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vi CONTENTS
613 Appendixes
A United States Customary and Metric Units of Measure / 613

B Principles of Plane Geometry / 615
C Formulas for Areas (A) of Plane Figures / 617
D Formulas for Volumes (V ) of Solid Figures / 618
E Trigonometry / 619
621 Answers to Odd-Numbered Applications
655 Index
Copyright 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
PREFACE
“I can’t think of any job in my sheet metal fabrication company where math is not
important. If you work in a manufacturing facility, you use math every day; you
need to compute angles and understand what happens to a piece of metal when it’s
bent to a certain angle.”1
Traci Tapani, Wyoming Machine
Mathematics for Machine Technology is written to overcome the often mechanical “plug in”
approach found in many trade-related mathematics textbooks. An understanding of mathe-
matical concepts is stressed in all topics ranging from general arithmetic processes to oblique
trigonometry, compound angles, and numerical control.
Both content and method are those that have been used by the authors in teaching ap-
plied machine technology mathematics classes for apprentices in machine, tool-and-die, and
tool design occupations. Each unit is developed as a learning experience based on preceding
units—making prerequisites unnecessary.
Presentation of basic concepts is accompanied by realistic industry-related examples and
actual industrial applications. The applications progress from the simple to those with solu-
tions that are relatively complex. Many problems require the student to work with illustra-
tions such as are found in machine technology handbooks and engineering drawings.
Great care has been taken in presenting explanations clearly and in providing easy-to-
follow procedural steps in solving exercise and problem examples. The book contains a suffi-
cient number of exercises and problems to permit the instructor to selectively plan assignments.
An analytical approach to problem solving is emphasized in the geometry, trigonometry,
compound angle, and numerical control sections. This approach is necessary in actual practice
in translating engineering drawing dimensions to machine working dimensions. Integration of
algebraic and geometric principles with trigonometry by careful sequence and treatment of ma-
terial also helps the student in solving industrial applications. The Instructor’s Guide provides
answers and solutions for all problems.
A majority of instructors state that their students are required to perform basic arithme-
tic operations on fractions and decimals prior to calculator usage. Thereafter, the students
use the calculator almost exclusively in problem-solving computations. The structuring of
calculator instructions and examples in this text reflects the instructors’ preferences. Calcu-
lator instructions and examples have been updated and greatly expanded in this edition. The
scientific calculator is introduced in the Preface. Extensive calculator instruction and exam-
ples are given directly following the units on fractions and mixed numbers and the units on
decimals. Further calculator instruction and examples are given throughout the text wher-
ever calculator applications are appropriate to the material presented. A Calculator Applica-
tions Index is provided at the end of the Preface. It provides a convenient reference for all the
material in the text for which calculator usage is presented. Often there are differences in the
1
Source: Thomas Friedman, “If You’ve Got the Skills, She’s Got the Job” New York Times, November 17, 2012, accessed
November 18, 2012, http://www.nytimes.com/2012/11/18/opinion/sunday/Friedman-You-Got-the-Skills.html
vii
viii Preface
methods of computation among various makes and models of calculators. Where there are
two basic ways of performing calculations, both ways are shown.
Changes from the previous edition have been made to improve the presentation of topics
and to update material.
A survey of instructors using the sixth edition was conducted. Based on their comments
and suggestions, changes were made. The result is an updated and improved seventh edition
that includes the following revisions:
Three major changes were made in this edition.
The United States is the only major industrial country in the world that does not use
the metric system. We need to acquaint our students with the prevailing system in the
rest of the world. This is particularly true if we want to market our machined products
outside the United States. To meet this challenge, a unit was added on metric calipers
and height gages and a unit was added on metric micrometers.
Electronic digital instruments are replacing hand-read/analog instruments. Two units
were added to acquaint student with using electronic digital instruments. One unit was
added on digital calipers and height gages and a unit was added on digital micrometers.
Students have a tendency to forget a concept if it is not used frequently. To help students
retain an idea most sets of applications begin with six “Tooling Up” exercises that use
concepts from earlier units. These “Tooling Up” exercises are in each unit except for
Unit 1 and the nine Achievement Review units at the end of each section.
About the Authors

John C. Peterson is a retired professor of mathematics at Chattanooga State Technical
Community College, Chattanooga, Tennessee. Before he began teaching, he worked on sev-
eral assembly lines in industry. He has taught at the middle school, high school, two-year
college, and university levels. Dr. Peterson is the author or coauthor of four other Cengage
Learning books: Introductory Technical Mathematics (with Robert D. Smith), Technical
Mathematics, Technical Mathematics with Calculus, and Math for the Automotive Trade
(with William J. deKryger). In addition, he has had over 80 papers published in various jour-
nals, has given over 200 presentations, and has served as a vice president of the American
Mathematical Association of Two-Year Colleges.
Robert D. Smith was Associate Professor Emeritus of Industrial Technology at Central
Connecticut State University, New Britain, Connecticut. Mr. Smith had experience in the
manufacturing industry as tool designer, quality control engineer, and chief manufacturing
engineer. He also taught applied mathematics, physics, and industrial materials and pro-
cesses on the secondary technical school level and machine technology applied mathematics
for apprentices in machine, tool-and-die, and tool design occupations. He was the author of
Technical Mathematics 4e, also published by Cengage Learning.
Acknowledgments
The publisher wishes to acknowledge the following instructors for their detailed reviews of
this text:
Dan Taylor
Orange Coast College
Costa Mesa, California
Edwin Thomas
Central Carolina Community College
Sanford, North Carolina
In addition, the publisher and author acknowledge Linda Willey for her tireless commitment
to the technical review of the text, examples, applications, answers, and solutions.
Preface ix
Introduction to the Scientific Calculator

A scientific calculator is to be used in conjunction with the material presented in this text-
book. Complex mathematical calculations can be made quickly, accurately, and easily with a
scientific calculator.
Although most functions are performed in the same way, there are some variations among
different makes and models of scientific calculators. In this book, generally, where there are
two basic ways of performing a function, or sequencing, both ways are shown. However, not
all of the differences among the various makes and models of calculators can be shown. It is
very important that you become familiar with the operation of your scientific calculator. An
owner’s manual or user’s guide is included with the purchase of a scientific calculator; it ex-
plains the essential features and keys of the specific calculator, as well as providing informa-
tion on the proper use. It is important that the owner’s manual or user’s guide be studied and
referred to whenever there is a question regarding calculator usage. Also, information can be
obtained from the manufacturer’s Internet website, which is often listed in the user’s guide.
For use in this textbook, examples are shown and problems are solved with calculators
having EOSTM (Equation Operating System), V.P.A.M. (Visually Perfect Algebraic Meth-
od), or D.A.L. (Direct Algebraic Logic). Key operations are performed following the math-
ematical expressions exactly as they are written.
Most scientific calculator keys can perform more than one function. Depending on the
calculator, generally the 2nd key or SHIFT key enable you to use alternate functions. The
alternate functions are marked above the key. Alternate functions are shown and explained
in the book where their applications are appropriate to specific content.
Decisions Regarding Calculator Use

The exercises and problems presented throughout the text are well suited for solutions us-
ing a calculator. However, it is felt that decisions regarding calculator usage should be left
to the discretion of the course classroom or shop instructor. The instructor best knows the
unique learning environment and objectives to be achieved by the students in a course.
Judgments should be made by the instructor as to the degree of emphasis to be placed on
calculator applications, when and where a calculator is to be used, and the selection of
specific problems for solution by calculator. Therefore, exercises and problems in this text
are not specifically identified as calculator applications.
Calculator instruction and examples of the basic operations of addition, subtraction,
multiplication, and division of fractions are presented in Unit 7. They are presented for deci-
mals in Unit 16. Further calculator instruction and examples of mathematics operations and
functions are given throughout the text wherever calculator applications are appropriate to
the material presented.
The index that follows lists the mathematics operations or functions and the pages on
which the calculator instruction is first given for the operations or functions. It provides a
convenient reference for all material in the text for which calculator usage is presented. The
operations and functions are listed in the order in which material is presented in the text.
x Preface
Used with permission of Texas Instruments, http://education.ti.com
Casio FX-115W, S-V.P.A.M. Texas Instruments Tl-30XIIB Sharp EL-506W, advanced D.A.L.
Calculator Application Index

