« ForrigeFortsæt »
II. By William STIRLING, M.D., D.Sc., LL.D., Professor of Physiology
and Histology in the Victoria University of Manchester;
Dean of the Medical Faculty. Thomas BARTHOLINUS: A Seventeenth Century Elaboration of the
phrase, “Sectio Cadaveris, Hodie." We know that the dissections practised by the earliest anatomists of Venice, of Bologna and Montpellier were done only occasionally because the subjects were few. They were also done rapidly for obvious reasons. Moreover they were performed, not by, the professor, but by the barber surgeon. It was " anatemno" rather than “ dissectio.” Even Mondinus allotted but four sittings to an Anatomy.
When Leyden was a great School of Medicine, the intercourse between the Anatomists of Holland, Denmark and Sweden we know was not only very intimate, but occasional jealousies manifested themselves between the rival schools of Leyden, Copenhagen and Upsala. One of the interesting and puisant figures of the seventeenth century was Th. Bartholinus, the son of Caspar Bartholinus. Thomas was born in 1616, thus being fourteen years older than Olaus Rudbeck, who ultimately became Professor of Anatomy in Upsala, and with whom Bartholinus waged a wordy war in regard to the priority of the discovery of the lymphatics. After travelling much in Europe, Bartholinus, like many of the distinguished doctors of his time, graduated as Doctor of Medicine in Basel or Basle in 1645, and on his return to his native town of Copenhagen, he was elected Professor of Mathematics. In 1648, however, he became Professor of Anatomy. He soon became famous as a teacher, author and correspondent, and attracted around him many pupils. His speeches were always elegant and often with a broad spice of humour. He re-edited
and published his father's “Institutiones Anatomicæ," and published many papers of his own, including several on the lymphatic and lacteal vessels, his first publication on this subject being in 1652. We shall return to this subject by and bye.
Some of us have read elsewhere the words Sectio cadaveris,
hodie,” printed on a narrow board and hung in an inconspicuous position at the entrance to a great hospital. The announcement was made in Latin, perhaps lest the casual passer by or the entering patients should divine the significance of the announcement. Not so Bartholinus, as the following announcement makes plain in stately language with due regard to the serious nature and importance of the task, and with a fine sense of the dignity of his own importance. The following announcement is an excellent sample of the style adopted by Bartholinus :
TH. BARTHOLINUS. QUOD FELIX FAUSTUMQUE SIT ET MORTALIBUS SALUTARE! Favente Summo Rumine, Jubente Glem. Rege, Annuente Perillustri Cancellario, Consentiente denique Magnifico Dn. Rectore et Facultate medica Sh. Bartholinus D. et P. P. cadaveris virilis dissectionem crastina luce, die . . Ann... hor. 1 pomerid. auspicaturus sequentibusque diebus, fi Deus, fi valetudo convenerit, continuaturus, omnium ordinum Auditores, spectatores, auditum ut veniant et spectatum quibus volupe, qui se mortales sciunt et cognoscere amant, qui illustre Anatomes studium suspiciunt, qui se suamque corporis Majestatem amant, in Theatrum Anatomicum summo, quo potest, officio et pari humanitate invitat, convocati. MAY THIS BE FORTUNATE, PROSPEROUS, AND HEALTH-GIVING TO
MORTALS! With the favour of the Supreme Being, at the bidding of our Gracious King, with the approval of the Illustrious Chancellor, and finally with the consent of the High Rector and the Medical Faculty, Th. Bartholinus, Med. Doct. et Prof., who will commence his dissection of a male corpse to-morrow, the
of at 1 p.m., and will continue it on the following days if God and his health permit, invites hearers and spectators of any rank to come to hear and see, who care to do so, who know that they are mortal and love to learn, and who reverence the illustrious study of Anatomy, and love themselves and their own physical dignitycalled together into the theatre of Anatomy, with the highest possible respect and equal courtesy.
The accompanying reduced picture in the North Italian style is the first illustration used in a printed work on Anatomy. It is taken from one of the editions of the Fasciculus Medicinæ, by Johannes de Ketham, a German surgeon, who lived in Italy towards the end of the fifteenth century and who collected various medical writings for the use of practitioners of medicine under the above title. The first edition was published in Venice in 1491, and is a folio imp. per Johannen et Gregorium fratres de Forlivio, die 26 Julii. The woodcut shows the manner in which a body was opened in those days. Above in the chair or cathedra is seated a young beardless man in his teaching garment. On a table lies a naked male corpse which a barber or “secant,"—with a large curved knife in his hand,- is about to open. It was chiefly the condition of the thoracic and abdominal viscera that was attended to. The onlooker nearest the head of the corpse appears to be either demonstrating or giving instructions to the secant. Under the table is placed a basket.
