Brief Contents
PART 1
Welcome to College Reading, Writing, and Thinking 1
CHAPTER 1 2
Introduction to College Reading, Writing, and Thinking
CHAPTER 2 26
Active Reading
CHAPTER 3 45
The Writing Process
SPOTLIGHT ON STUDENT WRITING 68 Literacy Narrative
CHAPTER 4 79
The Writing Product: Academic Essay Fundamentals
SPOTLIGHT ON STUDENT WRITING 110 Response Essay
PART 2
Essential Elements of Academic
Reading and Writing 123
CHAPTER 5 124
Summarizing Texts
CHAPTER 6 145
Responding to Texts
CHAPTER 7 168
Critically Evaluating Texts
CHAPTER 8 188 Rhetorical Analysis
SPOTLIGHT ON STUDENT WRITING 209 Synthesis Essay
PART 3
Reading and Writing about Multiple Texts 223
CHAPTER 9 224 Comparing Texts
CHAPTER 10 246 Synthesizing Texts
CHAPTER 11 271 Arguing with Texts
SPOTLIGHT ON STUDENT WRITING 299 Argumentative Synthesis Essay
PART 4
Research and Documentation 311
CHAPTER 12 312 Planning a Research Paper
CHAPTER 13 337 Writing a Research Paper
CHAPTER 14 363 Reading Visuals
CHAPTER 15 388 MLA and APA Documentation
SPOTLIGHT ON STUDENT WRITING 411 Revising and Editing a Research Paper
PART 5 Anthology of Theme-Based Readings 427
THEME 428
What Barriers Do College Students Face?
THEME 442
How Can We Help People Who Are Unhoused?
THEME 456
What Makes Life Meaningful?
THEME 486 America: Land of the Free?
THEME 502 What Makes a Persuasive Argument?
Preface xxii
PART 1
Welcome to College Reading, Writing, and Thinking 1
CHAPTER 1
Introduction to College Reading, Writing, and Thinking 2
Theme: How to Develop a Successful College Mindset? 2
Identifying Strategies for Success 2
Recognizing Key Factors for Succeeding in College 6
College Reading: Sinking In 6
College Writing: Giving It Time and Effort 8
Motivation and Interest 9
Beliefs about Learning 10
Reading and Writing about Students’ Mindsets 10
READING SELECTION: “Brainology: Transforming Students’ Motivation to Learn” by Carol S. Dweck 11
Academic Style: Introductory Phrases to Acknowledge Sources 18
Developing a Critical-Thinking Mindset 19
READING SELECTION: “Impact of Poverty on Students: All in Their Minds?” by Mary Ellen Flannery 20
CHAPTER 2
Active Reading 26
Theme: What Is the Effect of Multitasking on Learning? 26
Realizing Reading and Writing as Processes 26
Previewing before Reading 29
READING SELECTION: “Online Students Multitask More (Not in a Good Way)” by Doug Lederman 30
Identifying the Topic, Thesis, and Main Ideas in a Reading 34
Topic versus Thesis 34
Identifying Main Ideas 35
Academic Style: Signal Verbs 36
Annotating and Summarizing 37
Annotating a Text 37
Summarizing a Text 38
CHAPTER 3
The Writing Process 45
Theme: How Do Writers Write? 45
An Overview: Understanding Writing as a Process 46
Defining the Purpose of a Writing Task 46
Prewriting 47
Choosing a Topic 48
Generating and Organizing Ideas 48
Drafting 51
READING SELECTION: “Advice for Aspiring Black Writers, from Black Writers” by Taylor Bryant 52
Academic Style: Attribution 56
Revising, Editing, and Proofreading 57
Revising for Content and Organization 57
READING SELECTION: “Writing as a Process: An Interview with Mike Rose” by Tina Arora 58
Editing Sentences and Proofreading for Errors 61
SPOTLIGHT ON STUDENT WRITING
Literacy Narrative 68
Defining the Purpose of the Writing Task and Picking a Topic 68
Prewriting 70
Drafting 71
Revising 72
Editing and Proofreading 74
Formatting the Paper 75
CHAPTER 4
The Writing Product: Academic Essay Fundamentals 79
Theme: Why Is Sleep So Important? 79
Analyzing Essay Structure 80
Essay Parts and Their Purpose 80
A Published Student Essay 80
Analyze a Writing Prompt 84
READING SELECTION: “Why Do We Sleep? There Are Plenty of Theories, but Nobody Really Knows for Sure” by Teodora Stoica 85
Academic Style: Appositives 90
Drafting a Tentative Thesis and an Essay Plan 91
Tentative Thesis 91
Essay Plan 92
Writing an Effective Essay Introduction 93
Sensible Strategies for Introductions 93
Introductions to Avoid 95
Writing Body Paragraphs 96
Writing a Strong Conclusion 97
Sensible Strategies for Writing a Conclusion 97
Conclusions to Avoid 97
Revising and Editing to Improve an Essay Draft 98
SPOTLIGHT ON STUDENT WRITING
Response Essay 110
Annotating to Evaluate Student Writing 110
First Reading: Annotations for Comprehension 110
Second Reading: Annotations for Evaluation 110
Sample Student Papers 111
STUDENT PAPER: “The Good, the Bad, and the Math” by Alejandra Jimenez 112
STUDENT PAPER: “Involuntary Resignation” by Veronica Alvarez 115
Peer Review 120
Strategies for Readers Giving Feedback 120
Strategies for Writers Receiving Feedback 121
PART 2
Essential Elements of Academic Reading and Writing 123
CHAPTER 5
Summarizing Texts 124
Theme: What Is the Purpose of a College Education? 124
Reading to Summarize 124
Applying Vocabulary Strategies 125
Understanding a Reading’s Structure 126
Annotating and Summarizing Main Ideas 126
READING SELECTION: “What’s the Purpose of College?” by Brandon Busteed 127
Drafting a Summary 129
Preparing to Write a Summary 129
Writing the Opening Sentence 130
Revising and Editing, Checking and Proofreading a Draft Summary 132
Revising 132
Editing 132
Checking 132
Patchwriting Plagiarism 133
Copying without Quoting 134
Proofreading 135
Academic Style: Making Writing Flow Logically 137
Summarizing an Article 138
READING SELECTION: “Education Is the Answer to Many of Life’s Challenges” by Donald Guy Generals 138
CHAPTER 6