Operations/Functions Page
Addition, subtraction, multiplication, and divisions of fractions
and mixed numbers 39–41
Combined arithmetic operations of fractions and mixed numbers 41–43
Addition, subtraction, multiplication, and division of decimals 89–90
Powers of positive numbers (square key, universal power key) 90
Roots of positive numbers (square root key, root key) 90–91
Combined operations of decimals 91–93
Pi key 212
Negative numbers (negative key) 220
Powers of negative numbers and negative exponents 223–224
Roots of negative numbers 224
Fractional exponents (positive and negative) 224–225
Combined operations of signed numbers 225
Scientific notation (scientific notation key, exponent entry key) 244–245
Decimal-degrees and degrees, minutes, seconds conversion 315–316
Arithmetic operations with degrees, minutes, seconds 316–319
Sine, cosine, tangent functions 456
Cosecant, secant, cotangent functions 457
Angles of given functions (inverse functions) 457–458
Functions of angles greater than 90° 501–503
Common Fractions
1
SECTION
and Decimal
Fractions
Introduction to Common Fractions

UNIT 1 and Mixed Numbers
Objectives After studying this unit you should be able to
●● Express fractions in lowest terms.
●● Express fractions as equivalent fractions.
●● Express mixed numbers as improper fractions.
●● Express improper fractions as mixed numbers.
Most measurements and calculations made by a machinist are not limited to whole numbers.
Dimensions are sometimes given as fractions and certain measuring tools are graduated in fractional
units. The machinist must be able to make calculations using fractions and to measure fractional values.
Fractional Parts
A fraction is a value that shows the number of equal parts taken of a whole quantity or unit.
The symbols used to indicate a fraction are the bar (—) and the slash ( / ).
Line segment AB as shown in Figure 1-1 is divided into 4 equal parts.
1 part 1 part 1
1 part 5 5 5 of the length of the line segment.
total parts 4 parts 4
2 parts 2 parts 2
2 parts 5 5 5 of the length of the line segment.
3 parts 3 parts 3
3 parts 5 5 5 of the length of the line segment.
4 parts 4 parts 4
4 parts 5 5 5 5 1, or unity (four parts make up the whole).
1
2 Section 1 Common Fractions and Decimal Fractions
4
4
= 1 OR UNITY (4 OF 4 PARTS)
3
4
(3 OF 4 PARTS)
2
4
(2 OF 4 PARTS)
1
4
(1 OF 4 PARTS)
A B
Figure 1-1
Each of the 4 equal parts of the line segment AB in Figure 1-2 is divided into eight equal
parts. There is a total of 4 3 8, or 32, parts.
1 32
1 part = of the total length. 32 = 1 OR UNITY (32 OF 32 PARTS)
32
23
32
(23 OF 32 PARTS)
7 12
7 parts = 32 of the total length. (12 OF 32 PARTS)
32
7
32
12 parts =
12
of the total length. (7 OF 32 PARTS)
32
1
32
23
(1 OF 32
23 parts = 32 of the total length. PARTS)
A B
32
32 parts = 32 of the total length. 1 1 1
2 OF 32 = 64
8 1
1 1 1 1 32
OR 4
2 of 1 part = 2 3 32 = 64 of the total length.
Figure 1-2
8 1
Note: 8 parts 5
32
of the total length and also of the total length.
4
8 1
Therefore, 5 .
32 4
Definitions of Fractions
A fraction is a value that shows the number of equal parts taken of a whole quantity or unit.
3 5 99 17
Some examples of fractions are , , , and . These same fractions written with a
4 8 100 12
slash are 3@4, 5@8, 99@100, and 17@12.
The denominator of a fraction is the number that shows how many equal parts are in the
whole quantity. The denominator is written below the bar.
The numerator of a fraction is the number that shows how many equal parts of the whole
are taken. The numerator is written above the bar.
The numerator and denominator are called the terms of the fraction.
3 d numerator
4 d denominator
UNIT 1 Introduction to Common Fractions and Mixed Numbers 3
5 3 13
A common fraction consists of two whole numbers. , , and are all examples of com-
5 7 4
mon fractions.
A proper fraction has a numerator that is smaller than its denominator. Examples of proper
3 5 91 247
fractions are , , , and .
4 11 92 961
An improper fraction is a fraction in which the numerator is larger than or equal to the
3 5 11 6 17
denominator, as in , , , , .
2 4 8 6 17 7 1
A mixed number is a number composed of a whole number and a fraction, as in 3 , 7 .
8 2
7 7 1 1
Note: 3 means 3 1 It is read as three and seven-eighths. 7 means 7 1 . It is
8 8 2 2
read as seven and one-half.
Writing fractions with a slash can cause people to misread a number. For example, some
11 1
people might think that 11@4 means 11@4 5 rather than 1 . For this reason, the slash nota-
4 4
tion for fractions will not be used in this book.
A complex fraction is a fraction in which one or both of the terms are fractions or mixed
3 3 7 1
4 32 8 4 16 4 4
numbers, as in , 15 , , 2 , 5 .
6 4 3 25 78
Expressing Fractions as Equivalent Fractions

The numerator and denominator of a fraction can be multiplied or divided by the same num-
1 134 4
ber without changing the value. For example, 5 5 . Both the numerator and de-
2 234 8
1 4
nominator are multiplied by 4. Because and have the same value, they are equivalent.
2 8
8 844 2 8 2
Also, 5 5 . Both numerator and denominator are divided by 4. Since and
12 12 4 4 3 12 3
have the same value, they are equivalent. Equivalent fractions are necessary for comparing
two fractions or for addition and subtraction of fractions.
A fraction is in its lowest terms when the numerator and denominator do not contain a
5 7 3 11 15 9
common factor, as in , , , , , . Factors are the numbers used in multiplying. For
9 8 4 12 32 11
example, 2 and 5 are each factors of 10; 2 3 5 5 10. Expressing a fraction in lowest terms is
often called reducing a fraction to lowest terms.
c Procedure To reduce a fraction to lowest terms

●● Divide both numerator and denominator by the greatest common factor (GCF).
12
Example Reduce to lowest terms.
42
12 4 2 6
Both terms can be divided by 2. 5
42 4 2 21
Note: The fraction is reduced, but not to lowest terms.

6
Further reduce .
21 643 2
Both terms can be divided by 3. 5 Ans
21 4 3 7
2 12
Note: The value
7
may be obtained in one step if each term of
42
is divided by
2 3 3, or 6. Six is the greatest common factor (GCF).
12 4 6 2
5 Ans
42 4 6 7
c Procedure To express a fraction as an equivalent fraction with an indicated

denominator that is larger than the denominator of the fraction
●● Divide the indicated denominator by the denominator of the fraction.
●● Multiply both the numerator and denominator of the fraction by the value obtained.
3
Example Express as an equivalent fraction with 12 as the denominator.
4
Divide 12 by 4. 12 4 4 5 3
333 9
Multiply both 3 and 4 by 3. 5 Ans
4 3 3 12
Expressing Mixed Numbers as Improper Fractions
c Procedure To express a mixed number as an improper fraction

●● Multiply the whole number by the denominator.
●● Add the numerator to obtain the numerator of the improper fraction.
●● The denominator is the same as that of the original fraction.
1
Example 1 Express 4 as an improper fraction.
2
Multiply the whole number by the denominator.
Add the numerator to obtain the numerator for the improper fraction.
The denominator is the same as that of the original fraction.
43211 9
5 Ans
2 2
3
Example 2 Express 12 as an improper fraction.
16
12 3 16 1 3 195
5 Ans
16 16
Expressing Improper Fractions as Mixed Numbers
c Procedure To express an improper fraction as a mixed number

●● Divide the numerator by the denominator.
●● Express the remainder as a fraction.
Examples Express the following improper fractions as mixed numbers.