FRONTISPIECE FROM JOHANNES DE KETHAM, 1494. We know that women were admitted to these dissections in Montpellier. Félix Plater, of Basle, who studied medicine at Montpellier about 1550, records that the anatomical theatre was often used for dissections, which were presided over by a professor, while a barber, scalpel in hand, did the mechanical work. Besides the students, the audience consisted of seigneurs, bourgeoisie in large numbers, and women, even when a male corpse was dissected.
Fischer (Louis). The Condition of the Upper Air Passages Before
and After Intubation of the Larnyx. Archives of Pediat.,
Feb., 1904, p. 101. DR. FISCHER examined ten children, all belonging to the tenement house district of New York City, who had been intubated in the Willard Parker Hospital at periods varying from three to seven years previously. All were in fair or good condition, and showed no evidence of a deleterious effect from the intubation. Eight of the ten cases had signs of rickets, and nine of the ten had hypertrophy of the tonsils, conditions predisposing, according to the writer, to laryngeal stenosis when diphtheria is contracted by such children. It would seem that in America intubation has entirely replaced tracheotomy for the relief of acute laryngeal stenosis, rubber tubes being used exclusively, and tracheotomy resorted to for the cure of “retained tubes.” Dr. Fischer quotes Rogers as stating that hypertrophy of the subglottic tissue is the commonest cause of post-diphtheritic stenosis necessitating longcontinued intubation. Less often, he says, there is ulceration followed by cicatricial contraction, and both are independent of intubation. Exuberant granulations within the larynx also apparently do not occur with intubation, no matter how prolonged. From various writers it would seem that the frequency of post-diptheritic stenosis is not more than 1 per cent. of the cases. Dr. Fischer also gives a second series of 26 cases intubated in private practice two to eight years previously. Of these, one died from asphyxia through auto-intubation, one died from scarlet fever two years after intubation, and one could not be followed, though the immediate results were good. The majority of the patients in this list also suffered from rachitis and enlarged tonsils or adenoid vegetations. As regards the cause of stenosis, it is to be remembered that granulations in the vicinity of the tracheal wound are worse the nearer the cannula is to the vocal chords, and that if the tracheotomy has existed long enough, it, and not the original intubation, may have given rise to the cicatricial tissue. In the treatment of stenosis the points to be emphasized are:-(1) Use of the largest-sized tube possible inserted under an anæsthetic. In case of contraction rapid dilatation should be done with the small sizes working up to the large special tube. (2) The tube should be left in undisturbed for six weeks at least. If dilatation is impossible, or if after dilatation autoextubation takes place frequently, "a thyrotomy should be done, and the tube be held in place.” In no case can a cough, a chronic cough or chronic laryngitis be attributed to the wearing of the tube, and Dr. Fischer concludes that the larynx is very tolerant to a well-fitting rubber tube.
R. W. MARSDEN.
Devic (E.) and CHARVET (J.). A Contribution to the Study of
Ulceration of the Duodenum Associated with Affections of the
Kidneys. Rev. de Méd., 1903, p. 881. Vol. xxiii. This important and well-considered paper is the result of the authors' observations in thirteen cases, whose clinical histories, along with a report of the autopsy in each case, are given in detail. After a full account of the history of the subject, in which especial attention is drawn to recent papers by Barié and Delaunay on “ Duodenite ulcéreuse urémique," the authors deal fully with the subject from the points of view of its ætiology, pathological anatomy and pathology, and come to the following conclusions:
1. Ulceration of the duodenum must be included among the complications of chronic kidney disease, especially of interstitial nephritis in its later stages of uræmia.
2. Its frequency is greater than has formerly been supposed. It is probably not specially sought for post-mortem.
3. It is met with in three forms (which are the successive stages of the same process)—a) simple hæmorrhagic infiltration of the mucosa ; (6) follicular or linear erosions of the mucosa; (c) true perforating ulcers. All three forms are usually met with in the first part of the duodenum, especially on its posterior wall, and in the authors' cases no tendency towards healing was found.
4. The ulceration seems to be dependent upon a variety of causes, the chief excitants being the accumulation within the organism of toxic products, and coincident infectious diseases; among the predisposing causes are diseases of the general circulatory system, local endarteritis of the small arterioles of the duodenal wall and trophic changes from the effects of toxæmia on the nervous system. Mention is made here of the coincidence in a fourth of the authors' cases of scoliosis.
5. Usually the ulcer gives rise to no symptoms, its essential characters being, in addition to absence of repair, its rapid and deep extension with the consequent frequent hæmorrhage and perforation.
T. A. GOODFELLOW.
LIBMAN (E.). Widal Reaction. Medical News, Jan. 30, 1904, p. 204. The writer has studied the test in 1,500 cases, 550 of which gave a negative result. He recommend that two dilutions should be used in each case since in some instances a positive result may be obtained with 1 in 50, when the same serum gives a negative or indefinite reaction with 1 in 20. He explains this occurrence by the lytic action