Responding to Texts 145
Theme: What Makes People Happy? 145
Reading Critically 145
Identifying Types of Support 146
READING SELECTION: “More Money Does Make You Happier” by Ellie Zolfagharifard and Ollie Gillman 147
Using the SOS Organizational Pattern 150
Summary 150
Opinion 151
Support 152
READING SELECTION: “Can Money Really Buy Happiness?” by John Grohol 153
Drafting a Response Essay: The SOS Organizational Pattern 155
Organizing and Developing Body Paragraphs 158
Chronological Order 158
Climactic Order 158
Simple-to-Complex Order 159
Development of Depth and Detail 159
CHAPTER 7
Critically Evaluating Texts 168
Theme: How Can We Help People Who Are Unhoused? 168
Reading to Critique 169
Critiquing Support 169
Critiquing Examples 169
Critiquing Expert Testimony 170
Critiquing Explanation 171
Critiquing Factual and Statistical Evidence 172
READING SELECTION: “What Housing First Really Means” by Ben Cattell Noll 173
Preparing to Write a Critique Essay by Examining Support 175
Examination of All Support 176
Examination of the Most Important Support 176
Drafting a Critique Essay Using the SOS Pattern 177
READING SELECTION: “Housing First and Homelessness: The Rhetoric and the Reality” by Stephen Eide 178
Revising a Critique for Development and Support 181
Academic Style: Quote Sandwich 182
CHAPTER 8
Rhetorical Analysis 188
Theme: When Should Americans Be Involved in Foreign Conflicts? 188
Rhetorical Analysis 189
Context 189
Situation and Author 189
Purpose and Audience 190
Purpose 191
Intended and Specific Audience 191
Appeals 192
Tone and Denotation and Connotation of Words 192
Tone 192
Denotation and Connotation 194
Reading to Analyze Rhetoric 194
READING SELECTION: “Remarks at a United States-France Ceremony Commemorating the 40th Anniversary of the Normandy Invasion, D-Day” by President Ronald Reagan 195
Preparing to Write a Rhetorical Analysis 198
Writing a Thesis 199
Introducing a Rhetorical Analysis 200
Writing a Body Paragraph 201
Concluding a Rhetorical Analysis 203
SPOTLIGHT ON STUDENT WRITING
Synthesis Essay 209
Analyzing Essay Structure and Use of Evidence 209
First Reading: Annotations for Comprehension 209
Second Reading: Annotations for Analysis 209
Analyzing Student Papers 210
STUDENT PAPER: “What Makes One Happy?” by Michelle Asadulla 211
STUDENT PAPER: “Money, Friends, Purpose, and Happiness” by Kristen Chen 216
Annotating and Analyzing for Peer Review 222
PART 3
Reading and Writing about Multiple Texts 223
CHAPTER 9
Comparing Texts 224
Theme: Should We Support a Universal Basic Income? 224
Reading to Identify Parallel Points 225
READING SELECTION: “A Universal Basic Income: What Difference Might It Make?” by Christine Morley, Phillip Ablett, and Jenni Mays 226
Comparing Sources and Synthesizing Information 230
Reading to Synthesize Additional Information 231
READING SELECTION: “America’s Real ‘Freedom Dividend’: Hard Work and Pro-Business Policies” by Larry Elder 231
Organizational Methods 234
Preparing and Drafting a Compare-Contrast Essay 236
From Notes to Outline 236
Developing a Compare-Contrast Thesis Statement 237
Drafting a Compare-Contrast Essay 238
Academic Style: Creating Transitions 240
CHAPTER
10
Synthesizing Texts 246
Theme: How Will Climate Change Affect Us? 246
Purpose of Synthesizing Sources 247
Reading to Synthesize 247
READING SELECTION: “American Refugees: How Climate Change Might Force U.S. Migration North and Where They Could Go” by M.L. Nestel 248
Keeping Track of Your Reading Notes 253
READING SELECTION: “Black Lives Matter: The Link Between Climate Change and Racial Justice” by Adelle Thomas and Rueanna Haynes 254
Categorizing and Organizing Information 257
Categorizing Information 257
Creating an Outline or Paper Plan 259
Writing a Thesis Statement for a Synthesis 260
Synthesizing Information in Body Paragraphs Using Pie Structure 261
Starting a Synthesis Paper 262
Academic Style: Conciseness 265
CHAPTER 11
Arguing with Texts 271
Theme: How Free Is Speech on College Campuses? 271
Identifying Parts of an Argument 272
Claim 272
Writing a Claim in an Argument 272
Reasons 274 Support 275
READING SELECTION: “A College Lecture on Confederate Statues Made Me Realize I’m
Squelching Free Speech on Campus” by Kevin Weis 276
Introducing Controversial Issues 278
Provide Background Information 279
Define Terms 279
Structuring an Argument 280
Deductive Reasoning: Arguing from Claim or Reason to Support 280
Inductive Reasoning: Arguing from Support to Reason or Claim 280
READING SELECTION: “3 Approaches for Confronting Microaggressions” by Tyrone Fleurizard 283
Evaluating Logic 286
Avoiding the Issue 286
Weak Cause and Effect 287
Pretending to Offer Proof, but Not Really 287
Oversimplifying the Issue 287
Responding to Counterarguments 288
Identifying Rebuttal versus Concession 288
Where to Place a Counterargument 290
Academic Style: “Although . . . Because” Claim 290
Evaluating an Argument 292
SPOTLIGHT ON STUDENT WRITING
Argumentative Synthesis Essay 299
Annotating and Analyzing Student Essays 299
STUDENT PAPER: “Segmented Sleep: Nature vs. Nurture” by Renee Burke 300
STUDENT PAPER: “The Two-Way Correlation Between Sleep Disturbances and Dementia” by Xiaoyan Huo 306
Alternative Table of Contents by Essay Genre
This alternative table of contents can be used to locate examples of paper types and approaches to writing that are explained in Chapters 1 through 14 of the text.
