Talk:Paper - On the first appearance of the renal artery, and the relative development of the kidneys and wolffian bodies in pig embryos (1905)
ON THE FIRST APPEARANCE OF THE RENAL ARTERY, AND THE RELATIVE DEVELOPMENT OF THE KIDNEYS AND WOLFFIAN BODIES IN PIG EMBRYOS
Hill EC. On the first appearance of the renal artery, and the relative development of the kidneys and wolffian bodies in pig embryos. (1905) Johns Hopkins Hospital Bulletin 16: .
Bt Eben C. Hill. Frovi the Anatomical Laboratory of the Johns HopJcins University.
A review of the literature on the development of the kidneys and Wolffian bodies in pig embryos, shows but little concerning the blood supply and the relative size of these organs. Perhaps the most extensive study is found in Keibel's Normentafel, in which the anlages and subsequent development of these glands are traced histologically. Here, however, no measurements except those of the embryos are given. In the accounts of the embryology of the arterial system there is no work which shows the relative development of the blood supply to these two glands. At the suggestion of Dr. Pohlman, I measured these organs in pig embryos, and made a number of arterial injections. These injections demonstrate the first appearance and development of the renal artery and afford an opportunity to compare the blood supply of the kidney and Wolffian body in pig embryos ranging from 20 mm. to 75 mm. in length. The measurements show the relative size of these glands at various stages from 20 mm. to 132 mm.
Material and Methods. — The abundance of material from the slaughter houses offered every facility for numerous meas
urements and repeated injections upon live pig embryos, while the valuable collection of human embryos belonging to Professor Mall afforded opportunity to compare the human fetal development with that of the pig. The pig embryo is especially adapted for the study of the Wolffian bodies because of the relatively larger development of this organ in the pig than in man or rabbit.
Measurements. — As each uterus was opened the vertexbreech lengths of the embryos were made and measurements of the kidneys and Wolffian bodies were taken. These measurements were then averaged and the results were used in plotting the curves of their relative development. In cases where the growth of these organs was abnormal, their measurements were not included in the averages.
Injections. — In making injections, India ink, diluted to one-third of its commercial strength, was used.' In certain instances, pure water formed a precipitate, when added to the
^Taguchi's method modified. Arch. f. Mikr. Anat., 1888.
February, 1905.]
JOHNS HOPKINS HOSPITAL BULLETIN.
61
commercial ink, but this could be easily remedied by the addition of a small amount of weak ammonia. Lamp-black solutions proved to be most unsatisfactory, because of the difficulty in obtaining solutions of similar consistency. Frequently, also, this injection mass would clog the needle of the sj'ringe. All injections were made through the hypogastric artery before the embryo was removed from its surrounding membranes. In this way the organism was protected from undue pressure and from injury in handling. During the operation, the embryo still attached to a portion of the uterine wall was immersed in warm water. A ligature was passed around the umbilical cord close to the wall of the uterus, thereby preventing infusion of the injection mass through the uterine tissues. The hypogastric vein was then pricked with a needle, thus reducing the pressure in the circulatory system consequent upon the entrance of the injection fluid. All injections were made with a fine hypodermic syringe by piercing the hypogastric artery close to the abdominal wall. To obtain an even flow it was necessary to have a perfectly adjusted syringe devoid of all capacity markings. With such a syringe an even pressure of about one drop in three seconds was maintained with little difficulty. By watching the femoral arteries the progress of the fluid was followed and an injection without extravasation was obtained. After the injection, the membranes were removed and a measurement of the body length was taken. Then an abdominal incision was made and the liver and portions of the intestines were dissected away, exposing the kidneys and Wolffian bodies. In the smaller stages it was necessary to displace the Wolffian body m order to obtain a measurement of the kidney, as at this time it is completely hidden by the larger gland. The positions of these organs relative to the vertebral column were also noted, though this was more easily discerned after clearing.
Clearing. — To clear the specimens, the Schultz method, modified by Dr. Mall, was used. The specimen was first thrown into 95 per cent alcohol until completely shriveled. As a rule forty-eight hours were sufficient to accomplish this result. Then the upper portion of the embryo, just above the twelfth thoracic vertebra, was dissected off, leaving the Wolffian bodies and the kidneys attached to the body wall. Thus during the clearing in a 3 per cent solution of sodium hydroxide, which followed, the action of the reagent could be watched and controlled. This usually took from four to eight hours. When the tissues had become translucent in this medium the specimen was transferred to 20 per cent glycerine for a week or more, and was then placed in absolute glycerine where it became transparent. Upon complete clearing the vertebral column was shown quite prominently and its position relative to the kidneys and Wolffian bodies was noted. In this absolute glycerine the organs became so firm that the remaining portions of the body wall were removed and the specimen was then placed between watch crystals for microscopic study. Injections were also attempted through the liver while the embryo was alive, but the vascularization of the Wolffian bodies is such that venous injections were most unsatisfactory. The causes of this will be taken up later.
TABLE SHOWING THE LENGTH IN MILLIMETERS OF THE KIDNEYS AND WOLFFIAN BODIES OF PIG EMBRYOS.
The measurements were made from vertex to breech, and include all of the embryos in each uterus. In case of asymmetric development of these glands in any embryo averages were made of the lengths of both organs.
Relative Size of the Kidney and Wolffian Body at Different Stages.
Vertex-Breech.
Kidney. WoltBan Body.
20
1.2
7.3
21
1.2
7.3
20
1.1
7.4
Uterus 1
23
1.2
7.2
22
1.3
7.1
21
1.0
7.3
20
1.2
7.2
28
2.5
9.0
28
2.6
8.0
Uterus 2
29 27
2.5 2.4
8.5 9.2
28
3.0
7.0
29
2.T
8.7
30
2.8
8.6
32
3.2
8.8
Uterus 3
30 33
3.5 3.4
8.7 8.8
29
2.9
8.9
34
3.5
8.7
' 31
3.9
9.2
33
4.0
9.1
Uterus 4
33
3.8
9.0
35
3.7
9.1
. 33
4.1
8.9
- 38
5.0
10.0
39
5.5
9.5
38
5.5
10.0
Uterus 5
38
5.0
10.0
39
5.0
10.0
39
6.5 abnormally
8.3 abnormally
L
large.
small.
r 39
5.5
10.0
39
5.5
9.5
Uterus 6
38
5.7
9.5
39
5.5
10.0
40
5.6
10.2
f 40
5.8
10.0
41
5.9
10.0
40
5.9
11.0
42
5.9
11.0
Uterus 7
41 43
6.8 6.0
10.0
11.2
41
5.8
10.5
42
3.9
11.3
39
5.6
11.5
. 41
5.9
10.0
(- 49
8.0
11.5
48
7.0
12.0
48
6.5
11.1
Uterus 8
49 48
6.0 7.0
12.0
10.0
49
7.3
11.0
48
7.5
11.5
. 49
8.0
10.5
f 49 1 49
7.3
11.0
7.8
10.5
Uterus 9
49
6.8
12.0
1 48
8.0
10.0
1^ 50
7.8
10.5
• 57
9.2
11.5
57
9.0
11.4
56
9.2
11.2
Uterus 10
58
9.0
11.5
57
0.3
11.0
59
9.5
11.5
. 58
9.0
11.4
62
JOHNS HOPKINS HOSPITAL BULLETIN.
