. The significance of this will perhaps be better understood after reading the description of caprification—that is if we may assume with Müller that this is really a process of fertilisation, in which there is a mutual adaptation of the inflorescences of the fig and caprifig and the insect which is an agent in procuring fertilisation. Before proceeding to that description, it should be mentioned that a variety of the fig exists in Brittany in which normal male flowers are abundantly produced. Yet, as in the caprifig, the males are not developed until long after the females have passed the receptive stage. The position this variety occupies in relation to other varieties and to the caprifig has not been ascertained. It may be a reversion to an original monœcious condition.

Phyllotaxis

I HAVE noticed in the laurel and the Spanish chestnut species, in which the leaves have normally a distichous arrangement, that when a vigorous shoot takes a vertical direction—for example, after the stock has been cut down near the ground—the leafage of such a shoot is often quincuncial. The phenomenon suggests three possible interpretations, Is this to be regarded as a fixed adaptive habit, the spiral phyllotaxis being the fittest for the upright, the two-ranked for the more numerous lateral twigs? Or are the exceptional instances endeavours after greater economy of space in the packing of the buds? Or, finally, ought we to discern in the peculiarities of the more vigorous shoots a reversion towards some ancestral condition?

XXIV. On the anatomy of Victoria regia.―Part II

In a contribution to the Philosophical Transactions of this Society, published in 1852 (Part II. p. 289), I gave an account of the internal anatomy of the stem or rhizome of Victoria regia . I then stated that I regarded the arrangement of the vascular structures as essentially agreeing with that typical in Monocotyledons, and I directed attention to certain points of less importance, some of which appeared to strengthen the general argument in question, while others were opposed to it. Subsequently I have had an opportunity of studying the anatomy and development of the leaves, roots, and flowers of Victoria , and of observing some interesting facts which have not been clearly made out in any of the various memoirs which have appeared on this subject. I have also been led to a reconsideration of the subject of the anatomy of the stem by a criticism which appeared in the ‘Flora Indica’ (p. 236), the distinguished authors of which, in their advocacy of the opinion that the Order Nymphæaceæ is really Dicotyledonous, question the agreement which I have declared to exist between the structure of the stems of Victoria and of Monocotyledons. In the present paper, which may be regarded as a continuation and completion of the former, I shall first deal with the debated question of the structure of the rhizome, and afterwards give an account of the development of the appendicular organs, including the flower, and of the phenomena presented in the germination of the seed. For the abso­lute determination of the question whether a stem were organized on the Monocotyledonous or the Dicotyledonous type, it would be requisite first of all to define clearly what conditions we regard as typical in the two classes. This is no easy matter in the present state of our knowledge. The old terms Endogenous and Exogenous growth are founded on no corresponding contrast in the organization of the plants to which they refer. Exogenous growth is a reality, but endogenous growth is a figment of the imagination. The general distinctions between the stems of the two great classes of Angiospermous Flowering Plants depend upon a different mode of arrangement of the fibro-vascular bundles, and, usually, in addition to this, upon a different mode of arrangement of the elementary organs in the fibro-vascular bundles. These are the only essential differences; the formation of annual rings is by no means a constant phenomenon in perennial Dico­tyledons. It offers, however, a negative character for the Monocotyledons, since, from the construction and arrangement of their fibro-vascular bundles, they cannot produce annual (or periodical) rings of the same kind as those of the Dicotyledons. The layers formed in such exceptional instances as Yucca, Dracæna , and analogous stems are totally different from those of the layers of Dicotyledons, being formed of entirely new fibro-vascular cords quite independent of those of the inner substance of the stem, while the successive layers of the stems of Dicotyledons are ordinarily horizontal developments from the cambium layers of the pre-existing bundles.

On the more Distinctive Characters of Animals and Vegetables

The object proposed in this paper is to notice, briefly, the various particulars in which animal beings are regarded by naturalists as most remarkably differing from those which possess the inferior organization of a vegetable, and to show that, in respect of each of these distinctions, exceptional instances occur in the case of some species, so that none of these are capable of affording grounds for an exact scientific definition between the two great kingdoms of organized nature, and that such a definition cannot be established. 1. The first points of difference mentioned as generally pevailing between plants and animals, were the evident particulars of form, size, and duration of existence. The animal usually presents a bilateral symmetry of form, being divisible along the median line into two halves of similar outline; and its limited number of similar organs and parts entirely differs from the complex and irregular branching of a plant. But, to mention no other exception to this general rule, the ramified form of Polypipherae, entirely resembling that of a vegetable, though unquestionably possessing an animal nature, sufficiently shows that this ground of distinction is far from universal. In connexion with the more definite form of animals, may be noticed their more limited size and duration of existence. A forest tree may continue to live and flourish for centuries, gradually increasing in size throughout this long period; an animal, on the other hand, soon arrives at its full growth, and its entire existence is limited to a definite ...