Argument
Reading: “What’s the Purpose of College?” by Brandon Busteed 127
Reading: “Education Is the Answer to Many of Life’s Challenges” by Donald Guy Generals 138
Reading: “What Housing First Really Means” by Ben Cattell Noll 173
Reading: “America’s Real ‘Freedom Dividend’: Hard Work and Pro-Business Policies” by Larry Elder 231
Reading: STUDENT ESSAY: “A College Lecture on Confederate Statues Made Me Realize I’m
Squelching Free Speech on Campus” by Kevin Weis 276
Reading: “Six Lessons to Succeed as a First-Generation College Student” by Carolyn J. Stefanco 431
Reading: STUDENT ESSAY: “Academia, Love Me Back” by Tiffany Martinez 433
Reading: “Laziness Does Not Exist: But Unseen Barriers Do” by Devon Price 436
Reading: “To House the Unhoused, Hear the Unhoused” by Julia Irwin 443
Reading: “Compassion as the Source of Happiness” by His Holiness the 14th Dalai Lama 457
Reading: “A Reflection on the Meaning of Life: Remembering Vicktor Frankl in the Aftermath of Anthony Bourdain’s Death” by Mirsad Serdarevic 461
Reading: “Crafting the ‘Day of Infamy’ Speech” from the US National Archives 493
Reading: “A Modest Proposal” by Dr. Jonathan Swift 503
Reading: “Ain’t I a Woman?” by Sojourner Truth 509
Argumentative Synthesis
Reading: “Can Money Really Buy Happiness?” by John Grohol 153
Reading: “A Universal Basic Income: What Difference Might It Make?” by Christine Morley 226
Reading: “American Refugees: How Climate Change Might Force U.S Migration North and Where They Could Go” by M.L. Nestel 248
Reading: “Black Lives Matter: The Link Between Climate Change and Racial Justice” by Adelle Thomas and Rueanna Hayes 254
Reading: STUDENT ESSAY: “3 Approaches for Confronting Microaggressions” by Tyrone Fleurizard 283
Reading: STUDENT ESSAY: “Segmented Sleep: Nature vs. Nurture” by Renee Burke 300
Reading: STUDENT ESSAY: “The Two-Way Correlation Between Sleep Disturbances and Dementia” by Xiaoyan Huo 306
Comparison
Reading: “A Universal Income: What Difference Might It Make?” by Christine Morley 226
Reading: “Food, Showers, Tents: Does the Help, Help the Homeless?” by Amy Taxin and Geoff Mulvihill 445
Reading: “Ain’t I a Woman?” by Sojourner Truth 509
Critique
Reading: “Online Students Multitask More (Not in a Good Way)” by Doug Lederman 30
Reading: “Housing First and Homelessness: The Rhetoric and the Reality” by Stephen Eide 178
Reading: “A Universal Basic Income: What Difference Might It Make?” by Christine Morley 226
Reading: “America’s Real ‘Freedom Dividend’: Hard Work and Pro-Business Policies” by Larry Elder 231
Reading: “We Need Rental Assistance and Services, Not Punitive Policies, to End Homelessness” by Peggy Bailey 448
Reading: “Solve Homelessness by Addressing Its Root Causes: Mental-Health and SubstanceAbuse Issues Underlie the Problem” by Richard Bebout 454
Explanatory Synthesis
Reading: “Online Students Multitask More (Not in a Good Way)” by Doug Lederman 30
Reading: “Multitasking May Hurt Your Performance but It Makes You Feel Better” by Ohio State University 41
Reading: STUDENT ESSAY: “To Sleep or Not to Sleep, That Is the Question” by Courtney Roberts 81
Reading: “Why Do We Sleep?” by Teodora Stoica 85
Reading: “More Money Does Make You Happier” by Ellie Zolfagharifard and Ollie Gillman 147
Reading: STUDENT ESSAY: “What Makes One Happy?” by Michelle Asadulla 211
Reading: STUDENT ESSAY: “Money, Friends, Purpose, and Happiness” by Kristen Chen 216
Reading: “Food, Showers, Tents: Does the Help, Help the Homeless?” by Amy Taxin and Geoff Mulvihill 445
Literacy Narrative
Reading: Spotlight on Student Writing Process: “Literacy Narrative” 68
Reading: STUDENT PAPER: “The Good, the Bad, and the Math” by Alejandra Jimenez 112
Reading: STUDENT PAPER: “Involuntary Resignation” by Veronica Alvarez 116
Literature
Reading: Excerpt from “Narrative of the Life of Frederick Douglass, an American Slave” by Frederick Douglass 468
Reading: “Rat Park” by Stuart McMillen 474
Reading: “The New Colossus” (Poem) by Emma Lazarus 487
Reading: “Immigrants in Our Own Land” (Poem) by Jimmy Santiago Baca 491
Reading: “To the Lady” (Poem) by Mitsuye Yamada 497
Reading: “Call It COVID” (Poem) by Tatiana Tran 522
Research Paper
Reading: STUDENT ESSAY: “To Sleep or Not to Sleep, That Is the College Student’s Eternal Question” by Courtney Roberts 81
Reading: “Why Do We Sleep?” by Teodora Stoica 85
Reading: STUDENT ESSAY: “Segmented Sleep: Nature vs. Nurture” by Renee Burke 300
Reading: STUDENT ESSAY: “The Two-Way Correlation Between Sleep Disturbances and Dementia” by Xiaoyan Huo 306
Reading: “Fake Medical News: Avoiding Pitfalls and Perils” by Amar Shireesh Kanekar and Avinash Thombre 343
Reading: STUDENT ESSAY: “Final Draft: Taking Refuge: Climate Migration in the United States” by Jamie Ferrante 418
Response
Reading: STUDENT ESSAY: “The Good, the Bad, and the Math” by Alejandra Jimenez 112
Reading: STUDENT ESSAY: “Involuntary Resignation” by Veronica Alvarez 116
Reading: “Education Is the Answer to Many of Life’s Challenges” by Donald Guy Generals 138
Reading: “Can Money Really Buy Happiness?” by John Grohol 153