[No. 167.
Vertex-Breech. 60
Uterus
13
70 67 67
f 68 67 68
Uterus
14 ^
69
67
68
. 67
f 84.5 84.5 84.0
Uterus
15
85.0 84.5 84.0 85.0
85.0
Uterus
16
84.6 84.4
90.0 91.0
Uterus
17
90.0 89.5 90.1
94.3 94.5
Uterus
18
94.3 94.0 94.4 94.3
'112.2
Uterus
" 1
112.5 111.9 112.0
120.6
Uterus
20
121.0 120.8 120,7
132.4 132.6
Uterus
21
r
131.9 133.0 132.5
155.1
Uterus
22
156.9 157.2 155.5
Kidney. Wolffian Body.
9.2
11.5
10.6
abnormally
9.8 abnormally
large.
small.
9.5
11.4
9.4
11.5
9.4
11.5
9.3
11.0
9.5
11.7
9.0
11.3
9.5
11.0
9.7
10.5
11.5
11.5
11.5
11.0
11.0
12.0
11.5
11.0
11.4
11.5
11.5
11.0
11.7
11.8
11.5
12.0
11.5
11.4
11.4
11.5
11.2
11.2
11.5
11.7
11.6
11.4
14.4
10.0
14.5
10.0
15.0
10.0
14.6
9.5
14.2
11.0
U.O
11.0
17.2
abnormally
8.0 abnormally
large.
small.
14.5
10.2
14.7
10.0
14.3
10.5
15.0
9.7
15.3
9.5
15.0
9.7
14.6
10.0
15.0
9.6
15.7
9.2
15.9
9.0
15.6
9.0
15.5
9.8
15.7
8.7
15.6
8.9
18.3
7.1
18.4
7.0
18.0
7.1
18.0
6.7
19.4
5.6
19.6
5.4
19.5
5.5
19.5
5.5
20.0
At this stage the Wolffian
20.3
bodies have
become so atro
21.0
phled at the anterior end
20.5
that accurate measurements
21.0
are Impossible.
23.6
23.8
24.0
23.8
That a balancing of function exists between these two glands is suggested by the fact that an embryo having an unusually large kidney development has correspondingly small Wolffian bodies.
In the accompanying diagram, the curves are constructed from the foregoing measurements and represent the growth of the kidney and Wolffian body as compared with the general development of the embryos. In the case of the WolfiSan body it is impossible to properly depict the atrophy of this gland by a curve, because the degeneration which occurs mainly in the cephalic end is marked rather by a decrease in width than in length.
Embryological Development of the Wolffian Body and Kidney. — As is well knovra, the Wolffian body finds its anlage in the Wolffian duct which is developed as a solid mesoblastic cord of cells, lying close to the vertebral column in the abdominal cavity. This cord of cells acquires a lumen and penetrates the urogenital portion of the cloaca. Adjacent to the anterior end of this duct on the outer side lie the mesoblastic cells which later become the Wolffian body. The rapid growth of this gland from the 7 mm. stage to that of 10 mm. has been described by Allen." He states that between 7 mm. and 8 mm. the Wolffian body is almost doubled in size, while at 10 mm. it is half as broad again, and has also increased dorso-ventrally. MacCallum has found at this same stage of 8 mm. well-formed glomeruli and tubules throughout the whole length of the organ.' The Wolffian duct is also fully developed and according to Minot is larger proportionately at this stage than at any time later.
The Wolffian bodies are elongated structures attached to the mesentery close to the dorsal wall. The anterior and posterior ends curve toward the median line, though the curve is more exaggerated in the case of the former. The anterior end tapers slightly when the gland is at its fullest development, and it is in this portion that atrophy begins. The Wolffian duct lies as a ridge on the flat dorso-lateral surface of the gland and extending from the anterior end empties into the urogenital part of the cloaca. During its course across the organ it sends out at regular intervals tubules which are very much contorted and almost encircle the periphery of the organ. The arteries supplying the gland penetrate the dorso-medial portion and form with the distal end of these tubules glomeruli similar in structure to those of the true kidney, though slightly larger.'
The venous system in this gland consists of branching capillaries which follow the periphery and anastomose profusely in the midst of the organ. Injections consequently resulted in almost solid masses of black with no definite structure. The relation of the arteries and veins is easily discerned by sections and shows a vascular arrangement similar to that of the kidney. The arteries and veins in the glomeruli are sur
A study of the foregoing tables shows comparatively little variation in the body lengths of the embryos in each uterus. In the cases of abnormal development of the kidney, it is interesting to note the corresponding size of the Wolffian body.
' Allen, B. M., Embryonic Development of Ovary and Testis of Mammals, American Journal of Anatomy, Vol. Ill, No. 2.
MacCallum, J. B., Notes .on the Wolffian bodies of Higher Mammals, American Journal of Anatomy, Vol. I, No. 3.
MacCallum, op. cit.
Febeuaet, 1905.]
JOHNS HOPKINS HOSPITAL BULLETIN.
63
rounded by an epithelial membrane similar in structure to Bowman's capsule of the kidney, and the histological structure of the tubules is also quite similar. Each tubide begins at the glomerulus as a somewhat constricted tube and widens in the middle, narrowing again before reaching the duct. The space between the tubules, according to Minot, is lined with epithelium and gives evidence of a sinusoidal circulation. Kidney. — The kidney, as has been long known, arises as a tubular diverticulum from the Wolffian duct near its entrance into the cloaca. This broadens at its distal end, forming the renal pelvis, while the tubular portion becomes the ureter. When the embryo is 12 mm. in length the pelvis of the renal
between the Wolffian body and kidneys is more easily illustrated.
In Figure 1 the kidney is moving in a cephalic direction toward its permanent position and has at this stage received no apparent blood supply. To ascertain that no injection had reached the organ it was completely mascerated and studied under high power. No suggestion of arterial supply was discovered and it is probable that the renal arteries in the pig embryo as in the human fetus do not penetrate the kidneys until they have reached their permanent position. It was supposed that these arteries might enter the kidneys earlier and grow i;p the aorta as the organ ascended, but injections
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Diagram showing tlie relative size of the Itidney and Wolffian body as compared with the length of the embryo. Averages were made of the measurements of the embryos in each ulterus except ia certain cases of abnormal development, when only the average of those normally developed was taken.
anlage is between the fifth lumbar and second sacral vertebrae, just below the division of the dorsal aorta into the right and left hypogastric arteries."
From this stage in the development of the kidney and WolSian body, which has already been so thoroughly worked out, the following figures trace the relative development of these glands and their blood supply.
It was found best in order to avoid confusion to omit from the drawing the adrenal glands, ureters and Wolffian ducts as well as the ovary or testis. In this way the comparison
'Lewis, F. T., The Gross Anatomy of a 12 mm. pig, Vol. VII, Americal Journal of Anatomy.
and examinations of sections show no vascularization until the kidney has reached its permanent position. That the absence of injection fluid in the kidney at this stage was not due to imperfect injection is evinced by the fact that the finest capillaries of the lower extremities and viscera are completely filled.
As in the htmian embryo, rotation of the kidney occurs before the entrance of the blood supply. According to Pohlman, this rotation takes place in the human embryo at 14 mm.° My study of sections of pig embryos places the rotation of the
° Pohlman, A. G., Concerning the embryology of Kidney Anomalies, American Medicine, Vol. VII, No. 25, pages 987-990.
