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Embolism, Gives the Subject Great Importance. an Important Point

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Embolism, Gives the Subject Great Importance. an Important Point embolism, gives the subject great importance. magnesia sulph. The bromides are often of de¬ The limits of this paper do not permit any dis¬ cided value in quieting the cerebral circulation, cussion of the subjects of intracranial haemor¬ as are also warm baths. Nitro-glycerine is fre¬ rhage and thrombosis and embolism. Miliary quently of value in these cases, especially when aneurism, as has been noted, is very infrequent we have a sudden raising of arterial tension and in the vessels of the cord, and as non-traumatic the danger of intracranial haemorrhage imminent. haemorrhage into the cord is a comparatively rare In these acute conditions an ice cap to the head event, this fact might be adduced to strengthen is valuable. the position taken, that these small aneurisms are The above imperfect sketch of arterio-sclerosis always, practical^', the precursors of haemorrhage of the central nervous system will. I trust, aid in in the brain. Of course there are other reasons directing attention to the importance of the sub¬ why haemorrhages into the cord are infrequent, ject, and show the necessity of more careful clin¬ as the length, size and mode of distribution of the ical work to make the picture complete. spinal vessels. It is doubtful whether any symp¬ 9 E. Townsend St. toms can be ascribed to changes in the blood¬ vessels of the cord, unless we include anaemia and hyperaemia, which can hardly be said to be con¬ REPORT ON THE OPHTHALMOSCOPIC ditions which can be recognized clinically. EXAMINATION OF DR. PRESTON'S The purely theoretical suggestion mentioned CASES OF ARTERIO-SCLEROSIS. in the first of this that athe¬ part paper, perhaps BY HARRY FRIEDENWALD, M.D., roma of the vessels of the cord be a factor may OF BALTIMORE, MD. in the of sclerotic degeneration of the production a the short of the result of fibres in the manner if confirmed As preface to report indicated, may, the examination of Dr. Pres¬ by any facts, prove useful in clearing up our some¬ ophthalmoscopic what indistinct ideas of the production of these ton's cases, I should like to state that it is but lesions. recently that attention has been attracted to those of the retinal arteries as are found in There are, as we have seen, no very pathogno- changes monic symptoms of arterio sclerosis of the vessels general arterio-sclerosis. A few years ago Ole described several cases of disease in the of the central nervous The Bull1 system. diagnosis retinal and showed how this the must rest upon the general symptoms that have arteries, was cause of ascribed to embol¬ been outlined. When a patient presents certain symptoms frequently of these and shows sclerosis of the ism. Raehlmann2 made an exceedingly careful symptoms, of the relation between and retinal vessels that can be examined, we can pronounce study general arterio besides a few scattered with some degree of certainty upon the probable sclerosis, collecting condition of the arteries of the brain. The cases in literature. He examined ninety cases of oph¬ arterio-sclerosis and found that in most thalmoscope sometimes, though by no means al¬ general cases the retinal arteries were narrow and tortu¬ ways, shows us a condition of sclerosis in athero¬ that cent, showed whitish ma of the vessels of the retina, Raehlmann found ous, 19 per margins the retinal that 21 changes in the vessels in forty-four out of ninety along arteries, per cent, pre¬ sented localized in their course, but cases examined, or nearly fifty per cent. He de¬ narrowings that retinal aneurisms are rare. scribes a certain appearance of the very Confining hazy vessels, ourselves to these of arterial with¬ as if a thin veil were stretched over them. signs disease looking the in the veins which He noted dilatations and constrictions in the ves¬ out considering changes he likewise we must admit that sels and in two cases aneurism, and found the frequently found, are remarkable. in¬ veins affected in cent, of the the results very They are, also, twenty-six per if remember that in all cases. deed, surprising, you works on such are One can say little as to treatment, other than ophthalmoscopy changes not considered 6 cent, referred the rules that are laid down for the treat¬ throughout ; per general we find ment of the condition. It is to; that in the very latest, that of Gowers, general necessary statement to that for who have a of arterio¬ the referring general atheroma, high degree " " patients in cases in which it is well marked elsewhere sclerosis to avoid violent sudden exertion for ob¬ he has ' ' often looked for in the retina vious reasons. At the same time appearances systematic, its existence but without success." regular exercise in the open air, with hill climb¬ suggesting in suitable