Reading: “America’s Real ‘Freedom Dividend’: Hard Work and Pro-Business Policies” by Larry Elder 231
Reading: STUDENT ESSAY: “Academia, Love Me Back” by Tiffany Martinez 433
Reading: “We Need Rental Assistance and Services, Not Punitive Policies, to End Homelessness” by Peggy Bailey 448
Reading: “Trump Official Rephrases Statue of Liberty Poem to Defend Targeting of Legal Migrants” by Zachary Small 488
Rhetorical Analysis
Reading: “Trump Official Rephrases Statue of Liberty Poem to Defend Targeting of Legal
Migrants” by Zachary Small 488
Reading: “Crafting the ‘Day of Infamy’ Speech” from the US National Archives 493
Reading: “OP-ED: Let’s Push the Language of Journalism Past Its Limits” by Alissa Quart 519
Summary
Reading: “Brainology: Transforming Students’ Motivation to Learn” by Carol S. Dweck 11
Reading: “Impact of Poverty on Students: All in Their Minds?” by Mary Ellen Flannery 20
Reading: “How to Spot Fake Health News, According to Experts” by Peter Flax 319
Reading: “Emily Esfahani Smith Melds Wisdom and Psychology on a Journey Toward Meaning” by Catherine Yang 464
Visual Analysis
Reading: “Saying Her Name: What Monuments to Sojourner Truth Can Teach Us about Memorializing Black Lives” by Frances Cathryn 512
Writing Process
Reading: “Advice for Aspiring Black Writers, from Black Writers” by Taylor Bryant 52
Reading: “Writing as a Process: An Interview with Mike Rose” by Tina Arora 58
Reading: Student Spotlight: Literacy Narrative 68
Reading: STUDENT ESSAY: “Paper Draft and Final Draft: Taking Refuge: Climate Migration in the United States” by Jamie Ferrante 412
Reading: “Crafting the ‘Day of Infamy’ Speech” from the US National Archive 493
Speeches
Reading: “Remarks at a United States-France Ceremony Commemorating the 40th Anniversary of the Normandy Invasion, D-Day” by President Ronald Reagan 195
Reading: “Crafting the ‘Day of Infamy’ Speech” from the US National Archive 493
Reading: “Remarks on Signing the Bill Providing Restitution for the Wartime Internment of Japanese-American Civilians” by President Ronald Reagan 499
Reading: “Ain’t I a Woman?” by Sojourner Truth 509
Reading: “The Gettysburg Address” by Abraham Lincoln 510
Preface
Preface to the 2nd Edition
Writing to Read, Reading to Write presents reading, writing, and critical thinking as meaningful and complementary endeavors that form the foundation of students’ academic success. Treating reading and writing as recursive processes, each chapter builds on these skills to help students at all levels achieve college-level writing. Scaffolding and support for these skills are embedded in every chapter in the form of guided practice and explicit instruction around strategies for successful first-year writing. This student-centered approach to the writing course is supported by a robust selection of digital assignments, assessments, and study tools in McGraw Hill Education’s Connect Composition platform.
An Emphasis on Reading, Writing, and Critical Thinking
Recognizing that students often come to the composition course lacking the reading and critical-thinking skills necessary to produce college-level writing, Writing to Read, Reading to Write builds in support for developing these complementary and intertwined skills. With Writing to Read, Reading to Write, students will develop their reading, writing, and thinking skills in a logical progression, beginning with foundational coverage of reading and writing processes, and building up to the strategies and skills students will apply to their own academic work.
Reading
A focus on reading strategies, such as previewing, annotating, and summarizing, gives students who are underprepared for the first-year composition course, or in the corequisite support sections, a chance to practice those skills, and continually apply and build on them, as they embark on college-level work. For on-level students, these reading strategies reinforce best practices for engaging with challenging texts.
• Annotated Reading selections help students identify a reading’s key elements, such as its thesis or claim, main points, support and evidence, and key vocabulary, providing much-needed support in academic reading skills, for students at all reading levels.
• “Before Reading,” “During Reading,” and “After Reading” exercises support each reading selection, enabling deep comprehension of the selections, necessary for students to produce thoughtful prose. Online in Connect these assignments can be completed in Power of Process, which prompts students to be active readers as they preview, annotate, and reflect on the readings in the text.
• An Anthology of Theme-Based Readings offers 25 additional reading selections, allowing students to apply their reading, writing, and thinking skills to readings of their choice.
• SmartBook 2.0, found online in Connect, uses adaptive assessments to create a personalized reading experience customized to individual student needs.
SmartBook continually adapts to pinpoint knowledge gaps and focus learning on concepts requiring additional study. It supports student engagement and helps students and instructors track progress in achieving reading and study goals.