64
JOHNS HOPKINS HOSPITAL BULLETIN.
[No. 167.
kidneys in this genus between 12 and 15 mm. The vascularization of these glands in the human fetus, as has also been proved by Polilman, talces place during the time the embryo is increasing in length from 25 mm. to 30 mm. In the pig embryo, the first appearance of the renal artery which I have been able to demonstrate, occurs at 28 mm.
The Wolffian bodies at this stage are highly vascularized and the glomeruli are fully developed.
The number of arteries leading from the aorta to these glands during the early stages is approximately the same, while the increase in size is proportional to the body growth.
Figure 2 shows the entrance of the renal artery at the earliest stage, though only a very slight arterial supply to the glomeruli was discernible. The Wolffian body is more highly vascularized and has broadened and lengthened.
In Figure 3 the glomeruli of the kidney have received their arterial supply while the Wolffian arteries have increased considerably in diameter. The organ has also increased in size. The heavy injection shown in the dorso-medial region indicates as in the first two figures the region of the glomeruli. It is around these that the tubules end. The position of the organs relative to the vertebrae is but slightly changed. At this stage the development of these vertebrae and the kidneys and Wolffian bodies seems quite proportional.
Figure 4 shows the rapid increase in the vascularization of the kidney and its relative growth. A slight atrophying of the anterior portion of the Wolffian body has begun, and the arterial supply of the glomeruli of this part of the gland is less extensive than in the posterior end, where the blood supply still continues to increase.
In Figure 5 the four anteriorly situated arteries to the Wolffian body have decreased in diameter and the accompanying glomeruli show consequent lack of blood supply. The posterior glomeruli on the other hand are still well vascularized, and there is no atrophy of the gland itself in this portion. The kidney manifests a further development, both in the number of its glomeruli and in its uniform growth.
In Figure 6 it was found to be impossible to separate the two glands so that we find the Wolffian body closely attached to the lower ventral border of the kidney. The atrophy of the anterior portion of the Wolffian body has become most evident, though this degeneration is more manifest in width than in length. The glomeruli in this part of the gland have practically no blood supply and several of the arteries have entirely disappeared. By this time the cortex of the kidney has become so thickened that only the bhirred outlines of the arteries are discernible.'
Figure 7 shows the complete disappearance of the anterior Wolffian arteries and the absence of glomeruli in this portion of the gland. Three of the posterior arteries still persist
'Recent injections which were cleared in a saturated solution of sodium hydroxide instead of a 2% solution bring out quite distinctly the course and distribution of the renal arteries and the location of the glomeruli in the kidneys of pig embryos 68 mm. and 75 mm. in length. The general arrangement of these arteries and glomeruli is similar to that found in figure five.
and supply the glomeruli of this part of the organ, though one of these seems ready to atrophy. In the kidney development there is little more to be noticed except a general increase in size and blood supply.
Injection methods give no further information concerning the Wolffian body after this stage. It is well known, however, that the anterior portion continues to rapidly diminish in width and later in length, and that the remaining tubules are finally claimed by the testis or ovary.
In the male the Wolffian duct becomes the canal of the epididymis, the vas deferens and the common ejaculatory duct, and the remains of the gland itself become the vasa afferentia, ductuli aberrantes and the rudimentary paradidymis.
In the female, the duct becomes the longitudinal duct of the parovarium and the hydatids of Morgagni, while the tubules of the Wolffian body are transformed into the rudimentary tubules of the parovarium and of the paroophoron.
SUMMAEY.
A. The renal artery penetrates the kidney when the embryo
has attained a length of 28 mm. ; rotation of this gland having occurred between 12 mm. and 15 mm.
B. A balancing of function is suggested by a study of the
measurements of these glands.
C. As the blood supply to the kidney increases there is a
corresponding atrophying of the Wolffian arteries.
D. Atrophy of the Wolffian arteries is first evident when the
embryo is 45 mm. in length.
E. As atrophy of the Wolffian body itself continues, the sex
gland becomes more firmly attached to the posterior
portion, and the remaining tubules and duct are
claimed by the ovary or testis.
Before completing this article, I wish to thank Professor
Keibel, of the University of Freiburg, for the privileges of
his laboratory, in which a portion of this work was done.
INSTRUCTION IN PSYCHIATRY AND NEUROPATHOLOGY.
A limited number of graduates in medicine can have an opportunity for work in the laboratory of the Sheppard and Enoch Pratt Hospital.
Instruction in neuropathology will be given by the director of the laboratory, and those attending the course will be permitted to attend the clinical and other conferences of the medical staff. Clinical forms of insanity will be discussed, as well as the hospital and home care of the insane.
Physicians taking this course will also have an opportunity to attend the neurological clinics at the Johns Hopkins Hospital.
For particulars, apply by letter to Dr. E. N. Brush, Physicianin-Chief and Superintendent, Sheppard and Enoch Pratt Hospital, Station " A," Baltimore.
THE JOHNS HOPKINS HOSPITAL BULLETIN, FEBRUARY, 1905.
PLATE VIII.
Flo. 1. — The right Wolffian body and the left kidney of a pig embryo 20 millimeters long: injected through the hypogastric artery with India ink. The length of the Wolffian body is 7.3 mm., and the kidney is 1.2 mm. long. D. A., dorsal aorta. K., kidney. L. H. A., left hypogastric artery. W., Wolffian body. 12 T. R., twelfth thoracic rib. 1 S. V., first sacral vertebra.
Fig. 2. — The right Wolffian body and the left kidney of a pig embryo 28 mm. long; injected through the hypogastric artery with India ink. The entrance of the renal artery is first demonstrated at this stage. The length of the Wolffian body is 8.5 mm., and the length of the kidney is 2.6 mm. 12 T. V., twelfth thoracic vertebra. 1 S. V., first sacral vertebra.
Fig. 3. — The right Wolffian body and the left kidney of a pig embryo 33 mm. long; injected through the hypogastric artery with India ink. The length of the Wolffian body is 9.1 mm., and the kidney is 3.9 mm. long. K! T. V., thirteenth thoracic vertebra. 1 S. v., first sacral vertebra.
Fig. 4. — The right Wolffian body and the left kidney of a pig embryo 45 mm. long; injected through the hypogastric artery. The length of the Wolffian body is 10.6, and the length of the kidney is 6.3 mm. 14 T. V., fourteenth thoracic vertebra. G L. V., sixth lumbar vertebra.
THE JOHNS HOPKINS HOSPITAL BULLETIN, FEBRUARY, 1905.
Lh
Fid. 5.— The right Wolffian hody ami the left kidney of a pig emhryo .54 mm. in length; injected through the hypogastric artery. The length of the Wolffian body is 11.2 mm., and the length of the kidney is S mm. 14 T. V., fourteenth thoracic vertebra. L. V.. sixth lumbar vertebra.
m
TV. 14
LVt
Pi(i. fi.— The right Wolffian body and right kidney of a pig emljryo US mm. long; injected through the hypogastric artery with India ink. The length of the Wolffian body is 11.3 mm., and the length of the kidney is 11. .5 mm. 14 T. V.. fourteenth thoracic vertebra. 6 L. V., sixth lumbar vertebra.
