Lehrbuch der Greisenkrankheiten

1909 Journal of the American Medical Association  
The present volume is valuable not only because of the records of experimental work by Dr. Delille but because it contains a thorough review of the rapidly increasing literature of the subject. The conflicting views concerning certain phenomena are set forth, and an effort is made to reconcile the discrepancies, particularly those regarding the effects of hypophysectomy. The experimental work by Dr. Delille is concerned almost entirely with the effect of extracts of hypophysis when injected
more » ... s when injected into animals and man during health and in disease. There is no discussion regarding the technic of operating on the gland. Dr. Delille discusses the experiments of Masay, which attempted to create for experimental purposes, by the administration of a so-called hypophysotoxic serum a condition analogous to that following surgical removal of the gland. This serum was prepared by immunizing guinea-pigs with an extract of hypophysis. He criticises the value of the conclusions drawn because no account was taken of the possible effect of the serum on the rest of the body, particularly the other glands, but he admits that work by this method would be valuable if careful observations were made concerning the effects of the serum. In the essential pointe Delille is in harmony with Gushing (The Journal. July 24, 1900, liii. 249), but he differs in several details. He finds that in animals an anterior lobe extract causes moderate hyperactivity of the hypophysis and thyroid, but Gushing states that it does little or nothing. Some of Delille's conclusions are especially interesting, as for example, the signs and symptoms of diminished and in¬ creased activity of the gland. He sums up those of hypophyseal insufficiency and dyshypophysism as follows: hypoten¬ sion, tachycardia, distressing sensations of heat, profuse sweats, oliguria, anorexia, asthenia, disturbances of nutrition (loss of flesh; obesity in certain cases, trophic changes, etc.), psychic troubles, insomnia, disturbed growth (physical and mental backwardness), diminution of resistance to intoxica¬ tions, special signs of intracranial compression due to pituitary tumor. The evidences of hyperhypophysism he says aie: hypertension, polyuria. glycosuria, troubles of nutrition (loss of flesh; often obesity, etc.) : the number of blood-cells equal or above normal; hypertrophie processes of development (gigantism, acromegaly); psychic troubles, somnolence; nearly always a genital insufficiency; frequently hypothyroidism ; and special signs of intracranial pressure due to pituitary tumor. Gushing states that polyuria. sometimes associated with glyco¬ suria, is a, somewhat characteristic symptom of hyposecretion of the anterior lobe instead of hyperhypophysism. Moreover, he regards adiposity as a more constant and more important sign of hyposecretion than does Delille. Concerning the indications for hypophyseal medication Delille seems to hold perhaps too radical an opinion for the present state of knowledge when he makes the following statement: "The direct hypophyseal organotherapy Will find its indication in every case in which one wishes to raise the arterial tension, slow the pulse, increase diuresis, suppress troublesome sensations of heat and profuse sweats, ameliorate the appetite and sleep, cause the disappearance of asthenia, attenuate certain psychic troubles, exercise a stimulating action on nutrition and development; in short, hypophyseal organotherapy will be prescribed in every case in which the certain or probable diagnosis of hypophyseal insufficiency shall be made. One should abstain from this medication with patients who have a hypertension." As regards the administration of the extract Delille says : "One should use by preference the total extract, for it is, in equal doses, nearly as active as the posterior lobe; besides it is easier to prepare and consequently less expensive. The prop¬ erties of the anterior lobe are still too mysterious to warrant the use of its extract in practice. The daily dose of the total extract which one should advise ought not to be more than that of half of one fresh gland of the beef, save in exceptional cases. The patient should be strictly watched in the course of the treatment; the arterial pressure should be taken regu¬ larly and one should depend on it to increase or diminish the doses, to suspend or to resume medication." Lehrbuch der Greisenkrankheiten. Herausgegeben von Prof. Dr. J. Schwalbe, Berlin. Paper. Pp. 914. Price, 26 marks. Stuttgart: Verlag von Ferdinand Enke, 1909. The necessity for a special work on the disease of old age does not at first seem perfectly clear. While it may be argued that there is as much justification for a work of this sort as for one on diseases of children, most readers will feel that the peculiar problems presented by infant-feeding, the rapid progressive changes of infancy and childhood, the partiality of so many acute infectious diseases for childhood, and certain anatomic and physiologic peculiarities of the young, offer valid reasons for the existence of treatises on the diseases of children, which reasons do not quite have their counterpart when the maladies of old age are considered. One must admit, however, that certain characteristics of old age are worth emphasizing and perhaps even embodying in a special volume; one thinks at once of the regressive and atrophic changes in tissues, the vascular scleroses, the frequency of carcinoma, the vulnerability to pneumonia, etc. These peculiarities are well brought out in this work. Of m ei ssity, much that is not peculiar to old age is embodied. Perhaps we ought not to say of necessity, for we are inclined to think that had there been a liberal omission of much of the description that would apply to disease of all ages (which knowledge should be assumed as possessed by the reader), and if there had been more concentration of the peculiarities of the various affections in old age, the value of the book would have been increased. Most of the articles are good, as the names of the writers would lead us to expect. Some of these writers are them¬ selves old, but they write with the vigor of youth and the wisdom of advanced years. Some articles are unusually full, e. g., Hope-Seyler's on respiratory diseases, and Ortner's on typhoid fever. Fiirbringer's article on prostatic hypertrophy is reasonably complete, yet carcinoma of the prostate is cov¬ ered in half a page. Ebstein might appropriately have gone more into details on arteriosclerosis. The book may be commended as thoroughly reliable, though we feel that the physician who needs help in the diagnosis of treatment of a disease in the aged, be it pneumonia, typhoid, gastritis or carcinoma of any organ, will be more apt to turn for help to his work on general medicine or to special works than to this book, which, after all, is much on the order of a compend of symptoms and signs of disease as seen in the old with the treatment. The average physician is sadly deficient in his knowledge of the laws of accident and industrial insurance and of the Proper method of making examinations and writing out reports concerning his findings in this class of cases. The object of this work is to supply this knowledge; but on reading it one is impressed by the fact that it is apparently written in the interests of the accident-insurance companies rather than in the interest of the physician or of scientific medicine; invidious comparisons are frequently made between the lifeinsurance examiner and the accident-insurance examiner. Physicians are urged to "develop themselves into adjusters for the companies they represent." "A doctor who adjusts for an accident-insurance company is so well intrenched with his company that it is almost an impossibility for another physician to secure any examinations from the company." For all of this examining and adjusting and playing the interests of the company against those of the patient, the compensation is altogether inadequate, for it is stated that "accident-insurance companies seldom pay more than two or three dollars for each examination." That the advice given in settlement of cases is at times to the advantage of the com-•pany at the expense of what is just to the insured, is well shown on page 102, under "Diseases of the Brain." "When
doi:10.1001/jama.1909.02550210071022 fatcat:dlehtsjszbe73lljotwrtcuxxi