• Power of Process, also in Connect, provides strategies that guide students in learning how to critically read a piece of writing or consider a text as a possible source for incorporation into their own work. After they progress through the strategies, responding to prompts by annotating and highlighting, students are encouraged to reflect on their processes and interaction with the text. In this way, Power of Process guides students to engage with texts closely and critically so that they develop awareness of their process decisions and ultimately begin to make those decisions consciously on their own—a hallmark of strategic, self-regulating readers and writers.
• Instructors can choose from 100 readings in the Power of Process reader or from Writing to Read, Reading to Write, or they can upload their own readings. In keeping with McGraw Hill’s commitment to equity, diversity, and inclusion, 50% of the readings in both the text and in Power of Process are written by Black, Indigenous, and People of Color (BIPOC) authors.
Writing
A process-oriented, recursive approach to writing supports students’ reading, writing, and learning, no matter their level upon entering the course. Students will learn how to use writing to call up background knowledge before reading or to reflect on a text after reading; they will write to generate and explore ideas, and to draft, edit, revise, and proofread their own college-level texts.
• At the end of each chapter, Reading and Writing Activities guide students through selecting a topic, prewriting, drafting, revising, editing, and proofreading to develop a complete piece of writing.
• Pair and Share activities are strategically placed throughout the reading and writing activities, offering peer-review opportunities at various stages of the writing process.
• Online in Connect’s Writing Assignment Plus, students benefit from just-in-time learning resources as they draft responses to writing prompts. The built-in
In Writing Assignment Plus, instructors can provide summative and directive feedback on students’ work. A customizable scoring guide provides assessment transparency to students, while allowing them to see why and how to improve.
grammar checker and originality detection alert students to issues before they submit their work and offer resources that direct them on how to correct errors within the context of their own writing, empowering them to achieve their writing goals.
• Connect Composition grants students four years of access to the complete Connect Composition Handbook, which features coverage of style, grammar, and mechanics, as well as up-to-date guidance on MLA and APA documentation styles. In Connect Composition, teachers can also assign a range of assessments, including quizzes and tests, that are tied to the handbook.
Critical Thinking
Each chapter is based on a thought-provoking question to encourage inquiry and critical thinking. Students will develop an academic mindset, critically reading, evaluating, and responding to texts of various kinds and alternating points of view.
• A broad selection of readings aligns with thoughtfully chosen themes that provide a structure for student learning and a foundation for understanding reading, writing, and research processes. By reading related articles, students have an opportunity to understand a topic in depth, and the text provides students with more material with which to draft their resulting work.
• Engage with the Reading questions following each reading selection prompt students to think critically about the text, explain complex passages, or respond to an author’s arguments with their own ideas or analysis. The strategies they encounter through their engagement with other texts will build understanding of writing strategies and how they could apply to their own writing projects.
Scaffolding and Support for the First-Year Course
The structure of Writing to Read, Reading to Write has been carefully designed to guide students through a logical progression of skills, with each new topic building on the last.
• Reading, writing, and thinking critically. Part 1, Welcome to College Reading, Writing, and Thinking, introduces students to the right mindset for college success, foundational reading strategies, the nature of the writing process, and the fundamentals of an academic essay.
• Focusing on academic reading and writing. Employing skills from Part 1, in Part 2 critical academic writing skills are developed with a focus on single texts. Students will engage in important strategies, including summarizing the ideas of others, responding thoughtfully to texts, and critically evaluating texts.
• Engaging with multiple texts. Building on Parts 1 and 2, in the third section students deal with multiple texts, enhancing the essential elements of reading and writing by demonstrating how students can compare or synthesize different sources in an objective analysis or through critical evaluation, as well as how they can develop original arguments supported by various sources.
• Conducting research and citing sources. Part 4, Research and Documentation, guides students through the research process, including how to locate and evaluate sources, how to write an informative or argumentative academic research paper, and how to analyze and incorporate visuals.
• Reading to expand perspectives and understanding. Part 5, Anthology of ThemeBased Readings, is a collection of diverse views on themes students and their teachers may wish to read and write about. Readings are intentionally selected to spark critical and creative thinking and to inspire students’ writing.
In addition to the logical structure of the text, further scaffolding is provided throughout.
After Reading: Identify Audience; Identify Purpose
Write responses to the following exercises using complete sentences.
5. Consider the audience: Who are the intended readers of this text? Do you think readers other than the intended audience can also benefit from the ideas in this selection?
• Writing prompts are offered at two levels, those that require students to meet the core objectives of the first-year writing course, and a selection of Challenge Choice prompts that require a bit more reading, researching, and thinking. Offering students additional options for completing the writing assignment empowers all students to succeed.
6. Think about the purpose: Do the authors want the audience to be informed, instructed, or persuaded? Could there be more than one purpose? Explain.
Engage
with the Reading
Write responses to the following exercises using complete sentences.
• For students who struggle with sentence-level clarity, or who are new to the expectations of college-level writing assignments, Academic Style boxes provide professional and student writing examples that model a range of writerly concerns related to academic prose, such as writing clear, concise sentences or integrating quotations, encouraging students to read as writers and to emulate strong writing.
1. Review your annotations from exercise 3 under “During Reading,” and select the writing advice given by professional authors that you can identify with. In your own words, explain that advice and how or why you feel it applies to you.
2. Review your annotations from exercise 4 under “During Reading,” and select the writing advice given by professional authors that you do not find useful or relevant to you. In your own words, explain that writing advice and why you do not find it useful or relevant.
• Reading, writing, and research skills are further supported by Adaptive Learning Assignment. Found in Connect, Adaptive Learning Assignment provides each student a personalized path to learning concepts instructors assign in their course. The assignments continually adapt to the individual, identifying knowledge gaps
3. Look back over your annotations and your answers to exercises 1 and 2 above. Then describe your own writing process and purposes, how they are similar to or different from those of professional writers, and how you might change your writing routine to improve them.