Pro. 7.— The right Wolffian body and right kidney of a pig embryo 75 mm. long; injected through the hypogastric artery with India ink. The length of the Wolffian body is 10.9 mm., and the length of the kidney is 12.2 mm.
February, 1905.]
JOHNS HOPKINS HOSPITAL BULLETIN.
65
HIGH BIFURCATION OF THE BRACHIAL ARTERY WITH REUNION AT THE ELBOW.
By Minerva Herrinton.
The abnormality herewith reported is of interest because it blends three variations, which, taken alone, are not common in one specimen. The specimen is from the left arm of a white woman, 50 years old, whose death was caused by acute aneurysm (No. 1131). It was my good fortune to dissect this arm while a student of anatomy at the Johns Hopkins University, and with the permission of Dr. Mall I report it.
The axillary and brachial arteries are normal in arrangement until the middle third of the arm is reached. Then
ehial artery at the elbow and that if it bifurcates higher this same force has a tendency to reunite the branches as shown in these cases.
Without entering into the discussion of the arteries of the early embryo, it may be noted that in their later development those arteries which are more favored are preserved. Such branches pass to the ulnar and radial muscle masses and then are arranged on either side of the humerus and later slide down to the forearm. In case the brachial arterv bifurcates
Fig. 1. — Outline of the Brachial Artery and its Branches. Reduced. 1, brachial artery; 2, radial; 3, ulnar; 4, branch accompanying ulnar vein ; 5 and 6, branches anastomosing with the posterior ulnar recurrent and anastomotica magna ; 7, anastomotica ; 8, superior profunda; A, branch accompanying the musculospiral nerve; B, branches to muscles and the anastomoses around the elbow Joint.
between the middle and lower thirds of the arm the artery divides into the ulnar and radial arteries, which are about equal in size. These branches continued somewhat separated until they passed the elbow, when they came in apposition and anastomosed by an opening about as large as the lumen of either of the arteries. The accompanying figure, which is drawn at one-fourth scale, shows the dimensions, form and relation of the arteries. The anastomoses with the posterior ulnar recurrent and anastomotica magna are also shown.
A specimen in the Army Medical Museum at Washington, prepared by Dr. D. S. Lamb, shows a similar variation, high division of the brachial artery with partial reunion at the usual site of its bifurcation into the radial and ulnar. Similar cases are also reported by Quain,' Henle,' Tiedemann,' Power,* Green," Maestre ° and others, which together indicate that there must be some force which favors the bifurcation of the bra
while the muscle masses are high and obstacles are then placed between the two branches, the condition continues during life. If the bifurcation is low, say the lower third of the humerus, there is no marked obstacle, and by a process of union and shifting the two arteries may unite until they reach an obstacle, which is at the usual point of division. For this reason a bifurcation in the lower third of the upper arm is rare. In this case some obstacle prevented such a union all the way down, but since these arteries were again close together at the usual point of bifurcation, one of the many small branches which united them at this point in the embryo enlarged, for it was " put into use frequently," so to speak. From this time on there "was a balance which favored the circulation first through one of the channels of the bifurcation and then through the other, which of necessity caused blood to flow through the anastomosis. Had this not been so, one of the
66
JOHNS HOPKINS HOSPITAL BULLETIN.
[No. 167.
two channels would have been obliterated or the anastomosis would have closed, as under similar conditions the foramen ovale, ductus arteriosus and other vessels become obliterated.
EEFEEENCES.
1. Quain, E. : Anatom}' of the Arteries of the Human Body. London, 1844; atlas.
Elements of Anatomy, Vol. II, Part II, London and
New York, 1892.
2. Henle, J. : Handbueh der Systematischen Anatomie des Menschen, Vol. Ill, Gefasslehre. Braunschweig, 1876.
3. Tiedemann, E. : Explicationes supplementorum ad tabulas arteriarum corporis humani. Heidelberg, 1846 ; atlas.
4. Power, J. H. Anatomy of the Arteries of the Human Body. Phila., 1863.
5. Green, P. H. : An Account of the Varieties in the Arterial System of the Human Body. Dublin, 1830.
6. Maestre, A. : Notable anomalio de la arteria humeral. La Espana Medica. Madrid, 1864, IX.
A preparation by D. S. Lamb, Act. Asst. Surg. U. S. A., in the Army Medical Museum is that of a dissected and injected right arm showing high division of the brachial artery with partial reunion at the usual site of bifurcation into the radial and ulnar.
FIXATION OF TISSUES BY INJECTION INTO THE ARTERIES.
By Burton D. Myers, M. D., Associate Professor of Anatomy, University of Indiana.
Diiring the past year, while preparing tissues for the course in histology at Johns Hopkins University, the injection method recommended by McFarland ' of Leland Stanford, Jr., University, was given a trial. The result was so excellent as to lead to its continued use.
The method as suggested by McFarland is very simple. Two bottles with an outlet near the bottom are fitted up with tubes and clamps. This system is to be run up by means of rope and pulley to such a height as will give the gravity pressure required. Simple as the method is, it is very effective. It has, however, the disadvantage of being somewhat inconvenient to handle, and of giving no satisfactory registration of the pressure used, for the pressure varies not alone
'Jour, of App. Microscopy, Vol. II, No. 10.
with the height of the injection flask, but with the specific gravity of the injection mass. Moreover, the method is such an excellent one that some of the more expensive fixing agents were experimented with, which would have been out of the question if one had to fill up an extensive injection apparatus, consisting of a flask and six or seven feet of rubber tubing, with so expensive a fixer as Hermann's fluid, for instance. Still further, it is entirely too difficult to keep so extensive a system as warm as is necessar}' for a fine injection of blood-vessels with carmine gelatin. Therefore connection was made, in the laboratory, with a very effective air-blast run by water pressure, and this in turn gave place to the inexpensive apparatus figured below. As will be seen readil}^, the figure illustrates a blast apparatus. The tube W, leading from a water tap, is attached to a glass tube B, a part of the apparatus. This glass tube B ends at x, a constricted portion of a chamber to which the air has free access through the tube A. Water passing through the system leaves the txihe B at X, drawing along with it a quantity of air into the tube C. The force of the water in this tube C is broken by the cap at its lower end, and the water and air escape through the openings D and D' into the chamber E, out of which there are but two ways of escape, one at F and the other at G. The escape of the water at G is regulated by a screw clamp according to the air pressure desired. In the chamber E, the air, of course, rises to escape at F through the rubber tubing connecting F with the T tube interposed at H, through one arm of which connection is established, J, with the injection flask M, and through the arm K connection is made with the mercury manometer L.
It is obvious that in the chamber E and in the tubes F J K and in the flask M the air pressure is the same, and will be registered on the millimeter scale placed back of the open leg of the manometer.
On this scale the reading is doubled, for the mercury falls
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in the closed as much as it rises in the open arm, and the difference between the columns is the sum of the rise plus the fall, or double the rise.