11 3
5 11 4 4 5 2 Ans
4 4
43 1
5 43 4 3 5 14 Ans
3 3
931 3
5 931 4 8 5 116 Ans
8 8
Application
Fractional Parts
1. Write the fractional part that each length, A through F, represents of the total shown on
the scale in Figure 1-3.
A5
B5
A C5
B
C D5
D
E E5
F
F5
Figure 1-3
2. A welded support base is cut into four pieces as shown in Figure 1-4. What fractional part
of the total length does each of the four pieces represent? All dimensions are in inches.
Piece 1:
4
3 Piece 2:
2
1
Piece 3:
4
Piece 4:
12
16 64
Figure 1-4
3. The circle in Figure 1-5 is divided into equal parts. Write the fractional part represented
by each of the following:
a. 1 part 1
g. of 1 part
b. 3 parts 3
3
c. 7 parts h. of 1 part
4
d. 5 parts 1
i. of 1 part
e. 16 parts 10
1 1 Figure 1-5
f. of 1 part j. of 1 part
2 16

4. Reduce to halves.
4 25
a. e.
8 10
9 18
b. f.
18 12
100 126
c. g.
200 36
121 225
d. h.
242 50
5. Reduce to lowest terms.

6 14
a. f.
8 6
12 24
b. g.
4 8
6 65
c. h.
10 15
30 25
d. i.
5 150
11 14
e. j.
44 105
6. Express as thirty-seconds.
1 21
a. e.
4 16
3 19
b. f.
4 2
11 197
c. g.
8 16
7 21
d. h.
16 8
7. Express as equivalent fractions as indicated.
3 ? 14 ?
a. 5 f. 5
4 8 3 18
7 ? 7 ?
b. 5 g. 5
12 36 16 128
6 ? 13 ?
c. 5 h. 5
15 60 8 48
17 ? 21 ?
d. 5 i. 5
14 42 16 160
20 ?
e. 5
9 45
Mixed Numbers and Improper Fractions

8. Express the following mixed numbers as improper fractions.
2 1
a. 2 g. 10
3 3
7 4
b. 1 h. 9
8 5
2 1
c. 5 i. 100
5 2
3 63
d. 3 j. 4
8 64
9 3
e. 5 k. 49
32 8
3 13
f. 8 l. 408
7 16
9. Express the following improper fractions as mixed numbers.

5 127
a. g.
3 32
21 57
b. h.
2 15
9 150
c. i.
8 9
87 235
d. j.
4 16
72 514
e. k.
9 4
127 401
f. l.
124 64
10. Express the following mixed numbers as improper fractions. Then express the
improper fractions as the equivalent fractions indicated.
1 ? 2 ?
a. 2 5 d. 12 5
2 8 3 18
3 ? 7 ?
b. 3 5 e. 9 5
8 16 8 64
4 ? 1 ?
c. 7 5 f. 15 5
5 15 2 128
11. Sketch and redimension the plate shown in Figure 1-6. Reduce all proper fractions to
lowest terms. Reduce all improper fractions to lowest terms and express as mixed
numbers. All dimensions are in inches.
9
4
40
32
37
32 DIA
56 44
64 64
156
128
65
32
11
8
18
32
4 70
8 64 24
22 64
DIA 3 HOLES
16
104
32
Figure 1-6
Addition of Common Fractions

UNIT 2 and Mixed Numbers
Objectives After studying this unit you should be able to
●● Determine lowest common denominators.
●● Express fractions as equivalent fractions having lowest common denominators.
●● Add fractions and mixed numbers.
A machinist must be able to add fractions and mixed numbers in order to determine the length of stock
required for a job, the distances between various parts of a machined piece, and the depth of holes and
cutouts in a workpiece.
Lowest Common Denominators

Fractions cannot be added unless they have a common denominator. Common denominator
5 7 15
means that the denominators of each of the fractions are the same, as in , , .
8 8 8
3 1 7
In order to add fractions that do not have common denominators, such as 1 1 , it
8 4 16
is necessary to change to equivalent fractions with common denominators. Multiplying the
denominators does give a common denominator, but it could be a very large number. We
often find it easier to determine the lowest common denominator.
The lowest common denominator is the smallest denominator that is evenly divisible by
each of the denominators of the fractions being added. Stated in another way, the lowest
common denominator is the smallest denominator into which each denominator can be divided
without leaving a remainder.
c Procedure To find the lowest common denominator

●● Determine the smallest number into which all denominators can be divided without
leaving a remainder.
●● Use this number as a common denominator.
3 1 7
Example 1 Find the lowest common denominator of , , and .
8 4 16
The smallest number into which 8, 4, and 16 can be divided without leaving a remainder is 16.
Write 16 as the lowest common denominator.
3 1 7 5
Example 2 Find the lowest common denominator of , , , and .
4 3 8 12
The smallest number into which 4, 3, 8, and 12 can be divided is 24.
The lowest common denominator is 24.
Note: In this example, denominators such as 48, 72, and 96 are common denomi-
nators because 4, 3, 8, and 12 divide evenly into these numbers, but they are not the
lowest common denominators.
Although any common denominator can be used when adding fractions, it is generally
easier and faster to use the lowest common denominator.
UNIT 2 Addition of Common Fractions and Mixed Numbers 9

with the Lowest Common Denominator
c Procedure To change fractions into equivalent fractions having the lowest

common denominator
●● Divide the lowest common denominator by each denominator.
●● Multiply both the numerator and denominator of each fraction by the value obtained.
2 7 1
Example 1 Express , , and as equivalent fractions having a lowest common
3 15 2
denominator.
2 3 10 20
The lowest common denominator is 30. 30 4 3 5 10; 5 Ans
3 3 10 30
732 14
Divide 30 by each denominator. 30 4 15 5 2; 5 Ans
15 3 2 30
Multiply each term of the fraction
1 3 15 15
by the value obtained. 30 4 2 5 15; 5 Ans
2 3 15 30
5 15 3 9
Example 2 Change , , , and to equivalent fractions having a lowest
8 32 4 16
common denominator.
The lowest common denominator is 32.
5 3 4 20 3 3 8 24
32 4 8 5 4; 5 Ans 32 4 4 5 8; 5 Ans
8 3 4 32 4 3 8 32
15 3 1 15 932 18
32 4 32 5 1; 5 Ans 32 4 16 5 2; 5 Ans
32 3 1 32 16 3 2 32
Adding Fractions
c Procedure To add fractions

●● Express the fractions as equivalent fractions having the lowest common denominator.
●● Add the numerators and write their sum over the lowest common denominator.
●● Express an improper fraction as a mixed number when necessary and reduce the frac-
tional part to lowest terms.
1 3 7 5
Example 1 Add 1 1 1 .
2 5 10 6
Express the fractions as equivalent fractions
1 15
with 30 as the denominator. 5
2 30
3 18
5
5 30
7 21
5
10 30
5 25
1 5
6 30
15 1 18 1 21 1 25
Add the numerators and write their sum over 5
the lowest common denominator, 30. 30
79 19
Express the fraction as a mixed number. 5 5 2 Ans
30 30
Example 2 Determine the total length of the shaft shown in Figure 2-1. All
dimensions are in inches.
3 15 29 7 1
32 16 32 8 4
Figure 2-1
Express the fractions as equivalent

3 3
fractions with 32 as the denominator. 5
32 32
15 30
5
16 32
29 29
5
32 32
7 28
5
8 32
1 8
1 5
4 32
3 1 30 1 29 1 28 1 8
Add the numerators and write their sum over 5
the lowest common denominator, 32. 32
98
Express as a mixed number and reduce to
32 98 2 1
lowest terms. 5 53 53
32 32 16
10
Total length 5 3 Ans
16
Adding Fractions, Mixed Numbers, and Whole Numbers

c Procedure To add fractions, mixed numbers, and whole numbers
●● Add the whole numbers.
●● Add the fractions.
●● Combine whole number and fraction.
1 1 5 19
Example 1 Add 1 7 1 3 1 12 .
3 2 12 24
Express the fractional parts as equivalent
1 8
fractions with 24 as the denominator. 5
3 24
757
1 12
3 53
2 24
5 10
5
12 24
19 19
12 5 12
24 24
Add the whole numbers. 5 7 1 3 1 2 5 12
8 1 12 1 10 1 19 49
Add the fractions. 5 5
24 24
49
Combine the whole number and the fractions. 5 12
24
49 1
Express the answer in lowest terms. 5 12 5 14 Ans
24 24
1
Example 2 Find the distance between the two -inch diameter holes in the plate shown in Figure 2-2.
2
All dimensions are in inches.
151
13 26
5
32 64
1 1
47 47 2
DIA 2
DIA
1 51
64 64
3 12
1 5
16 64
85
2
64 1 13
1 47 3
32 64 16
Figure 2-2
210
Distance 5 3 Ans
64
Application
Tooling Up
15
1. Reduce the fraction to halves.
30
12
2. Reduce to lowest terms.
30
11 ?
3. Express and as equivalent fractions.
8 32
3
4. Express the mixed number 7 as an improper fraction.
5
97
5. Express as a mixed number.
12
3 ?
6. Express the mixed number 9 as an improper fraction and then express that improper fraction in the form .
5 15
Lowest Common Denominators