Academic Style: Attribution
When you summarize or quote, you should identify the source of that information and convey
why that source is reputable. In such cases, you can reference the person or organization by providing attribution. That is, along with the quote or summary, you identify the source of the information. You may also want to state the credentials of the source—that is, what makes the source qualified to address the topic.
Examples of Sentences Using Attribution
• The author of ten best-selling books on personal finance, Suze Orman explains that “writing is hard work, not magic.”
Adult Literacy, shows that most professional writers create multiple drafts. attribution attribution
• Research published in a peer-reviewed academic journal, the Journal of Adolescent
and focusing on areas where remediation is needed. All adaptive content—including questions and integrated concept resources—is specifically targeted to, and directly aligned with, the individual learning objectives being assessed in the course.
A Student-Centered Approach
Throughout the chapters, students are reminded they are at the center of their learning and must actively participate to be successful as they read, write, think, and engage with assignments. By offering varied approaches to writing projects and a range of reading selections, this program meets students where they are, encourages them to adopt a college mindset, and to achieve the goals of the course.
The New Three Rs: Relevant, Representative, and Reflective
While reading, writing, and critical thinking encapsulate the academic mindset of the book, engaging students with relevant topics, representative readings, and opportunities for reflection is at the heart of the text.
words. Writing is impossible without a plan. To me, the word “deadline” always has one meaning: I’m dead if I waited till the due day to start writing my paper. Last but not least, being unfamiliar with the topic that I was assigned for is also a difficulty for me. In order to write about something I have never heard before, I should do some researches before thinking about the topic. The thinking process is only fun, when I make up questions and ask myself to answer them.
• Relevant. Themes and readings were chosen for their potential to connect to students’ lives. Throughout the text, students are encouraged to understand how academic topics and research connect to the larger world or to the communities around them, as well as to their own lived experiences.
• Representative. Featured professional authors and student writers represent the variety of experiences and backgrounds of today’s students, including secondlanguage learners, writers of color, and first-generation college students.
REVISING
Since the student created a graphic organizer and immediately after composed a first draft, she decided to put this writing away for some time. She felt by taking a break, she could return to the first draft, then to read it with fresh eyes and renewed energy.
• Reflective. Chapters present diverse views on a chosen theme, prompting students to question texts, discover new perspectives, and draw their own conclusions.
Spotlights on Student Writing
One chapter at the conclusion of each section profiles real college students and showcases their written work. This Spotlight on Student Writing feature gives students
When the student returned to working on the first draft, she read it focusing on making the ideas clearer and better organized. She crossed out unnecessary information and added specific examples and details (marked in red ink). She also clarified the organization by changing the order of information and by adding transitions (also in red). The student’s second draft appears in Figure 3.
FIGURE 3 One Student’s Second Draft
Writing is a Tool (Revising version), by Jane Nguyen. Used with permission.
To be honest, writing has never been interesting to me; when I was young, I always catch myself talking more than putting things down on the paper. I had energy to ran around, but had none to sit down and write. Later on in life, I figured that writing had a lot of benefits. I was able to organize my thoughts, think more careful before making something happen, and most importantly, I was able to express myself.
1 caught words
After my last year in middle school, I realized I should find a better way to keep my thinking together. Since then, I started to write, a lot.
2 ideas my could
Of course, At first, it was just for fun purposes. I wrote songs when I feel like my crush turned his head and looked at my direction. I wrote down some crazy dreams in the morning after I woke up, because I thought that one day I can publish them; but turned out, those dreams were from a movie I saw before bed last night. I wrote down my mom’s grocery list and put it in her purse
FIGURE 2 One Student’s First Draft (continued )
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whether their seat is central or peripheral. We will notice here some of the prominent symptoms resulting from nerve injuries which may be useful in distinguishing peripheral from central lesions, although in many cases it is only by the careful consideration of all symptoms and the impartial weighing of all attending circumstances that a probable conclusion can be arrived at.
The rapid loss of muscular tone and the early atrophy of the muscles is a mark of paralysis from nerve-injury which distinguishes it from cerebral paralysis, even when the latter occupies circumscribed areas, as is sometimes the case in cortical brain lesion. In spinal paralysis also the muscles retain their tone and volume (the latter being slightly diminished by disuse), except in extensive destruction of gray matter, when all tonicity is lost, and in lesions of the anterior horns of gray matter (poliomyelitis), when there is loss of muscular tone and marked atrophy. The first of these spinal affections may be distinguished by the profound anæsthesia and by the paralysis being bilateral—by the implication of bladder and rectum and the tendency to the formation of bed-sores; such symptoms being only possible from nerve-injury when the cauda equina is involved. In poliomyelitis the complete integrity of sensation—which is almost always interfered with at some period after nerve-injury—and the history of previous constitutional disturbance will aid us in recognizing the diseased condition. While the reflexes are wanting in peripheral, they are, as a rule, retained, and often exaggerated, in cerebral and spinal paralysis; the exceptions being in the two lesions of the cord above mentioned, in which the reflex arc is of course destroyed by the implication of the gray matter. Loss or alteration of sensation, where it occurs from nerve-injury, generally shows itself in the distribution of the nerve, while the sensitive disturbances from disease or injury of the brain or spinal cord are less strictly confined to special nerve territories. The trophic disturbances arising from nerve-irritation are distinctively characteristic of nerve-injury.