Let us suppose our animal, preferably a young one, killed, the artery exposed, and the ligatures in place ready for tying in the glass canula N. Let us suppose the injection flask filled with 300 or 400 ce. of normal salt solution heated to 38 or 40° C, and the cork in place, through which, by means of a glass tube, connection between J and M is established. Now loosen the screw clamp at just enough to let the 13inch tube and the canula N fill with the injection mass and drive out all the air. Kow cut the artery, insert the canula and tie it in place. Then cut one of the large veins, say the inferior vena cava, to permit the washing out of the vessels, turn on the water at the tap and loosen the clamp at 0. If only a little water is turned on, the water and most of the air escape at G and the air pressure remains very low. Even if the full water pressure is turned on, if the escape at G is too free, considerable air escapes that way and the air pressure remains low. Therefore, when a good flow of water is established, gradually tighten the screw clamp at G, at the same time watching the manometer; the water begins to back up in the chamber E, escape for the air at G is cut off, and the air pressure rises. Thus a balance may be established between the water pressure used and the air pressure.
If the water in the chamber E rises much beyond the openings D D', the clamp at G must be loosened a bit, or the water will back up into the tubes F K J and then over into the flask M.
The limit of the pressure to be secured with this apparatus depends upon the water pressure, which, however, is usually much greater than should be used for injection. It is usually possible to get a pressure of 240 to 250 mm. mercury, i. e., a 5-pound pressure, and as a rule one-fourth of this is sufficient.
When the vascular system is well washed out by the normal salt solution, clamp off the flow at 0, turn off the water at the tap, pour out the remaining normal salt solution, fill the flask as full as desired with the fixing agent heated to 40° C, and again begin the injection.
With this method any rapid fixer may be made use of. It is not always necessary to wash out the blood-vessels with normal salt solution. Fixation is usually better, however, for having done so. With mercuric bichloride it does not so much matter. With formalin and Hermann's fluid, however, it is advantageous for fine fixation. The best fixers have proven to be mercuric bichloride, formalin, Hermann's fluid, and alcohol.
By this method the tissues, after a few minutes bath in warm normal salt solution, are instantly penetrated to the last cell by the fixing agent. The advantages are very great. The tissues, within a few minutes after ansesthetizing the animal (for anaesthetizing, illuminating gas is recommended as being cheap, and causing no salivation), are perfectly fixed in a normal position, at normal distention, and during normal activity. The possibility of post-mortem changes in the
central nervous system is practically eliminated. The processes of digestion and absorption are arrested and fixed in the act, and tissues may thus be secured in any desired stage of physiological activity. Engorged tissues are caught with the blood in them, giving a picture of rare beauty. Blood and bone marrow are perfectly fixed.
For studying bone marrow the ribs of a kitten or baby rabbit fixed with HgCL will decalcify over night in a solution of 3 per cent HNO^ made up with 67 per cent alcohol, and from such ribs, sections 3J^ may be secured easily, giving a picture of bone marrow with its connective-tissue framework normally distended and marrow elements in normal position. On sections so thin an oil immersion objective may be used, blood stains employed, and eosinophilic cells in great numbers may be demonstrated outside the blood-vessels of the bone marrow. Particularly are these marrow elements, together with nucleated red blood corpuscles, shown with great beauty in the ribs of a 10-cm. embryo pig. Bone marrow in this form is a decidedly different tissue from bone marrow studied as a smear.
The thoracic wall of a small white rat, fixed by injection of Hermann's fluid, may be cut at S^/jl without decalcification, and, stained with iron hematoxylin, shows not only marrow elements, but the intercostal muscles and nerves in normal position with the usual beauty of a Hermann's fiuid fixation. In short, we get a penetration with Hermann's fluid impossible by the ordinary method of using it.
There is scarcely a tissue that is not shown with new beauty by this method of fixation. Sections of lung fixed by HgCl^ injection and cut at 3^/i give a picture unequalled in beauty. The epithelial lining is intact and shows the more perfectly in that the tissue is at normal distention.
A brain fixed and hardened in situ presents a very different appearance from a brain supported on a sheet of cotton.
The method is invaluable not only in preparing tissues for classes in histology, but also as a research method.
In the use of HgCL as a fixer by the usual method, the crystalline deposits formed are very annoying and detract from the value of the fixer. This dilficulty is overcome in the simplest manner. At a pressure 130 mm. mercury, 400 cc. of a saturated aqueous solution of HgCL are injected in about 10 minutes into a small kitten or rabbit, the time depending somewhat on the freeness of the venous opening. If the venous opening is not sufficiently free an csdema is likely to be caused, which in some cases is no disadvantage. Follow the injection of the HgCU by an injection of 500 cc. of 67 per cent alcohol. This not merely washes out the HgCl^, but the HgCL is about 3 times as soluble in alcohol of this strength as in water, so the washing out is doubly effective and the hardening of the tissue is begun at the same time. After such a washing out, if properly done, one may cut out whatever tissues desired without blackening the knife or tissues. It is usually best to leave the tissues in 67 per cent alcohol for one day, though, if necessary, they may be transferred at once to 82 per cent alcohol after having been washed out with 67 per cent alcohol.
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It is found best to inject only one-half an animal at once. The canula should be placed in the abdominal aorta with the mouth just above the cceliac axis when injecting the thoracic viscera and head and neck, and low down in the tlioracic aorta when injecting the abdominal viscera. In either case the vena cava should be opened either above or below the liver. It is best to place a block under the back of the animal to insure a free venous outflow.
If the animal is rare or valuable, a double canula may be placed in the abdominal aorta and the whole animal injected at once. After such an injection the whole animal, or the part injected may be left over night in 67 per cent alcohol and then removed to 83 per cent alcohol, which should be changed a few times. Thus a great deal of tissue, excellently prepared in a very short time, may be had on hand for any emergency.
The inner ear of a guinea pig fixed by HgCL injection gives a rarely fine picture on section. After decalcification the cochlea should be laid open by a section passing through the
modiolus. This permits better infiltration and imbedding, with the result that the delicate membranes are held in position by the celloidin when cut and do not present the appearance so often seen of having been dragged.
Tincture of iodine added to the 67 per cent alcohol used in washing out the HgCL showed no noticeable advantage.
A very valuable use of the method is in the preserving of brain tissue. A brain may be fixed in situ by formalin injection, and then removed, the brain stem cut out and placed in potassium dichromate solutions preparatory to sectioning and staining by the Weigert-Pal method. Those who have had the disappointment of having such post-mortem changes take ijlace in the inner capsule and pyramidal tracts, before the penetration of the fixer, as to render the tissue useless, will appreciate the value of this procedure.
Though many uses of the method have been noted they are but a part of the many ways in which the method was found very valuable in the Anatomical Laboratory of the Johns Hopkins University during the past year.
A CONVENIENT STILL TO MAKE ABSOLUTE ALCOHOL
By William J. Calvert, M. D.,
Assistant Professor of Internal Medicine, University of Missouri.
In 1895, while working in the Anatomical Laboratory of the Johns Hopkins University, it occurred to me that the home manufacture of absolute alcohol would be more economical and satisfactory than buying it in small quantities. With permission from Dr. F. P. Mall, a small still was made which for a time gave satisfactory results. This apparatus consisted of an ordinary tin can and an inverted Liebig's condenser for the first portion of the work. When ready for distillation the condenser was changed to the inclined position and the alcohol was caught in an ordinary receiver. While this apparatus gave satisfactory results, it required more care and knowledge for its operation than can ordinarily be placed in an average janitor, already busy with numberless small chores. Since then, an absolute alcohol still has been constructed by Dr. Mall, which requires practically no care or thought on the part of the operator, yields an excellent quality of alcohol, and is inexpensive. The apparatus is made of heavy copper, tinned on the inside, and a block-tin worm. It is composed of a gas-stove, an automatic water-bath, boiler, condenser, and receiver. (Figs. 1 and 5.)