Determine the lowest common denominators of the following sets of fractions.
2 1 5 5 7 3 19
7. , , 9. , , ,
3 6 12 6 12 16 24
3 9 5 4 3 7 1
8. , , 10. , , ,
5 10 6 5 4 10 2
Equivalent Fractions with Lowest Common Denominators

Express these fractions as equivalent fractions having the lowest common denominator.
1 3 5 9 1 3 1
11. , , 13. , , ,
2 4 12 10 4 5 5
7 3 1 3 7 17 3
12. , , 14. , , ,
16 8 2 16 32 64 4
Adding Fractions
15. Determine the dimensions A, B, C, D, E, and F of the profile gage in Figure 2-3. All
11
64
A5
1
2 5 B5
16
F
A C5
9
16 D5
21
64 E5
3 35 31 1 15 1 7
8 64 32 8 32 4 16 F5
B C D
E
Figure 2-3
16. Determine the overall length, width, and height of the casting in Figure 2-4. All
29
64
9
16
5
32
length 5
1
width 5
2
height 5
3
8 21
63 32
17 64 7
32 16
1
4
Figure 2-4
Adding Fractions, Mixed Numbers, and Whole Numbers

17. Determine dimensions A, B, C, D, E, F, and G of the plate in Figure 2-5. Reduce to
lowest terms where necessary. All dimensions are in inches.
G
E F A5
5 3 9 3
8
2 4 32
1 64 B5
19 C5
32
A D5
7
1
1 16
E5
1
1 4
D F5
4
G5
1 18
3 1
8
2 32 1 27
32
7
32
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8 A case of this kind is cited in the article “Pathologie des Méninges” in Nouv. Dict. de
Méd. et de Chirurg. pratiques, Paris, 1876, vol. xxii. p. 101.
9 Traité clinique et pratique des Maladies des Vieillards, par M. Durand-Fardel, Paris,
1854, p. 283.
The exciting causes comprise injuries to the head, both with and
without fracture; strong muscular effort, as in lifting, straining at stool
or in labor; powerful action of the heart in cases of hypertrophy. An
interesting case is reported10 by S. G. Webber of Boston, in which
the effusion was evidently caused by vomiting; a clot of blood
covered the greater part of the posterior two-thirds of the right
hemisphere. Sometimes meningeal hemorrhage may arise from the
bursting of an intracerebral apoplexy into the arachnoid cavity, as in
a remarkable case occurring in the practice of Morris Longstreth of
Philadelphia, of bilateral effusion.11 Outside the dura, corresponding
with the left middle cerebral lobe, was a considerable amount of
blood connected with a fracture of the skull, and on the right side a
large quantity of blood in the cavity of the arachnoid, originating in
the middle lobe, which was torn up. The patient had fallen in the
street; he was stupid, there was no paralysis, active delirium came
on, followed by coma and death in twenty-four hours. Here was
cerebral apoplexy bursting into the cavity of the arachnoid on the
right side, and causing the fall, which was the occasion of the
fracture and hemorrhage on the left side.
10 Boston Med. and Surg. Journal, Jan. 17, 1884.
11 Ibid., Dec. 28, 1882.
In young children, especially in the new-born, meningeal

hemorrhage may follow difficult and instrumental labor, either from
injury to the skull or from delay in the establishment of respiration, as
in breech presentation, though it sometimes occurs in cases in which
the labor has been normal. In a case of breech presentation under
my care in 1873 the child, a female weighing nine pounds, did not
cry or breathe for some minutes after birth, although delivery had not
been much delayed. Soon afterward it was noticed that it did not
move the right arm, although it moved the hand and the fingers. In
the course of twenty-four hours, during which time it cried much
more than usual, it became comatose, and remained so until its
death, three days after birth. The whole surface was livid, and the
child had two or three short convulsions. At the autopsy a clot about
the size of a grape was found in the pia mater on the upper surface
of the cerebellum, in the immediate vicinity of the pons Varolii. The
brain was so soft that the amount of injury received by the
cerebellum could not be exactly ascertained, but it was probable that
the clot extended into the fourth ventricle.
Thrombus of the sinuses of the dura mater, and less frequently of the
cerebral arteries, is the origin, in a considerable number of cases, of
meningeal hemorrhage in children, in consequence of pressure upon
the delicate vessels of the membranes caused by the obstructed
circulation. Bouchut12 reports an observation of hemorrhage
produced in this way.
12 E. Bouchut, Clinique de l'Hôpital des Enfants maladies, Paris, 1884, p. 263. See,
also, Steffen, op. cit., p. 352.
SYMPTOMS.—In some cases the attack is preceded by indications of

congestion, such as headache, vertigo, staggering, confusion of
ideas, noises in the ears, feeling of weight in the head, delirium,
stupor. At the time of the attack the patient frequently complains of
severe pain in the head, just as in cerebral hemorrhage, and then
falls to the ground with complete loss of consciousness. Sometimes
the symptoms come on gradually. Hemiplegia occurs in a notable
proportion of cases. Convulsions may occur at any time after the
attack. In Webber's case, already referred to, the first symptom was
sharp pain in the head and neck; this was followed by very severe
headache and pain on motion of the head. Intelligence gradually
diminished; on the sixth day there was almost no consciousness,
and the patient died in about eight days. She had occasional
spasms, in which both eyes were turned toward the left in extreme
conjugate deviation, and the left side of the face was distorted. The
spasms were followed by suspension of respiration for nearly a
minute, cyanosis, and paralysis of the left hand and leg. Both the
nature of the lesion and its seat were correctly diagnosticated during
the patient's lifetime.
As a rule, the condition of unconsciousness continues up to the time

of death, but in some cases there are intermissions during which the
patient responds to questions more or less promptly. Death takes
place at a period varying between a few hours and several days.
Durand-Fardel13 reports a case in which the patient lived a month
from the first attack, with preservation of the intellect and of motion.
An inmate of the Home for Aged Women in Boston, eighty-eight
years old, previously in good health, complained of severe pain in
the head one morning before rising. She took her breakfast in bed,
and immediately afterward vomited copiously. From that moment she
became insensible, and remained so until her death, seven days and
three hours afterward. During this time there was no stertor. No
decided paralysis could be discovered, but there was some rigidity of
the left arm. At the autopsy an effusion of blood was found in the
arachnoid cavity extending from below upward on each side to a
level with the top of the ear. There was a large amount of blood at
the base of the brain, and both lateral ventricles were distended with
bloody serum. The vessels were generally in an atheromatous
condition. There was no laceration of the brain. The source of the
hemorrhage could not be ascertained. In such a case the condition
of the patient in respect to power of movement often cannot be
ascertained with certainty, in consequence of the abolition of
consciousness. Complete muscular resolution is most common
when the effusion is bilateral, but when the hemorrhage is limited to
one side more or less paralysis of the opposite limbs may exist.
Should the blood make its way into the spinal canal, it might give rise
to special symptoms, but this is not probable in view of the large
amount of the cerebral effusion under the circumstances, which
would produce complete insensibility or speedily cause death by
pressure on the medulla.
13 Op. cit., p. 202.
The temperature of the body immediately after a copious cerebral or
meningeal hemorrhage falls below the normal point, and remains so
for several hours, after which it rises, its degree varying according to
circumstances. In fatal cases the elevation is extreme, and remains
so until death. If the patient recover, it gradually returns to the normal
standard.
Vomiting is a frequent symptom at the beginning of the attack, just as

in intracerebral hemorrhage, owing probably to compression of the
pneumogastric by the effusion at the base of the brain. In Webber's
case the vomiting was evidently the cause of the hemorrhage, and
not its consequence, since it had been a frequent symptom for
several days before the attack, and was probably due to the
presence of a calculus in the pelvis of the right kidney, which was
found at the autopsy, and there was no blood at the base of the
brain.
PATHOLOGICAL ANATOMY.—The chief points of interest in the morbid