But it is in the behavior of the nerves and muscles to electricity that we find some of the strongest points on which to base a diagnosis of nerve-injury, and, although not always conclusive as to the seat of
lesion, it enables us to reduce within very narrow limits the field for discrimination. The degenerative reaction which we have seen takes place in muscles the continuity of whose nerves have been destroyed, or in which degenerative changes have taken place in consequence of injury to their nerves, is never found in muscles paralyzed from the brain. In spinal paralysis resulting from transverse myelitis the electrical excitability of the nerves and muscles may be increased or diminished, but there is no degenerative reaction. In progressive muscular atrophy a careful electrical examination may discover the degenerative reaction in the affected muscles; but it is too obscure, and there are besides too many characteristic symptoms in that disease, to allow of a practical difficulty in diagnosis from its presence. In poliomyelitis anterior (infantile paralysis and the kindred affection in the adult) we have, it is true, the quantitative, qualitative changes of degenerative reaction, such as are seen after nerve-injury, and in such cases its presence is not conclusive of peripheral lesion. Here we may be assisted by remembering that while in poliomyelitis sensation is intact, in nerveinjury it is almost always affected in a greater or less degree, although it may have been recognizable but for a short time. In lead paralysis we also have the degenerative reaction, but whether the seat of lesion in that affection is central or peripheral is an undecided question.
T
REATMENT OF NERVE
-INJURIES
.—The therapeutics of nerve-injuries belong largely to surgery. When there is complete division of a nerve the ends should be united by suture at the time of injury. When this has not been done, and after the lapse of time no return of function is observed, the ends of the nerve should be sought for, refreshed with the knife, and brought together by suture. There is the more hope that such a procedure will be successful as we know that after a time the fibres of the peripheral portion of the nerve may be regenerated, even when there has been no reunion, and thus be in a condition to render the operation successful. It is a matter for consideration whether in injuries in which a certain portion of the nerve, not too great in extent, has been crushed or otherwise obviously destroyed, it would not be best to excise the destroyed
portion and bring the ends together Whether the use of electricity, the galvanic current, hastens the regeneration and restitution of the injured nerves cannot be affirmed with certainty, although in practice this has seemed to us to be the case, and the known catalytic action of the current gives us a possible explanation of such beneficial effects. But, however this may be, it is certain that with the first symptoms of returning function in the nerves and muscles the use of electricity obviously accelerates the improvement. And, again, in the treatment of the results of nerve-injury, such as paralysis, anæsthesia, pain, it is in the careful and very patient use of the electric currents, both faradic and galvanic, that most confidence is to be placed; the galvanic being generally most applicable and giving the better results. The symptoms of nerve-irritation are amongst those most difficult to treat successfully. Counter-irritation, heat, cold, electricity, may all be tried in vain, and as a last resource against pain, ulceration, and perverted nutrition we may be obliged to resort to nerve-stretching, or neurotomy. Under the head of Neuritis much must be said of treatment applicable to the inflammation, acute and chronic, resulting from nerve-injuries.
INFLAMMATION OF NERVES.
Neuritis.
Although inflammation of the nerves has been for a long time a recognized disease, its frequency and the extent and importance of its results have been appreciated only within a comparatively short time. The observations upon neuritis were formerly almost exclusively confined to acute cases, the results of traumatic lesions or the invasion of neighboring disease, while the more obscure forms occurring from cold, toxic substances in the circulation, constitutional disease, etc., or those apparently of spontaneous origin, escaped
attention, or were classed according to their symptoms simply as neurosis, functional disease of the nerves, or affections of the spinal cord. Hence the classic picture of neuritis is made to resemble exclusively the acute inflammation of other tissues, and tends to blind as to the subtler but not less important morbid processes in the nerves which at present we must classify as inflammation, though wanting, it may be, in some of the striking features seen in connection with inflammatory processes elsewhere. In short, we must not look for heat, redness, pain, and swelling as absolutely necessary to a neuritis.
Entering into the structure of the peripheral nerves we have the true nervous constituent, the fibres, and the non-nervous constituent, the peri- and endoneurium, in which are found the blood-vessels and lymph-channels. Though intimately combined, these tissues, absolutely distinct structurally and functionally, may be separately invaded by disease; and although it may not be practicable nor essential in every case to decide if we have to do with a parenchymatous or interstitial (peri-) neuritis, it is necessary to keep in mind how much the picture of disease may be modified according as one or the other of the constituents of the nerve are separately or predominantly involved. Thus, a different group of symptoms will be seen when the vascular peri- and endoneurium is the seat of inflammation from that which appears when the non-vascular nervefibres are themselves primarily attacked and succumb to the inflammatory process with simple degeneration of their tissue. Furthermore, it is not too speculative to consider that the different kinds of nerve-fibres may be liable separately or in different degrees to morbid conditions, so that when mixed nerves are the seat of neuritis, motor, sensitive, or trophic symptoms may have a different prominence in different cases in proportion as one or other kind of fibres is most affected.
ETIOLOGY.—Traumatic and mechanical injuries of nerves are the most common and best understood causes of neuritis. Not only may it be occasioned by wounds, blows, compression, and other insults to the nerves themselves, but jolting and concussion of the body,
and even sudden and severe muscular exertion, have been recorded as giving rise to it. We readily understand how neuritis is caused by the nerves becoming involved in an inflammation extending to them from adjacent parts, although the nerves in many instances show a remarkable resistance to surrounding disease. Less easily understood but undoubted causes of neuritis are to be found in the influence of cold, especially when the body is subjected to it after violent exertion. Although the causal connection is unexplained, we find neuritis a frequent sequel of acute diseases, as typhoid fever, diphtheria, smallpox, etc. In the course of many chronic constitutional affections, as syphilis, gout, elephantiasis græcorum, we encounter neuritis so frequently as to make us look for its cause in these diseases. Finally, neuritis may develop apparently spontaneously in one or many nerves.