The only especial requisite for the gas-stove is a stop-cock in the supply pipe by which the gas flow may be regulated, thus permitting the stop-cock in the gas main to be turned on full. A stove similar to No. 8157, Eimer and Amend's Catalogue, 1902, p. 211, is satisfactory.
Naturally the size of the still must depend on the amount of work to be done. For making an amount of absolute alcohol used in our universities the following dimensions are
sufficient : a water-bath, eleven inclies in diameter and eleven and one-half inches high, with a substantial support one and one-half inches above its bottom to support the boiler and still, will allow one and one-half inches of water about the sides and bottom of a boiler eight inches in diameter and ten inches high. The support for the boiler should be fastened to the sides and bottom of the bath, with a smaU depression on the upper surface or several small uprights to hold the boiler in one place. The automatic water supply now used on the ordinary water-bath in chemical laboratories is suificient. The connecting tube U should be three-fourths of an inch in diameter and not longer than one-fourth of an inch, placed four inches above the bottom of the bath. The tube V should be one inch in diameter, extend from a point level with top of bath to a point one inch below lower side of tube U, and be well anchored to side of water-bath, near the top. Supply tube X, Fig. 4; sufficiently large to take a one-half inch rubber tube, is inserted at a right angle into the posterior side of tube V two inches from top. One-fourth of an inch from tube V tube Z is bent downward at an angle of 15°; this is to prevent kinking of rubber tube connecting X with C. The height of the water in V is regulated by height of tube W, which is either fastened in V by penetrating a cork stopper or permanently Qxed in a cap to screw on V. Tube W should extend to one inch below top of V, and its lower end should accommodate a one-half inch rubber tube which carries waste water to a sink.
The boiler (Figs. 1 and 5) is eight inches in diameter
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and ten inches high from bottom to side Q, which may slope inward and upward at any desired angle. The opening P to P' should be at least four inches; walls of neck N may be parallel or slightly flared at top and two inches high. At top of iV a heavy flange M three-fourths of an inch wide is firmly attached. The top is composed of wall which closely fits into neck N and extends about one-quarter of an inch below the point P and P', with the lower edge slightly flanged inward as shown in the figure, to prevent, as far as possible, capillary attraction between the walls and N. At the top of a flange L, corresponding to flange M, is firmly attached, a sufficient distance above M to admit a rubber or asbestos ring. The top may then be firmly fastened to the boiler by placing
Fig. 1. Median section tlirougli the still.
Fig. 2 shows relative position between tube H, D and C. If the still is placed near or against a wall, tube H should be a little in front of the plane through D so that the cock I may be more easily rsached.
Fig. 3 shows course of block-tin worm from bottom of condenser to J in Fig. 1, seen from below upward.
Fig. 4 is a side view of V, showing tube X.
several simple clamps on flanges. Beginning at top of 0, the wall K extends upward, cone shaped, to an apex J, through which passes the lower end of the block-tin worm A. This joint will be more secure if the tin tube extends about one inch below the apex and is braced as shown in Fig. 1. Immediately above the point J the tin tube bends at almost a right angle and runs in a spiral direction outward and upward to the bottom of the condenser B, the bottom of which should be about one and one-half inches above the point /. The spiral tube is shown in Figs. 2 and 3. In the middle third of tube
F, Fig. 3, is soldered a short piece of tin tubing, in which a stop-cock I is placed, in such a manner as to form a small trap in the bottom of tube F, which must be filled before the alcohol, returning from the condenser, can flow back to the boiler. Fig. 3. This trap is made by removing the bottom and spreading the sides of tube F to receive tube E. Tube H, in Fig. 3, contains a stop-cock, which, when closed, causes the return alcohol from the condenser to fill the trap and flow into the boiler and when open permits the return alcohol to flow through tube H to the absolute alcohol receiver. The lower end of tube H is to receive a three-eighths rubber tube, which in turn connects with a glass tube the lower end of which penetrates a cork in the absolute alcohol receiver, which is an ordinary large bottle.
The worm should be of one-half inch block-tin tubing, the coils of which- should be from one and one-half to two inches
Fig. 5. — Side view of still, one-fourth scale.
apart and three-fourths of an inch from the walls of condenser B. When the coil reaches the top of condenser Bj it should be deflected until the wall of the condenser is reached, here securely fastened and then extend perpendicularly upward four or five inches. Condenser B should be at least five inches in diameter and ten inches high, and firmly attached to top E by four supports, E, E', E". It is necessary to have condenser and top K one rigid piece to prevent straining the block-tin tube and disarranging the trap in tube F. Near the bottom of the condenser is a cold water intake 0, for threeeighths rubber tubing, with stop-cock. On the opposite side one inch from top of condenser is an outflow pipe, C, for a onehalf inch rubber tube. One-fourth of an inch from condenser, tubes C and D are deflected at 45° to prevent tubing from kinldng. Across the top of condenser run two bars at right angles for supporting a handle to which is attached a rope which runs over a small pulley flxed in a bracket a few inches above the condenser. By means of this rope and pulley the condenser is raised so that the wall of top clears wall N
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of boiler and is then pushed to one side, so the boiler may be removed from the bath for cleaning and reiilling. If the condenser is thus handled there is no danger of injuring the joint between and N. The rubber tubing connecting the intake D with the water main and tube C with tube X must be sufficiently long to permit the condenser to swing free of the boiler.
The cheapest method of abstracting water from alcohol is by using fresh well burnt lime, quick lime according to the formula CaO + S^O = Ca{0H)2, which when expressed in atomic weight values is 55.85; 17.95 or 3.11 grams of quick lime for each gram of water. Ordinary commercial 95 per cent alcohol varies from 92 to 95 per cent alcohol, so contains from 5 to 8 grams of water per 100 cc. For safety it is best to calculate 5 grams of lime for each gram of water and allow for 10 cc. of water per 100 cc. of alcohol. On this basis it requires 500 grams of lime per liter or about four pounds of lime per gallon of alcohol.
Directions for operating the apparatus : The boiler is threefourths filled with lime and 95 per cent alcohol, placed in the water bath, tightly connected with the condenser and allowed to stand over night. On the following morning the bath is heated to, and kept at, about 90° to 93° C. During the first two or three trials the stove must be regulated by the stop-cock in the gas stove, keeping the valve at the gas main open full. When the gas supply has been regulated the valve in stove must remain untouched. The supply of water is regulated by the valve at D, keeping the valve on the water main open full. In this way when the apparatus is to be used instructions are to put — grams or pounds of lime and — quarts of 95 per cent alcohol in boiler, tightly connect boiler
and condenser, close valve /, allow to stand over night, in morning open water main valve and gas main valve full, light stove ; in afternoon, shut off gas and water ; next morning open water main and gas main valve full, light stove and open valve /. When alcohol ceases to flow into absolute alcohol receiver remove and tightly cork the absolute alcohol and immediately clean the boiler. If the lime is allowed to remain in boiler it may be difficult to remove.