anatomy relate to the seat and source of the effusion, the amount
and condition of the blood, the state of the vessels and that of the
brain, including the ventricles. In respect to the seat, the hemorrhage
may occupy the space between the cranial bones and the dura
mater; it may be found on the lower surface of the latter, in the
arachnoid cavity, or in the meshes of the pia mater, the so-called
subarachnoid space. Blood found upon the outer surface of the dura,
between that membrane and the bones, is almost always the result
of traumatic causes, such as blows or other injuries, with or without
fracture, or of caries of the skull. If below the dura, but between that
and the so-called parietal layer of the arachnoid, the lesion comes
under the title of pachymeningitis interna, already described as an
inflammatory disease of the dura with hemorrhagic effusion. The
arachnoid cavity and meshes of the pia are by far the most common
situations in which the blood is found in meningeal hemorrhage. The
origin of the effusion is either the rupture of a capillary aneurism of
one of the arterioles of the membrane or of one of the vessels
themselves in consequence of atheromatous or other degenerations
of its walls. On account of the minute size of the vessels it is seldom
possible to discover the exact point at which the rupture took place.
In rare instances the source of the hemorrhage is within the brain,
the blood being forced through the cerebral tissue, either into the
meshes of the pia or upon the surface of that membrane. The
amount of hemorrhage varies according to conditions which are
mostly unknown, but is probably dependent upon the size of the
ruptured vessel and the conditions under which the accident occurs,
such as muscular effort, cardiac action, etc. In some cases it is so
small as to give rise to no definite symptoms, as is evident from post-
mortem examinations of those who have died from other causes. In
these cases there may be either a single effusion or several. The
amount is largest when the arachnoid cavity is the seat of the
extravasation. The blood, which may be either liquid or more or less
coagulated, according to the time which has elapsed since the
hemorrhage, is usually found upon the convexity of the hemispheres,
most frequently on one side only, and oftenest on the left. But if the
rupture have taken place at the base, it often ascends on each side,
as in a case mentioned above. Where a large vessel has given way,
its contents may cover a great part of the surface of the brain. The
coagulum is found in a thin layer, which at the end of a few days is
covered with a transparent envelope, evidently composed of a
deposit or separation of fibrin. Should the patient survive long
enough, this membrane may become organized, receiving vessels
from the adjacent pia, and in turn become the seat of new
hemorrhages, exactly as in the hæmatoma of internal
pachymeningitis. In cases in which absorption of most of the fluid
part of the effusion takes place, the membrane remains more or less
dense and vascular, and usually contains a small quantity of
recently-effused blood within its meshes. Small cysts, containing
transparent or reddish-brown serum, are also occasionally observed
enclosed between the layers of the membrane. In very young
children, whose fontanels are not yet ossified, these cysts
sometimes attain to a large size, containing several pints of fluid,
which is more or less limpid from absorption of the coloring matter of
the blood, constituting the so-called dropsy of the arachnoid.14 The
convolutions of the brain are more or less flattened according to the
amount of the effusion, and the cortical substance is correspondingly
anæmic from pressure. The blood may make its way, if extravasated
in large quantities, into the ventricles, over the medulla, into the
spinal arachnoid cavity, or even into the central canal of the spinal
cord. The arteries of the brain, especially at the base, are frequently
in a state of atheromatous degeneration, and thrombi often occupy
the sinuses of the dura mater.
14 Charles West, M.D., Lectures on the Diseases of Childhood and Infancy, 6th ed.,
London, 1874, p. 62. These large cysts are much more frequently (perhaps solely)
found in cases of hemorrhagic pachymeningitis. (See Barthez and Sanné, op. cit., vol.
i. p. 157.)
DIAGNOSIS.—The distinction between meningeal hemorrhage and

cerebral apoplexy is always difficult, and in the majority of cases
impossible. Sudden pain in the head, vomiting, and lowering of the
bodily temperature (the thermometer should be placed in the
rectum), followed by loss of consciousness, are strongly suggestive
of hemorrhage within the cranium, either cerebral or meningeal. If
these symptoms are followed by coma and resolution without
obvious paralysis, the diagnosis would be almost impossible
between intra- and extra-cerebral extravasation. If the loss of
consciousness be not complete, so that the presence or absence of
paralysis can be ascertained, we can sometimes distinguish the
situation of the hemorrhage. Right-sided hemiplegia, with paralysis
of the face or tongue, or with aphasia, is most probably owing to
hemorrhage or embolism somewhere in the left motor tract, and
hence within the brain. If the absence of paralysis can be certainly
ascertained, the probabilities are in favor of meningeal apoplexy.
Convulsions affecting the face or limbs of one side would point to
irritation of the cortical centres of those parts, and so far to
extravasation on the surface of the brain (on the opposite side), as in
Webber's case. Where the amount of hemorrhage is small it
furnishes no diagnostic indications. In the case of new-born children
the presumption is in favor of meningeal effusion.
PROGNOSIS.—If the effusion be considerable in amount, as indicated

by prolonged coma with resolution, the issue is almost inevitably
fatal, though life is occasionally prolonged for a surprising length of
time. Slight hemorrhages are doubtless recovered from, but there
are no means for their certain diagnosis.
TREATMENT.—The treatment, which is essentially the same as that for

cerebral congestion, has for its object the arrest of the hemorrhage,
and, if that can be effected, the absorption of the effused blood. In
view of the former, the patient's head should be elevated and kept
cool by the application of ice. Unless the bowels have previously
been freely moved, saline laxatives, followed by enemata if
necessary, must be given. The state of the bladder must be carefully
attended to. Liquid nourishment alone, in moderate quantities at
regular intervals, is permissible, with stimulants if there be signs of
exhaustion. For the absorption of the effusion mild counter-irritation
to the scalp and the administration of the iodide of potassium may be
employed.
Congestion of the Cerebral Pia Mater.
The pia mater consists of two layers, separated by a loose

connective tissue. The outer layer, being that which was formerly
called the visceral layer of the arachnoid, is stretched smoothly over
the convolutions of the brain without dipping into the sulci; the inner
layer is closely connected with the surface of the brain, whose
inequalities it follows. The two layers are more firmly united together
over the convolutions than between them; in the latter situation the
connection is loose, and the space which separates the surfaces is
called the meshes of the pia. The membrane extends into the
ventricles, investing the ependyma and the choroid plexuses, and
over the medulla oblongata and spinal cord. In the normal condition
it is loosely attached to the brain, from which it can be stripped off
without loss of substance. The meshes of the pia, together with the
ventricles, constitute a series of cavities connected with each other,
containing a variable amount of cerebro-spinal fluid, and they
communicate with the lymph-spaces surrounding the blood-vessels.
Pressure within the cranial cavity, from congestion of the vessels or
from the products of inflammation, is thus relieved in a measure by
displacement of the cerebro-spinal fluid, which is driven out through
the perivascular lymph-spaces.
Congestion or hyperæmia of the pia mater probably never occurs

independently of that of the external surface of the brain, on account
of the intimate vascular connection of the two. In the adult it can only
exist to a limited extent, on account of the unyielding nature of the
cranial walls and of the limited compensatory action of the cerebro-
spinal fluid. In young children the incomplete ossification of the skull
and the delicate structure of the vessels are more favorable to
congestion.
ETIOLOGY.—The causes of hyperæmia of the pia mater are in the

main the same as those of congestion of the dura.
SYMPTOMS.—Since congestion of the pia always coexists with that of

the corresponding part of the external portion of the brain, it is
impossible to separate the symptoms belonging to each. They are
therefore usually included under the head of Cerebral Congestion, to
which article the reader is referred.
PATHOLOGICAL ANATOMY.—Arterial hyperæmia of the pia is seldom

discovered after death, the elasticity of the vessels causing
transudation of the fluid part of the blood through their walls. Venous
congestion of the pia is more frequently noticed, usually in
connection with that of the dura, the sinuses with their accompanying
veins being distended with blood, and in cases of long standing often
containing thrombi. Simple hyperæmia of the pia being rarely or
never fatal of itself, these appearances are usually accompanied by
those of inflammation of the membrane or of the cortical layer of the
brain (effusion of lymph or pus), or by hemorrhage.
TREATMENT.—In a case of suspected congestion of the pia the

treatment would be the same as that of cerebral congestion.
Inflammation of the Cerebral Pia Mater.
SYNONYMS.—Meningitis, Leptomeningitis, Acute non-tubercular

