Reports of Societies
Boston Medical and Surgical Journal
In the Lettsomian lecture, Bruce gives a compact summary of facts and conclusions in regard to the senescence of the circulatory system which, while presenting nothing essentially new, gives, under the following headings, a useful reminder : (1) Normal heart at the age of 40. (2) Injurious influences in middle life: (a) physical stress; (b) nervous influences; (c) extensive poisons; (d) disturbances of metabolism, including gout; (e) syphilis; (f) acute diseases ; (g) chronic diseases; (A)
... diseases; (A) complex causes. (3) Old standing organic heart disease. (4) Family heart. COMPENSATION in AORTIC INSUFFICIENCY. Dräsche s illustrates with several cases the possibility of re-establishment of function in diseased semilunar cusps under certain conditions. In this possibility is to be found an explanation of the complete disappearance in occasional cases of the régurgitant murmurs after the establishment of compensation, and also of the lack of anatomical evidence of insufficiency found at autopsy in some cases whicli had at some time previous shown unmistakable physical signs of valvular incompetence. He first draws attention to the marked disproportion between the area of the valve curtains and the diameter of the normal aorta, and suggests that to this surplus must be added the recognized power of stretching which the individual cusps possess. In these factors rests the power which the uninjured portions of the valve have of adapting themselves to supply the deficiencies brought about by disease in other portions. Such compensation that is, the assumption of additional burden by portions of the valve is more likely to take place where incompetence is the result of endocarditis than where arteriosclerosis is the cause. If there exists, then, only a partial insufficiency, we may hope that, through the effect of back pressure, the healthy portions of the valve will be so stretched and modified in shape as to entirely or partly compensate for the defect ; in this way single cusps are sometimes stretched to double their normal dimensions; while, if it is the edge of the valve that is thickened and non-elastic, it is possible for the portion of the valve still elastic to be so stretched as to bring forward a new portion to serve as edge. Another possible explanation for the disappearance of the diastolic murmur and the failure to substantiate former physical signs by the post-mortem report, is found in the adduced likelihood of absorption or sweeping away of soft vegetations, which had for a relatively short time interfered with the function of the valve. Accompanying the especial points is a more or less general discussion of the subject of aortic in-competence in general : the diagnostic points, the compensation by muscular hypertrophy, and the detail of several suggestive cases. GONORRHEAL ENDOCARDITIS. It is, perhaps, superfluous to refer again to the steadily increasing number of cases in which the gonococcus has been demonstrated in cultures from diseased valves, but the slowness with which gonorrhea takes its appropriately prominent place in the textbooks and teaching, as a causative factor in endocarditis, seems to justify reference to the report by Harris and Dabney,6 of one proven, and three undoubted, cases coming to autopsy within a reasonably short time at the hospital. A review of the literature, since the paper by Thayer and Lazear, is given. fi Wien. Med. Woch., Nos. 22 and 23. At the time the card system was devised, the metric system had not been made obligatory in the medical department of the army, and I presume that was the reason it was not thought of at that time. This was before the coming in of the present surgeon-general, who instituted the use of the metric system in the army in 1894, and the card system came into effect in 1890. Possibly, if it were done over again, the measurements would be made in the metric system. Dr. Otis : I should like to ask whether there does not occur occasionally a case in which there are really no defects, blemishes or moles which can be noted, and, if so, what do you do ? Dr. Alden : I know that such a thought would naturally occur, has occurred to a good many ; but actual experience has shown that such a man never exists. You always can find some peculiarities, and I think, if the doctor will try himself, he will find it true. One who has trained his habits of observation will see things that would escape casual observation. Sometimes,in the early days of the system, and sometimes, when a new officer takes hold of the matter, he sends on a card with only one or two scars or moles, and perhaps makes the remark that he cannot find any more. The card is usually sent back to look again, and see if he cannot find more. He then gives closer attention, and usually has no trouble 1 See page 513 of the Journal.