Bibliographical Notices Hypertrophy of the Muscular Walls of the Minute Arteries in Cases of Bright's Disease . By Geo. Johnson, M.B., F.R.C.P., President of the Metropolitan Counties Branch of the British Medical Association. Read at an ordinary meeting of the Metropolitan Counties Branch of the British Medical Association, March 30th, 1870

1870 Boston Medical and Surgical Journal  
of manipulation, we do not remember having seen the formula of " Hunt's cement," as it is called, which is extensively used for sealing the edges of the thin glass in the Army Medical Museum, and therefore we introduce it. Dr. Woodward states that it is prepared by evaporating Canada Balsam to a solid consistence, dissolving it in an equal bulk of benzole, and then thickening it to about the density of cream, with white lead or zinc, ground in oil. Tho larger part of the book is devoted to the
more » ... xamination of the secretions and excretions of the body, in health and in disease, the method of searching for parasitic organisms of the integuments and the muscles, medico-legal investigations, and the examinations of morbid growths. It is arranged very thoroughly upon a sort of natural system, and, as far as practicable, in accordance with tho so-called dicliotomous plan, having therefore the great advantage of presenting problems of diagnosis as they occur in actual practice. By this method, while different secretions and excretions form a basis of classification, classes are divided, according to the naked-eye characteristics, into orders, after which the microscopic appearances point out the generic and specific peculiarities that serve to distinguish the special malady existing, and so couduco to those great ends of microscopic study, tho more accurate diagnosis, prognosis, and treatment of disease ; in fact, the carefully drawn deductions which, throughout the book, Dr. Richardson draws from the appearances seen, and the advice given under supposed circumstances, give a charm and value to the perusal of it. We inontion especially his chapter on the examination of pus and mucus, of the blood, of tho sputum, &c, all of which are strictly in accordance with modern theories, and are safe and reliable authorities. An excellent index closes the book. President of the Metropolitan Counties Branch of the British Medical Association. In a small pamphlet of seven pages the author briefly states his views on the causes and consequences of this species of hypertrophy. The following is an abstract. The walls of the larger arteries are mainly composed of yellow elastic tissue, which serves to receive, transmit and equalize the cardiac impulse. The walls of the minute arteries borderingon the capillaries, on tliecontrary, aro composed principally of muscular fibres, transverse and longitudinal, and, subject to tho intelligence of the vaso-motor nerves acting in behalf of tho parts to bo supplied, serve, like stop-cocks, to govern the flow of blood to the various organs and tissues. "In consequence of degeneration of the kidney, the blood is morbidly changed. * * * * It is, therefore, more or less unsuited to nourish the tissues-more or less noxious to them. The minute arteries throughout the body resist the passage of this abnormal blood. The left ventricle, therefore, makes an increased effort to drive on this blood. Tho result of this antagonism of forces is, that the muscular walls of tho arteries, and those of the left ventricle of the heart, become simultaneously and in an equal degree hyportrophied. The persistent overaction of the muscular tissue, both cardiac and arterial, is found registered after death in a conspicuous and unmistakable hypertrophy." " Wo have found this hypertrophy of the minute arteries in various tissues (kidney, pia mater, skin, intestines, muscles, and probably elsewhere) associated with hypertrophy of tho left ventricle in every case that we have examined, amounting now to more than a dozen." Br. Johnson mentions, in conclusion, some of the phenomena of chronic Blight's disease, which, he says, are explained by the facts to which he has referred. "1. The hypertrophy of tho left ventricle is explained. That which Dr. Bright long ago surmised is now a demonstrated fact. There is an impediment to the jiassage of the altered blood ' through the distant subdivisions of the vascular system ;' henee ariso greater action of tho heart, and hypertrophy of its walls. " 2. The full, hard, radial pulse, and the increased pressure on the arterial walls indicated by the sphyginograph, are explained by the co-existence of excessive cardiac force, with an equal, or more than equal, excess of arterial resistance. " 3. The excessive dryness of the skin, and the difficulty of exciting diaphoresis, even by the hot-air bath, are accounted for by overaction of tho hyportrophied subcutaneous arteries resisting the relaxing effect of external warmth, which has so powerful an influence upon tho healthy skin. " 4.
doi:10.1056/nejm187010270831708 fatcat:wmoo74hqqfdi5poesbuv2nkiea