Cost of absolute alcohol made in this way is about as follows. From 50 to 75 per cent of 95 per cent alcohol is recovered as absolute :
1 gallon absolute costs,
2 gallons of 95 per cent, at 50 cents . . . .$1.00
8 lbs. of lime at from 3 to 4 cents 24
About 100 ft. gas 15
Water, about 10
$1.49
The cost in 95 per cent alcohol depends on the care in operating. If too much heat is used the loss will be greater. During the first day the alcohol need not boil, as a temperature near the boiling point will complete the reaction.
This still may also be used for making extracts, etc., and can be made of any desired capacity.
If the trap pictured in Fig. 3 be blown in a glass tube which could be connected with an ordinary Liebig's condenser a very convenient chemical apparatus would be had.
A number of these stills have been manufactured by Vaile and Young, 210 N. Calvert street, Baltimore, at a cost of about $25 each.
ANNOUNCEMENT CONCERNING GRADUATE INSTRUCTION IN THE MEDICAL DEPARTMENT
OF THE JOHNS HOPKINS UNIVERSITY.
By W. H. Howell, M. D., Dean of the Medical Faculty.
The courses that have been offered to gi-aduates in medicine by the Johns Hopkins University, since the opening of the Hospital in 1889, consisted in the beginning of a combination of general courses, laboratory and clinical, so arranged as to give systematic instruction to large groups of students. In recent years these courses have been given only during the months of May and June, and it has been found desirable to supplant the general courses, to a large extent, by special courses confined to a limited number of students. Although designated as graduate courses, the instruction has been for the most part of an elementary character, especially in the laboratory work, as many of those who entered had not enjoyed the advantages of a training in modern scientific methods. Our experience during the last few years, however, leads us to believe that at present there is no great need on the part of
graduates for elementary courses of this character. The wide adoption of laboratory methods in all of our reputable medical colleges, and the general improvement in medical iastruction that has been going on for a niimber of years past, have produced a better trained body of graduates, and those who desire to take post-graduate work are, as a rule, prepared for more special and advanced instruction. The Medical Faculty of the Johns Hopkins University believe, therefore, that the time has come to make specific provision for a higher grade of instruction to medical graduates. They have decided to abandon for the most part those systematic courses heretofore given in May and June, of which the chief aim was to supplement deficiencies in previous training. As a substitute for these May and June courses they propose to offer opportunities of a wider character which, while still
Febeuaet, 1905.]
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giving to those who so desire a chance to obtain elementary instruction, are especially intended to encourage the development of truly graduate work, such as can be accomplished most satisfactorily by individual study under competent direction. Specific regulations along these lines have been adopted and will be stated in full in the next annual announcement.
For the information of those who may desire to avail themselves of the facilities of the Medical School and the Hospital during the present session, it may be said that these regulations make possible the following opportunities :
1. In each department a limited number of graduates will be received during the whole or a part of the year, either to engage in advanced work of an individual character or to enter the regular courses given to undergraduates. Applications to enter upon such work should be made directly to the Head of the Department.
2. Each instructor in the Medical School may offer to graduates special courses in his subject at any time during the year. These courses may be similar to those heretofore offered during May and June only, that is, courses of a more or less elementary character, but limited to a small number of students so that personal supervision may be obtained from the instructor, or they may be arranged only for those who are prepared to do advanced work.
For the present the following courses may be announced. Those coming under the first group described are designated as University Courses, while those of shorter duration, coming under the second head, are designated as Special Courses. For further details, application may be made to the Dean of the Medical Department.
UNIVEKSITY COUESES.
These courses are of two kinds, elementary and advanced. The elementary courses will cover the subject as usually given to undergraduates in medicine and the work may be done with the medical classes. The advanced courses will be given only to those who are prepared to undertake special studies, and the work will be done under the personal supervision of the instructor in charge of the course.
Medicine, Elementary. A limited number of physicians will be admitted to the regular class exercises in this subject, including ward rounds, clinics and work in the clinical laboratory. Fee $100.00 for the entire year; $50.00 for a half year. Applications should be made to Professor Osier.
Medicine, Advanced. Physicians properly trained in the methods of clinical diagnosis will be given opportunities for experimental investigation in the clinical laboratory. Fee $50.00 for the year. Applications should be made to Dr. C. P. Emerson.
Gynecological PATJiOLOOT, Elementary. (Limited to three students.) Drs. Cullen and Hurdon.
The work in this course begins October 1 and extends to May 1. The class meets Tuesdays and Thursdays,
13 m. to 1 p. m. Fee $50.00. Applications for this course should be sent to Professor T. S. Cullen not later than September 15.
Obstetrics, Advanced. A limited number of physicians will be received for advanced instruction under Professor Williams during the Academic year — October to June. Those intending to enter upon this work should apply to Professor Williams stating the character of the work they desire and their qualifications for undertaking it. Fee $50.00
Pathology of the Heart and Circulatory System, Advanced. (Limited to five students.) Professor W. G. MacCallum. The course will begin October 9 and continue for fivt; weeks, with three exercises a week.
These exercises will consist of lectures, experiments on animals, and anatomical, chemical and microscopical demonstrations. The following topics will be considered : Diseases of the pericardium, diseases of the endocardium and myocardium, pathology of the pulmonary circulation, pathology of the systemic circulation, pathology of the lymphatic channels. Fee $30.00. Those desiring to take the course should correspond directly with Professor MacCallum.
Pathology, Elementary. A limited number of physicians will be received during the year in the courses in bacteriology and pathology. Fee for the entire year $50.00, fee for half year $25.00. Apply to Professor W. H. Welch.
Pharmacology and Toxicology, Elementary. January 1 to June.
A limited number of physicians will be received into the regular course as outlined in the catalogue of the Medical School. Fee $25.00. Apply to Professor J. J. Abel.
Pharmacology and Toxicology, Advanced. Professor Abel.
Those who have had the necessary preliminary training and who desire to do work of a special character will be received at any time during the Academic year. Fee $50.00 for the entire year.
Physiology, Elementary. (Limited to four.) Laboratory course in experimental physiology, October to December 25.
The work will consist in exercises in the various graphic methods used in physiology to study the properties of muscle and nerve and the circulatory and the respiratory organs. Fee $25.00. Apply to Professor W. H. Howell.
Physiology, Advanced. (Limited to two.) January to June 1. Professor Howell.
Individual instruction will be given in the methods used in physiological demonstrations and research. Especial attention will be paid to the methods employed in the study of the circulation. Fee $50.00.
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Anatomy, Advanced. Those who have had the necessary preliminary training and desire to undertalie the study of special problems, will be received at any time during the Academic year. Fee $25.00. Apply to Professor P. P. Mall.
Histology and Okganology, Elementary. Professor Harrison, Drs. Sabin and Knower, October 1 to February 15, Monday, Wednesday and Friday afternoons. (Limited to three.) Fee $50.00.
Neurology, Elementary. A systematic course in the gross and microscopic anatomy of the central nervous system, from February 1 to March 15. Lectures, Dr. Sabin, three hours a week; laboratory work. Dr. Sabin, Professor Harrison, Drs. Knower and Streeter, Monday, Wednesday and Friday afternoons. (Limited to five.) Fee $25.00.
Neurology, Advanced. (Limited to two.) Dr. Sabin, March 15 to June 1, forenoons.
The work will take up special topics in the development and structure of the central nervous system. Fee $25.00.
Neurological Technique, Advanced. (Limited to two.) Dr. Streeter, March 15 to June 1. A knowledge of general histological technique will be assumed. Fee $35.00.