is of value. Avoid¬ Prof. Hirschberg recently published the results ing cases, great careful of ance of excessive amounts of is of very ophthalmoscopic examinations liquids certainly between the of 60 and 80 an of water fifty persons ages years. important point. Large quantities Besides the other "senile he cannot but be injurious, by overfilling, or at least many changes" the total of fluid in finds that 46 per cent, of the persons examined greatly increasing quantity showed in the retinal arteries vessels that are already embarrassed. The diet changes ; 44 per should be light and nutritious. An occasional 1 Ninth International Medical Congress Reports, Washington, Vol III, p. 663. saline purge is beneficial, such as concentrated 2Zeitschr. f. Klin. Med., H. 5 and 6, Vol. XVI. Downloaded From: http://jama.jamanetwork.com/ by a Simon Fraser University User on 06/05/2015 cent, of the persons examined showed variations Of these forty retinae, nineteen presented de¬ in the caliber of the arteries at different points in cided local or general narrowing of the arteries their course ; 2 per cent, showed whitish lines with frequent tortuosity (twelve patients) ; ten on their margins. presented moderate or slight changes of the same Before going further, it would be well to ex¬ kind (seven patients); four presented whitish plain more definitely what is meant by these margins along the arteries (two patients); one terms. The healthy retinal artery is perfectly presented a haemorrhage on the papillae ; seven transparent. What we see is the blood column appeared thoroughly Hormal (five patients); two within it. When the walls of the arteries thicken appeared thoroughly normal, while there were at the expense of their inner caliber and the other extensive retinal changes. Besides these I thickened portion remains as transparent as the noted in several cases senile retinal changes, in healthy vessel—and this is commonly the case—- the characteristic little yellowish spots due to we detect the change in the narrowing of the colloid degeneration of the lamina vitrea of the column of blood. This thickening may take choroid. place at localized points, causing the localized The proportion of cases in which decided variations in the thickness of the blood column changes were found is so great that I am led to or throughout the course of the vessel. In the thoroughly accord with Raehlmann as to the fre¬ cases mentioned above, we must, therefore, re¬ quency of these changes and their importance in member that the terms refer only to the blood diagnosis. column, and that we infer from these the condi¬ tion of the vessel, for instance, when Raehlmann describes "localized narrowings of the arteries," A KNOWLEDGE OR A TIME REQUIRE¬ there are only localized narrowings of the blood MENT. A PLEA FOR A MORE RA¬ and we from these that there are column, infer SYSTEM OF localized thickenings of the walls of the vessel. In TIONAL MEDICAL ' ' those cases where white lines are seen along LEGISLATION. the margins of the vessels," the wall of the ves¬ BY YOUNG H. BOND, M.D., sel has lost of its and reflects DEAN OF THE MARION SIMS COLLEGE OF MEDICINE, part transparency, ST. LOUIS, MO. some light which is seen as the white lines. The move in the of This depends upon a change in the substance of very general direction med¬ ical the or the vessel, or a deposit within it different from legislation, during past year so, indi¬ that in the mentioned cates the urgent demand on the part of the pro¬ transparent thickening for the and above, and is much rarer. fession, just proper regulation of the of In it is My attention was first drawn to the localized practice medicine. addition significant narrowings (apparent !) of the retinal arteries in of the increase in competition and of the grow¬ of the art of the cases of optic nerve atrophy, and especially in ing metamorphosis medicine into those due to embolism of the central retinal science of medicine, of which the precepts and in which conditions are much less teachings follow such fixed laws, that he who artery, they studies learn. uncommon than is ordinarily supposed. But may their importance struck me when I saw them in the nineteenth century. a case of beginning retinitis albuminurica where Our nineteenth century is a wonderful one— the signs of inflammation were almost limited to the like of which has never been seen in the but one eye, while the localized narrowings whole compass of earthly years. Born during could be seen in the retinal arteries of both eyes.3 the great struggle of freedom against tyranny Since then I have paid more attention to this and oppression, living through the downfall of point and have found the changes not infrequently. the ancient superstition of the divine right of It was with great pleasure, therefore, that I Kings, it is about to make its exit from a world undertook to examine the retinal arteries of Dr.
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