James B. Herrick

Some unsolved problems connected with acute obstruction of the coronary artery

Abstract The purpose of this paper is to present in outline certain features of acute occlusion of the coronary artery concerning which there is still some obscurity. The hope is that a frank statement of these problems may stimulate clinicians, pathologists, and experimental workers to study and solve them. It is to be noted that acute occlusion of the artery is the only topic under consideration. Chronic, i.e., slowly progressive occlusion is not sharply demarcated from the acute process, but its features are of somewhat different character and may well be separately considered, at least for the present.

Peculiar Elongated and Sickle-Shaped Red Blood Corpuscles in a Case of Severe Anemia

This case is reported because of the unusual blood findings, no duplicate of which I have ever seen described.... Blood Examination.—The blood-count on Dec. 26, 1904, was: Red corpuscles, 2,570,000; white corpuscles, 40,000; hemoglobin (Dare) 40 per cent. color index, 0.78. December 31 the count was as follows: Erythrocytes, 2,880,000. Leukocytes, 15,250. Hemoglobin, 50 per cent. (Dare). The red corpuscles varied much in size, many microcytes being seen and some macrocytes. Polychromatophilia was present. Nucleated reds were numerous, 74 being seen in a count of 200 leukocytes, there being about 5,000 to the c.mm. The shape of the reds was very irregular, but what especially attracted attention was the large number of thin, elongated, sickle-shaped and crescent-shaped forms. These were seen in fresh specimens, no matter in what way the blood was spread on the slide and they were seen also in specimens fixed by heat, by alcohol and ether, and stained with the Ehrlich triacid stain as well as with control stains. They were not seen in specimens of blood taken at the same time from other individuals and prepared under exactly similar conditions. They were surely not artefacts, nor were they any form of parasite. In staining reactions they were exactly like their neighbors, the ordinary red corpuscles, though many took the stain heavily. In a few of the elongated forms a nucleus was seen. In the fresh specimen where there was a slight current in the blood before it had become entirely quiet, all of the red corpuscles, the elongated forms as well as those of ordinary form, seemed to be unusually pliable and flexible, bending and twisting in a remarkable manner as they bumped against each other or crowded through a narrow space and seeming almost rubberlike in their elastic resumption of the former shape.... No conclusions can be drawn from this case. Not even a definite diagnosis can be made....

Atypical Features of Acute Coronary Occlusion

Excerpt When I asked Dr. Means, our General Chairman, if the subject of acute coronary obstruction were not already old and well worn especially in Boston, he replied that he did not think the prob...

ON MISTAKING OTHER DISEASES FOR ACUTE CORONARY THROMBOSIS

Excerpt When a previously misunderstood or overlooked disease has been shown to be common, when its symptoms are first described, for a time it is likely to be a front page medical news item. It is...

In Defense of the Stethoscope

Excerpt There is a tendency nowadays to attack the stethoscope. It is criticized in print, in addresses in medical societies and in conversation between doctors. As a result it is losing caste as a...

CLINICAL SIGNS OF HEART DISEASE: WITH PARTICULAR REFERENCE TO ETIOLOGY

My special purpose in this paper is to stress the importance of a consideration of etiology in the diagnosis of heart disease. Perhaps most of us admit that an etiologic diagnosis is important. Why, then, take time to discuss the question? The answer is that in practice the etiologic feature is largely overlooked. The classification of heart disease has been, and still is, in a crude state. Chaotic is too strong a word to use regarding it, but it is decidedly unsystematic and unsatisfactory. The same is true of nomenclature. No wonder, then, that there is little uniformity in the diagnoses made by even the best physicians. The condition diagnosed aortic regurgitation by one is called by another syphilis of the aorta and aortic valves; by a third, aortic leak with cardiac hypertrophy but good compensation. The next patient is said by one physician to have mitral stenosis. The disease

ACUTE DILATATION OF THE STOMACH.: WITH REPORT OF TWO CASES, ONE OF WHICH COMPLICATED PNEUMONIA AND ENDED IN RECOVERY.

Acute dilatation of the stomach is a rare condition. In 1902 Thomson 1 collected less than fifty cases. A few have been reported since. It is a grave condition, truly appalling, as its high mortality well indicates. Its recognition is not always easy, yet important, as it is probable that the earlier treatment is begun the better is the outlook. I report these two cases of acute dilatation of the stomach, therefore, because the rarity, gravity and importance of recognition of the disease make it desirable that every observed case should be put on record. One of these cases recovered—the first recorded recovery, I believe, where the disease has been a complication of pneumonia or pleurisy; in the other patient an autopsy was not to be obtained. I can, therefore, make no contribution to the morbid anatomy of the disease, knowledge concerning which is extremely scanty, but very desirable as

SOME POINTS IN THE DIAGNOSIS OF GALL-STONES.

Repeated attacks of colic with the pain in the right hypochondrium, accompanied by nausea and vomiting and followed in a few hours by a slight jaundice, leave little doubt as to the existence of gall-stones. In the majority of cases it is on a history of such attacks with the finding of the calculi in the feces that the diagnosis is made. But the stones are not always so frank in making known their presence. They manifest themselves by irregular symptoms, they simulate other diseases, and other diseases simulate them, so that it is true, as Hoppe-Seyler says, that if the uncomplicated, regular cholelithiasis is difficult to recognize, much more difficult is it to recognize the irregular and complicated form of the disease. 1 It is to some of the symptoms most likely to be misinterpreted and to some diseases liable wrongly to be regarded as gall-stones that I wish

ON THE EXISTENCE OF EPIDEMIC CEREBRO-SPINAL MENINGITIS IN CHICAGO, WITH REPORT OF A CASE WITH AUTOPSY.

The object of this paper is to prove two facts, first that a genuine case of epidemic cerebro-spinal meningitis has occurred in Chicago, the proof resting on the clinical history and the autopsy, the latter showing the presence of the meninges of the diplococcus intracellularis meningitidis of Weichselbaum; second, that this case was not a sporadic one, but that many other cases have occurred, or in other words, that there is a mild epidemic of cerebro-spinal meningitis in this city. So far as I can learn this is the first case of this disease reported for some time in this city and the first case in which the presence of the meningococcus has been recorded as found, thus establishing the nature of the disease beyond a doubt. That many other cases have been recognized as epidemic cerebro-spinal meningitis, I am well aware from conversation with physicians. The patient was a

DIURETIN.Read before the Pathological Section of the Chicago Academy of Sciences, Feb. 9, 1893.

The experiments of Schroeder reported in 1889, and confirmed by clinical observations made at Schroeders suggestion, the same year by Gram, of Copenhagen, established the value of the alkaloid theobromine, a product of the seeds ofTheobroma cacao, as a diuretic of great power, acting by direct stimulation of the renal epithelium and lacking in the unpleasant effects upon the nervous system, tinnitus, restlessness, insomnia and delirium, attributed to its homologue caffeine. Gram, after trial of many compounds, overcame the disadvantage of the insolubility of the alkaloid by forming, by combination with salicylate of sodium, a double salt, sodium-theobromine-salicylate, which should contain at least 46.5 per cent. of the theobromine (Knolls is said to contain 48 per cent.) and to which the name diuretin has been given. The therapeutic as well as commercial value depends upon its richness in theobromine. The compound occurs in the form of a white powder,