hydrocephalus.
Meningitis (by which is generally understood inflammation of the pia)

appears under an acute, a chronic, and an epidemic form. The latter,
being a zymotic disease, is described in a separate article, to which
the reader is referred.
ETIOLOGY.—Meningitis occurs both as a primitive disease and as

secondary to other affections. The former is rare, the latter is more
frequent. The causes of idiopathic meningitis are for the most part
unknown. Exposure to the sun's rays and excessive indulgence in
alcoholic liquors are thought to excite it in some instances. It has
been known to follow blows and falls on the head which have
produced no injury to the skull. It is rather more commonly observed
in early manhood than at other periods of life. Secondary meningitis
may follow injury or disease of the cranial bones or of the dura, and
of the brain. A frequent cause is extension of disease of the ear to
the membranes and substance of the brain. The reader is referred to
the article on MEDICAL OTOLOGY for information concerning the
symptoms of that formidable complication. Certain diseases are
known to be occasionally complicated with meningitis—acute
articular rheumatism; erysipelas of the scalp and of the face; Bright's
disease, especially the chronic interstitial form; peritonitis; ulcerative
endocarditis; pyæmia; the eruptive fevers; the puerperal state; and
syphilis. Meningitis following or complicating acute rheumatism is
generally supposed to be not uncommon, but the number of cases in
which the existence of inflammation of the meninges has been
proved by autopsy is small. Fuller,15 along with three cases in which
dissection showed suppurative inflammation of the pia, cites several
others in which no cerebral disease was found after death, although
the symptoms gave every indication of it. True meningitis is rare in
chronic Bright's disease, the symptoms resembling it being caused,
in the majority of cases, by uræmia. Meningitis complicating
pneumonia is also rare, although cerebral symptoms are common
enough in that disease, especially in young children with
inflammation of the upper lobes. C. Neuwerk16 reports seventeen
cases of purulent meningitis complicating acute pneumonia. It was
more frequent in men, especially in alcoholic subjects, than in
women. The meningitis was generally total. The lungs were in a
state of gray or yellow hepatization.
15 H. W. Fuller, M.D., On Rheumatism, Rheumatic Gout, and Sciatica, 3d ed.,
Philada., 1864, p. 271. See also E. Leudet, Clinique médicale de l'Hôtel Dieu de
Rouen, Paris, 1874, p. 133.
16 Deutsches Archiv für klin. Med., xxix., 1881, p. 1; and Schmidt's Jahrbücher, Band
cxcviii., 1883, Nov. 5.
SYMPTOMS.—The symptoms of acute leptomeningitis vary much in

the course of the disease. This is readily explained by the complex
character of the functions of the parts involved in the inflammation. It
may be assumed that the cortical layer of the brain is implicated in
every case unless of the most transient and limited kind; the
substance of the brain, cerebellum, and medulla are subjected to
pressure from the afflux of blood, from the effused lymph and pus,
and from the accumulation of serum in the ventricles; the cranial
nerves are exposed to pressure from the deposit of lymph, which
may give rise to irritation or to suspension of function or both; parts
at a distance from the seat of lesion may be functionally disordered
by reflex action through communicating filaments. Finally, the
general system suffers from the effects of the high fever upon the
blood and the nutrition.
It is customary to speak of a stage of excitement followed by one of

depression as characteristic of the course of the disease; but
although active symptoms generally prevail in the early period, to be
succeeded later by coma and paralysis, this disposition is by no
means uniform. Sometimes sopor and paralysis constitute almost
the only symptoms throughout the disease—this is especially noticed
in infants—or active delirium and convulsions may persist until the
fatal termination. More frequently the two conditions alternate
several times with each other. A prodromic period of short duration, a
few hours or a day or two, is sometimes observed in primitive
meningitis, the patients complaining of headache, vertigo, vomiting,
restlessness, or lassitude. Infants are irritable or drowsy, with heat of
the head, quick pulse, and occasional vomiting. In secondary
meningitis this period is usually masked by the symptoms of the
primitive disease. In the majority of cases the beginning of acute
meningitis is abrupt. Rigor is sometimes the first symptom observed,
and in children is usually represented by a convulsion. More
commonly, however, the disease is ushered in by severe headache,
which is often referred to the forehead. The head is hot, the face is
flushed, the eyes are brilliant, the pupils are contracted, the pulse is
quick and hard, the temperature high (104° F. or upward). The
patient is wakeful, restless, and irritable, sensitive to light and to
sound. The skin is hyperæsthetic, especially that of the legs. There
may be wandering or even active delirium. Vomiting is not
unfrequent. There is thirst, but no desire for food. The urine is scanty
and high-colored, the bowels constipated. These symptoms
gradually increase in intensity, especially the pain in the head and
the delirium, and in many cases they are followed by convulsions, at
first in the form of twitchings of the facial muscles or of the limbs,
grinding the teeth, etc., which give place to tonic contractions of the
limbs or of the trunk, often confined at first to one or both members
of the same side, but afterward becoming general; the flexors of the
forearms and of the legs are most usually affected. The upper dorsal
muscles may become contracted, so that the head is drawn
backward, and more rarely trismus occurs.
A diminution in the rapidity of the pulse, which may fall to the normal
rate, or even below that, notwithstanding the persistence of the high
temperature, indicates the beginning of the stage of depression. This
change is sometimes sudden, though more often gradual in its
approach. The activity of the delirium subsides, giving place to a
somnolence which may seem to the inexperienced observer a
favorable indication, but which soon deepens into coma. The face
becomes pale, the features are sunken. Only an occasional grimace
or a movement of the hand to the head shows that the patient is to
some extent conscious of suffering. This condition may alternate with
the previous one from time to time, the comatose state being
interrupted by noisy delirium and tonic or clonic convulsions, or even
a partial return of consciousness, giving rise to fallacious hopes on
the part of the friends, and sometimes deceiving the physician
himself into a belief that a favorable issue is at hand. Before long,
however, the symptoms of brain-compression become permanent.
The rigidity of the limbs gives place to complete resolution. The
patient lies absolutely unconscious, with dilated pupils. The pulse
becomes again rapid in consequence of compression of the medulla,
and thread-like and irregular; for the same reason the respirations
increase to 40, 50, or 60 in the minute. The sphincters are relaxed,
and the patient dies without any recurrence of the active symptoms.
In rare cases recovery takes place, although almost never after the
symptoms of compression have continued without interruption for
any considerable length of time. Moreover, it is seldom that recovery
takes place in the adult without leaving some traces of permanent
damage, such as general debility, paralysis of one or more limbs,
deafness, mental weakness, epilepsy, etc. Many cases of general
paralysis of the insane and other forms of so-called mental disease
are the result of meningitis.
DURATION.—In the adult usually the disease lasts about a week or ten
days; exceptionally, it may last two or three weeks.
COURSE.—In young children the course of meningitis differs

somewhat from that which is observed in adults, though the
symptoms are essentially the same. It is more sudden in its onset
and shorter in its duration. The prodromal stage may be brief or
hardly noticeable; but in older children restlessness, sensitiveness to
light and sound, wakefulness, slight twitchings of the features or of
the limbs, a half-open condition of the eyelids during sleep,
occasional vomiting, etc., are more commonly noticed. Convulsions
are more common than in the adult, and sometimes constitute the
chief symptom. They may be confined to a single extremity, but in
general they shift from one limb to another. The muscles of the
eyeball are usually implicated, causing strabismus. Retraction of the
head is rarely absent, especially in young infants. These convulsions
are almost always tonic, but occasionally they alternate with clonic
ones. Distension and increased pulsation of the anterior fontanel is
always observed in infants a few months old affected with this
disease. When meningitis is secondary to some other disease, the
first symptom noticed in children is apt to be vomiting, with delirium.
According to Steffen, pneumonia is the disease most frequently
complicated with meningitis in children. As in tubercular meningitis,
the most prominent symptom may be mere sopor, sometimes with
intervals of intelligence. Simple meningitis in children is generally a
rapid disease, proving fatal in most cases within a week, and
sometimes even in a few hours. Exceptionally, it may last much
longer. A case occurring in a girl six years old, the duration of which
was fifty-five days, is reported by J. Bokai, Jr.;17 the diagnosis was
substantiated by autopsy. Another case, which recovered after seven
weeks, is mentioned by Henoch.18
17 Jahrb. f. Kinderkrankheiten, N. F., xviii. 1, p. 105; and Schmidt's Jahrb., 1882, No.
6, p. 269.
18 Eduard Henoch, Vorlesungen über Kinderkrankheiten, Berlin, 1881, p. 277.
PATHOLOGICAL ANATOMY.—The lesions, which are rarely general, may