Embryology, Elementary. (Limited to two.) Dr. Knower, March 15 to June 1.
A laboratory course in the development of the mammalian body as illustrated by pig and human embryos. Fee $25.00.
Human Embryology, Advanced. Professor P. P. Mall, October Ito June 1. (Limited to two.) Fee $25.00.
Experimental Embryology, Advanced and Research. Professor Harrison, March 15 to June 1. (Limited to two.) Fee $25.00.
Physiological Chemistry, Elementary. March 15 to June 1, every afternoon.
A limited number of physicians or others who have had the requisite preliminary training in chemistry will be received for the laboratory course and lectures given to the medical students. Fee $25.00. Apply to Professor Walter Jones. Physiological Chemistry, Advanced. Professors Abel and Jones.
Those who have the necessary preliminary training and who desire to do work of a special character will be received at any time during the Academic year. Fee $50.00, for the entire year.
SPECIAL COUESES.
Medicine. Drs. McCrae, Cole and Boggs, June 1 to July 1. (Limited to fifteen.) Fee $100.00. The course will not be given if less than eight register.
Api)lications for this course must be sent in not later
than May 10.
The whole material of the medical service will be
available for the class. Special attention will be given
to the study of the general methods used in the clinic. The course consists of:
I. Ward Rounds. Drs. McCrae and Cole, from 9 to 11 daily. Special attention will be given to diseases of the circulatory and digestive systems. II. Physical Diagnosis. Dr. McCrae, five hours a week. The general methods of diagnosis will be taken up and special attention given to diseases of the thoracic and abdominal organs. III. Clinical Microscopy and Medical Bacteriology. Dr. Boggs, three afternoons — 9 hours a week. This course consists of lectures, demonstrations and especially of practical work. All of the available specimens of blood, urine, sputum, gastric contents and stools are studied. The ordinary methods of clinical bacteriology will be demonstrated.
Pediatrics. Dr. S. Amberg, June 1 to August 1, daily from 11 to 13, Dispensary. (Limited to eight.) Fee $40.00. The participants are expected to examine patients personally under supervision.
Surgical Pathology. Professor Bloodgood. This course is given three times during the year, as follows: Course I, October 10 to December 30 ; Course II, January 10 to April 20; Course III, May 2 to June 30. (Each course will be limited to twelve.) Fee $50.00. The course consists of:
a. Systematic instruction in clinical and pathological
diagnosis, illustrated by pamphlets, photographs, museum specimens, and microscopic sections.
b. Demonstrations on all fresh material received in the
Surgical Pathological Laboratory.
Demonstrations, October to May, Tuesdays, 3 : 30 p. m. to 4:30 p. m. ; Wednesdays and Fridays, 1 : 30 to 3 : 30 p. m. Demonstrations in May and June, Tuesdays, Thursdays and Fridays, 8 to 9 a. m. Students taking this course should plan to give at least three hours a day to the work. Operative Surgery on Animals. Professor Gushing, April 39 to June 31, Wednesdays and Saturdays. Sixteen exercises of from four to five hours each, commencing at 8 : 30 a. m. (Limited to ten.) Fee $60.00.
The course will be limited to ten graduate students who will be divided into two groups of five, thus making up two complete operating staffs, an operator, first and second assistant, anaesthetist, and attendant. The members of the class rotate in these positions during the various exercises. An effort is made to carry out as closely as possible the same technique that is used in the general operating room of the Hospital. The graduates taking the course do all of the operative work themselves.
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Emphasis will be laid upon methods of operating in general, rather than upon any particular operations. A schedule of the exercises showing the operations performed will be furnished on application.
Genito-Urinary Surgery. Professor Young. Fee $100.00. A limited number of graduates will be taken for special work in Genito-Urinar}' Surgery. The course will include clinical and laboratory work and the student is expected to give his entire time, or most of it, to the department, and to enter for six months or more. Eesearch studies will be encouraged.
Orthopedic Sdrgeet. Dr. Baer, May 15 to August 1, Monday, Wednesday, Thursday and Saturday, 10 to 12 m. (Limited to ten.) Fee $50.00.
A course will be given in the Orthopedic Dispensary from 10 to 12 m. on the days noted in which the students will be given practical work in the diagnosis and treatment of all orthopedic affections. Ward rounds covering this class of cases will be made from 9 to 12 on Monday mornings. Opportunities at this and other hospitals will be posted during the course so that one may be able to see practically all orthopedic operations.
X-Eay Diagnosis and Therapeutics. Dr. Baetjer. This course is given three times during the year as follows ; Course I, October 15 to December 15; Course II, January 15 to March 15; Course III, April 15 to June 15. (Limited to five in each course.) Fee for each course, $50.00.
Each course will consist of daily demonstrations from 11 a. m. to 12 :30 p. m., and the aim of the course is to give a practical Imowledge of the construction of the X-Ray apparatus, and its use in diagnosis and treatment.
Gynecological Pathology. Professor CuUen, during March and April, Tuesday and Thursday, 12 to 1 p. m. Pathological Laboratory. (Limited to ten.) Fee $50.00. A course in the diagnosis of uterine scrapings. All pathological conditions of the cervix and body of the uterus that could be mistaken for cancer are discussed, and special consideration is given to the early diagnosis
of cancer of the uterus. The methods of obtaining and examining pieces of uterine tissue are given in detail. Cystoscopic Examinations. Dr. Hunner, Monday and Friday, 2 to 4 p. m. May 12 to July 30, inclusive. (Limited to six.) Fee $50.00.
Fifteen clinics covering the entire subject of diseases of the urinary tract in woman. Demonstrations of the newer instruments used in urinary work.
This course is for beginners in cystoscopy.
Bacteriology, Elementary. Dr. Ford, May 1 to June 1. Three mornings a week. (Limited to ten.) The character of the work will be adapted to the needs of the class. The course will include instruction in: 1. Elementary Bacteriology. 2. Sanitary Bacteriology, including water and milk. 3. Technique of agglutination, hremolysis and immunization of smaller animals. Fee $50.00. Pathology, Elementary. Dr. Bunting, May 1 to July 1. (Limited to ten.) Three afternoons a week. Lecture and laboratory exercises in general pathological histology. The course will not be given if less than five register. Applications must be received before April 15. Fee $50.00. Ophthalmoscopy and Ophthalmology. Dr. Mills, June 1 to July 1, Monday, Wednesday and Friday, 3 to 4 p. m. (Limited to ten.) Fee $25.00. This course is intended for general practitioners. Gross Anatomy. Professor Lewis, October 1 to June 1, hours arranged with the instructor. Fee $25.00 per month.
Dissection, study of prepared specimens and of frozen sections.
REGISTRATION. Before entering upon any of these courses of graduate instruction the student must register at the Office of the Dean of the j\Iedical School. Upon payment of the requisite fees a card will be issued stating the courses which the holder is permitted to take. This card must be presented to the instructor in charge of each course at the beginning of the classwork in order that the holder may be duly recognized as a member of the class.
SUMMARIES OR TITLES OF PAPERS BY MEMBERS OF THE HOSPITAL OR MEDICAL SCHOOL STAFF APPEARING ELSEWHERE THAN IN THE BULLETIN.
Vol. XVI.-No. 16 8.
BALTIMORE, MARCH, 1905.