occupy a greater or less extent of the membrane. They are usually
disposed symmetrically with regard to the two hemispheres, or
occupy corresponding regions of the base. The vessels are in the
beginning of the disease distended, the finest ramifications being
injected, giving a red color to the membrane, which varies in different
places from crimson to light pink. The perivascular spaces of the
larger vessels are filled with a grayish or yellowish fluid composed of
extravasated liquor sanguinis and white blood-corpuscles. The
meshes between the two layers of the pia are soon infiltrated with
pus, and the thickened membrane can be stripped off from the
surface of the brain, which is, however, adherent to it in places and is
torn in the process. Sometimes a thin layer of pus, which can be
scraped off with the knife, is found upon the surface of the pia. The
extent of the lesion varies much in different cases. It may be
confined to a limited region of the hemispheres, or it may spread to
the fissure of Sylvius, where two surfaces become adherent.
Sometimes the concrete pus and fibrin are deposited in thick masses
upon the base of the brain, often completely surrounding the cranial
nerves, and even the medulla. The inflammation may extend to the
lateral ventricles, which become filled with a turbid fluid containing
pus-cells, and sometimes wholly purulent. The choroid plexuses are
often covered with flecks of pus. When the distension of the
ventricles is very great, the gyri of the brain are more or less
flattened by compression against the cranium, and the outer layer of
the cerebral substance is bloodless and œdematous. The cerebral
sinuses are distended with blood, and frequently contain thrombi due
to an early stage of the inflammatory process, besides recent
coagula.
DIAGNOSIS.—The diagnosis of acute meningitis is often difficult, and

sometimes impossible, especially in the early stages, when the line
between congestion and inflammation cannot be drawn, and in
complicated cases. The typical symptoms are sudden and acute
pain in the head, with sensitiveness to light and sound, contracted
pupils, rapid pulse, and vomiting, followed by delirium, convulsions,
and coma. If these symptoms were observed in an individual
previously in good health, they would be strongly suggestive of the
disease, and yet many of them are often present in the beginning of
pneumonia, erysipelas, typhoid, typhus, and other eruptive fevers,
uræmia, and poisoning from narcotic substances. Hence it is
important to eliminate these sources of error before coming to a
conclusion, and a neglect of this precaution is a not infrequent
source of error in the diagnosis. A careful examination of the urine
will generally enable us to exclude uræmia. The presence or
absence of the eruptive fevers can usually be determined by the
attendant circumstances, and yet cases of scarlatina, typhoid fever,
variola, etc., beginning with active cerebral symptoms, are
sometimes hastily pronounced to be meningitis by inexperienced
observers. In poisoning by narcotics the history will often aid us in
the diagnosis; moreover, except in the case of opium, the pupils are
dilated instead of being contracted. In traumatic cases, with fracture
of the cranial bones, it is always difficult, and often impossible, to
distinguish between the symptoms of meningitis and those due to
other lesions. In concussion without fracture we must be guided in
our diagnosis by the same rules as in idiopathic cases. The
distinction between extreme congestion of the pia mater and
meningitis must be based chiefly upon the duration of the symptoms.
The former is usually brief in its course; the latter lasts one or two
weeks, and in cases which recover is often followed by after-effects
which are more or less permanent in their duration, such as paralysis
or rigidity of the limbs, mental defects, etc. Rapid recovery from the
acute symptoms would be strongly suspicious of congestion, and
doubtless in many such cases the treatment has been credited with
a success to which it was not entitled. The diagnosis from tubercular
meningitis will be reserved for the article on that disease.
PROGNOSIS.—Acute meningitis is fatal in the majority of cases,

though recovery is possible. A gradual diminution of the severity of
the symptoms, especially in respect to temperature, pulse, pain in
the head, and other cerebral phenomena, would afford
encouragement, but we must not trust too much to the brief
appearances of amendment so often observed.
TREATMENT.—The indications for treatment are threefold: 1st, to

prevent or arrest the inflammation; 2d, to modify its violence and
shorten its duration when arrest is no longer possible; and 3d, to
place the patient in the best condition to withstand the violence of the
disease and to recover from its effects. It is only by prompt action
that we can hope to attain the first object, that of preventing the
passage of hyperæmia into inflammation. The patient should be
placed in a cool and well-ventilated apartment of good size, from
which a bright light is excluded. His head, moderately raised, should
be kept cool by means of pounded ice enclosed in a rubber bag or a
bladder. One or more leeches, according to his age, should be
applied behind the ears, or blood may be drawn from the temples or
back of the neck by means of cupping. The bleeding should be
encouraged by poultices if necessary, but with young children the
abstraction of blood should be done with caution. An active purge
should be given, such as ten grains each of calomel and jalap,
followed by castor oil or infusion of senna; for children, from three to
six grains, according to age, followed by oil, would be sufficient. The
medicine should be repeated in a few hours if there be no effect.
Counter-irritation by means of blisters is recommended by most
authorities as a valuable aid in the first stage of the disease. Unless
the application be very extensive, it is not likely to be of any avail,
and extensive blistering would hardly fail to greatly reduce the
strength of the patient, and also is likely to irritate the kidneys. There
are no medicines which can be relied upon to arrest the
inflammatory process. Nevertheless, the tincture of aconite-root, in
the dose of from one to three drops, according to the age of the
patient, every two hours, might be given early, with the view of
fulfilling the second indication by its sedative property. The bromide
of potassium or of sodium, combined with small doses of chloral
hydrate or of sulphate of morphia, will also calm the excitement and
pain, and diminish convulsions. The success which sometimes
follows the employment of ergot in the epidemic cerebro-spinal
meningitis warrants its trial. Bartholow recommends the wet sheet
two or three times a day if the temperature is high. Steffen advises
four grains of sulphate of quinine with one grain of salicylate of soda,
from two to four times daily, for young children, and in double these
doses for older ones. The alimentation of the patient should be
carefully attended to during this stage. Nourishing liquid food, such
as milk, gruel, broth, eggs, with stimulants if indicated, should be
given at proper intervals, care being taken not to overload the
stomach, as is frequently done. When the patient can no longer
swallow the food must be given by the rectum. During the stage of
compression it is useless, in the present state of our knowledge, to
expect any benefit from the further administration of drugs, and the
treatment then consists mainly in giving small quantities of food at
regular intervals, and in such external applications as the bodily
temperature may require. The bladder must be relieved by the
catheter when necessary. Simple enemata are generally sufficient to
prevent constipation.
Chronic Cerebral Meningitis.
Chronic inflammation of the pia mater rarely follows the acute form,
but is generally secondary to other conditions, such as inflammation
and tumors of the dura, tumors and abscess of the brain, disease of
the vessels of the brain, suppurative otitis, and to constitutional
diseases, especially alcoholism, syphilis, and pulmonary
tuberculosis. It is one of the most common lesions found after death
from general paralysis of the insane. As a distinct affection,
unconnected with constitutional disease, it is extremely rare, though
less so, according to Flint,19 than the acute form. He cites a case in
which the symptoms were intermittent. The patient, fifteen years old,
died after a month's illness. The autopsy showed cerebral
hyperæmia, lymph at the base of the brain, and distension of the
ventricles with transparent fluid. There were no tubercles. In most
cases in which the results of chronic meningitis are found after death
the cortical substance of the brain is involved in the disease; hence
the difficulty in defining its symptoms, which are usually extremely
vague, and not always distinctive of cerebral disease. The principal
are pain in the head, vertigo, vomiting, impairment of the memory,
mental apathy, drowsiness, and muscular weakness. The anatomical
changes are thickening and opacity of the membrane by the deposit
of lymph upon its surface and into the connective tissue, adhesions
to the dura and to the cortical substances of the brain, together with
hyperæmia of the latter. These appearances are usually distributed
in irregular patches of greater or less extent.
19 Austin Flint, M.D., Principles and Practice of Medicine, 5th ed., Philada., 1881, p.
701.
The DIAGNOSIS of chronic meningitis is often obscure or impossible.

Long-continued pain in the head, accompanied by vertigo,
impairment of memory, drowsiness, mental apathy, etc., without
paralysis, would be suggestive of it, especially if there were
occasional intermissions of the symptoms. The probability would be
greatly increased if the patient had a syphilitic or alcoholic history.
The diagnosis should exclude tumor of the brain, chronic
pachymeningitis, and chronic hydrocephalus, but as these diseases
are often complicated with chronic meningitis, the distinction might
be very difficult. As already stated, chronic meningitis is almost a
constant lesion in general paralysis, as well as in other forms of
chronic insanity, but there are no special symptoms by which its
presence can be ascertained during life.
TREATMENT.—Our aim should be to relieve pain, diminish congestion,

and favor absorption. Counter-irritation to the head and nucha by
means of small blisters or croton oil should be employed with
moderation. Bromide of potassium, or, if necessary, small doses of
morphia, may be given if the pain be severe. Should there be
symptoms of cerebral congestion, such as acute delirium, flushing,
and heat of head, an ice-bag should be applied to the head and
leeches behind the ears, or blood may be drawn from the temples or
nucha by cupping. As an absorbent the iodide of potassium is much
recommended, but it is not likely to be effectual, except in syphilitic
cases. The bowels should be kept free, but without active purging.
The general health of the patient should be promoted by suitable diet
and regimen, by relief from excitement and fatigue, or by change of
scene and of climate. For the treatment of chronic meningitis
complicating syphilis, alcoholism, and tuberculosis, the reader is
referred to the articles treating of those diseases.
TUBERCULAR MENINGITIS.
BY FRANCIS MINOT, M.D.

DEFINITION.—Inflammation of the pia mater of the brain, with effusion
of lymph and pus, caused by the deposit of miliary tubercles upon its
surface or into its substance.
SYNONYMS.—Scrofulous meningitis, Granular meningitis, Basilar

meningitis, Acute hydrocephalus, Dropsy of the brain.
HISTORY.1—It is only within a comparatively recent time that

tubercular meningitis has been distinguished from other cerebral
diseases. Up to the eighteenth century the term hydrocephalus was
employed not only for the dropsical diseases of the head, including
internal and external hydrocephalus, but also for meningeal
inflammations, both simple and tubercular, and for congestion of the
brain and of the membranes; the accumulation of water in the
ventricles or between the membranes being looked upon as the
disease, and not as one of its consequences. The term was even
applied to external tumors, as cephalæmatoma and caput
succedaneum. We owe the first accurate account of the
symptomatology of acute hydrocephalus, or ventricular dropsy, to
Robert Whytt of Edinburgh, whose remarkable monograph, entitled
Observations on the Dropsy of the Brain, first published in 1768,
after his death, was founded upon the study of 20 cases with 10
autopsies. No addition of importance has been made by later
observers to his graphic description of the disease or to his rules for
its diagnosis. Whytt, however, had no clear notion of its pathogeny,
and it was not till 1815 that Gölis pointed out that acute ventricular
dropsy was a secondary condition depending upon previous
inflammation of the membranes or vessels of the brain.
1 See W. Hughes Willshire's valuable paper, entitled “Historic Data on Scrofulous
Meningitis,” in Brit. and For. Med.-Chir. Review, Oct., 1854.
In 1827, Guersant remarked that the inflammation of the meninges
constituting acute hydrocephalus presented such peculiarities as led
him to denominate it granular meningitis. He did not, however,
connect the granular deposit with tubercle. This was left for
Papavoine to effect, who in 1830 published two cases of tuberculous
arachnitis, in one of which effusion into the ventricles, or
hydrocephalus, existed. The meningeal granulations or tubercles
were described with care, and their coincidence with tuberculous
deposit elsewhere was remarked upon, as also the apparent
occurrence of the former previous to the inflammatory action in the
meninges, and in one case the existence of the tuberculous granules
without the sequence of inflammation. The important pathological
element of acute hydrocephalus thus clearly pointed out by
Papavoine now became apparent to observers, and obtained almost
universal assent. The attention of the profession in this country was
first called to it by W. W. Gerhard of Philadelphia in 1833, in an
admirable paper published in the American Journal of the Medical
Sciences,2 containing the reports of thirty-two cases with autopsies.
In every case but two tubercles were found in other organs besides
the meninges. In one of these two, gangrenous cavities were found
in the lungs without tubercles, though perfectly characterized miliary
tubercles existed in the membranes; in the other case the lungs were
not examined with care, Gerhard not being present at the autopsy.
2 Vols. xiii. and xiv., 1833-34.
Finally, the distinction between tubercular and simple meningitis was

pointed out by Guersant in 1839, and clearly established by Barthez
and Rilliet in 1843 in their systematic work on the diseases of
children; and it was further elucidated by Rilliet in 1847.
ETIOLOGY.—The causes of tubercular meningitis are predisposing

and exciting. Among the former are hereditary tendency to
tuberculosis and to the so-called scrofulous diathesis; the previous
existence of tubercle in any part of the body, especially in the lungs;
and the presence of caseous degeneration in the bronchial, the
mesenteric, and other glands, or in the parenchyma of various

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(eBook PDF) Mathematics for Machine

Technology 7th Edition

A United States Customary and Metric Units of Measure / 613

621 Answers to Odd-Numbered Applications

About the Authors

Introduction to the Scientific Calculator

Decisions Regarding Calculator Use

Used with permission of Texas Instruments, http://education.ti.com

Calculator Application Index

Introduction to Common Fractions

Expressing Fractions as Equivalent Fractions

c Procedure To reduce a fraction to lowest terms

Note: The fraction is reduced, but not to lowest terms.

c Procedure To express a fraction as an equivalent fraction with an indicated

Expressing Mixed Numbers as Improper Fractions

c Procedure To express a mixed number as an improper fraction

Expressing Improper Fractions as Mixed Numbers

c Procedure To express an improper fraction as a mixed number

Examples Express the following improper fractions as mixed numbers.

Expressing Fractions as Equivalent Fractions

5. Reduce to lowest terms.

Mixed Numbers and Improper Fractions

9. Express the following improper fractions as mixed numbers.

Addition of Common Fractions

Lowest Common Denominators

c Procedure To find the lowest common denominator

Expressing Fractions as Equivalent Fractions

c Procedure To change fractions into equivalent fractions having the lowest

c Procedure To add fractions

Express the fractions as equivalent

Adding Fractions, Mixed Numbers, and Whole Numbers

Lowest Common Denominators

Equivalent Fractions with Lowest Common Denominators

Adding Fractions, Mixed Numbers, and Whole Numbers

11 Ibid., Dec. 28, 1882.

In young children, especially in the new-born, meningeal

SYMPTOMS.—In some cases the attack is preceded by indications of

As a rule, the condition of unconsciousness continues up to the time

Vomiting is a frequent symptom at the beginning of the attack, just as

PATHOLOGICAL ANATOMY.—The chief points of interest in the morbid

DIAGNOSIS.—The distinction between meningeal hemorrhage and

PROGNOSIS.—If the effusion be considerable in amount, as indicated

TREATMENT.—The treatment, which is essentially the same as that for

Congestion of the Cerebral Pia Mater.

The pia mater consists of two layers, separated by a loose

Congestion or hyperæmia of the pia mater probably never occurs

ETIOLOGY.—The causes of hyperæmia of the pia mater are in the

SYMPTOMS.—Since congestion of the pia always coexists with that of

PATHOLOGICAL ANATOMY.—Arterial hyperæmia of the pia is seldom

TREATMENT.—In a case of suspected congestion of the pia the

SYNONYMS.—Meningitis, Leptomeningitis, Acute non-tubercular

Meningitis (by which is generally understood inflammation of the pia)

ETIOLOGY.—Meningitis occurs both as a primitive disease and as

SYMPTOMS.—The symptoms of acute leptomeningitis vary much in

It is customary to speak of a stage of excitement followed by one of

COURSE.—In young children the course of meningitis differs

18 Eduard Henoch, Vorlesungen über Kinderkrankheiten, Berlin, 1881, p. 277.

PATHOLOGICAL ANATOMY.—The lesions, which are rarely general, may

DIAGNOSIS.—The diagnosis of acute meningitis is often difficult, and