MORBID ANATOMY.—The macroscopic appearance of nerves affected by neuritis is very varied, according as the disease is more interstitial or parenchymatous, acute or chronic. Sometimes the nerve is swollen, red, or livid, the blood-vessels distended, with here and there points of hemorrhage, the glistening white of the fibres being changed to a dull gray. Sometimes the nerves are reduced to gray shrunken cords. When the perineurium has been the principal seat of the inflammation we may have swellings at intervals along the course of the nerve (neuritis nodosa, perineuritis nodosa acuta) or, as in chronic neuritis, the trunk of the nerve may be hard and thickened from proliferation of the connective tissue, sclerosis of the nerve. The nerve does not always present the appearance of continuous inflammation, but the evidence of neuritis may be seen at points along its course which are separated by sound tissue. These points of predilection are usually exposed positions of the nerve or near joints. Often the nerve appears to the naked eye normal, and the characteristic changes of neuritis are only revealed by the microscope. The microscopical changes in neuritis may extend to all of the constituents of the nerve, and present the ordinary picture of acute inflammation, hyperæmia, exudation, accumulation of white corpuscles in the tissues, and even the formation of pus, the nervefibres exhibiting in various degrees the destruction of the white
substance of Schwann and the axis-cylinder Or, as in chronic neuritis, the alterations may consist in the more gradual proliferation of the peri- and endoneurium, which, contracting, renders the nerve dense and hard and destroys the nerve-fibres by compression. In acute as well as in chronic neuritis the perineurium may be exclusively affected, the fibres remaining normal (Curschman and Eisenlohr). The nerve-fibres themselves may be the primary and almost exclusive seat of the neuritis, exhibiting more or less complete destruction of all their constituent parts, except the sheath of Schwann, without hyperæmia and with little or no alteration of the interstitial tissue. Sometimes the fibres are affected at intervals, the degeneration occupying a segment between two of Ranvier's nodes, leaving the fibre above and below normal (nèvrite segmentaire periaxile, Gombault). All of these lesions of the nerve-fibres may be recovered from by a process of regeneration, the fibres showing a remarkable tendency to recover their normal structure and function.
SYMPTOMS OF NEURITIS.—When a mixed nerve is the seat of an acute neuritis, with hyperæmia of its blood-vessels, it becomes swollen by inflammatory exudation, and can be felt as a hard cord amongst the surrounding tissues. It is not only highly sensitive to direct pressure, but muscular exertion, or even passive movement of the part, excites pain. Spontaneous pain is one of the most prominent symptoms, and is sometimes so severe and continuous as to destroy the self-control of the patient, and demand the employment of every agent we possess for benumbing sensibility and quieting the excited system. At first there may be hyperæsthesia of the skin in the region of the distribution of the nerve, but a much more constant and significant symptom is cutaneous anæsthesia, which generally makes its appearance early in the course of the disease. The degree and extent of the anæsthesia varies very much in different cases, but is seldom total, except over small areas, even when the inflammation has seriously damaged the nerve-fibres. This is explained by the sensibility supplied to the part by neighboring nerves, as already described in treating of traumatic nerve-injuries. Very characteristic of acute neuritis are various abnormal sensations (paræsthesiæ) which are developed in a greater or less degree during the progress
of the disease, and are described by the patients as numbness, tingling, pins and needles, burning, etc. In a case of acute neuritis of the ulnar nerve seen by the writer the patient was much annoyed by a persistent sensation of coldness in the little and ring fingers, which caused him to keep them heavily wrapped up even in the warm weather of summer. When motor symptoms make their appearance they begin with paresis of the muscles, which may increase rapidly to paralysis. As this is the result of destructive changes, more or less complete, in the motor nerve-fibres, we will have, as would be expected, accompanying the paralysis the symptoms already detailed in the consideration of nerve-injuries with destruction of continuity—namely, absence of muscular tone, loss of skin and tendon reflexes, increased mechanical excitability, atrophy of muscles, and the different forms of degenerative reaction, with loss of faradic contractility. When spasm or tremor has been observed in acute neuritis of mixed nerves, it is a matter of doubt whether it is not to be explained by reflex action of the cord excited by irritated centripetal fibres. Various trophic symptoms may show themselves, as herpes zoster or acute œdema. Erythematous streaks and patches are sometimes observed upon the skin along the course of the inflamed nerve-trunks. In chronic neuritis, into which acute neuritis generally subsides or which arises spontaneously, the symptoms above described are very much modified; indeed, cases occur which exist for a long time almost without symptoms. While the affected nerve may be hard and thickened by proliferation of its connective tissue, pain, spontaneous or elicited by pressure, is not of the aggravated character present in acute neuritis, and may be quite a subordinate symptom. It has more of a rheumatic character, is less distinctly localized, more paroxysmal, and has a greater tendency to radiate to other nerves. It is probable that many ill-defined, so-called rheumatic pains which are so frequently complained of are the result of obscure chronic neuritis. Anæsthesia and various paræsthesiæ are often more prominent symptoms than pain. Sometimes there is a hyperæsthesic condition of the skin, in which touching or stroking the affected part causes a peculiarly disagreeable nervous thrill, from which the patient shrinks, but which, however, is not described as pain.
The motor symptoms in chronic neuritis of mixed nerves often remain for a remarkably long time in abeyance or may be altogether wanting. They may appear as tremor, spasm, or contraction, these, however, being probably reflex phenomena. Most commonly there is paresis, which may deepen into paralysis with atrophy of muscles and degenerative reaction. The trophic changes dependent on chronic neuritis are frequently very prominent and important. The skin sometimes becomes rough and scaly, sometimes atrophied, smooth, and shining (glossy skin). Œdema of the subcutaneous cellular tissue is often seen, for example, on the dorsum of the hand, where it may be very marked. The hair of the affected part shows sometimes increased growth, sometimes it falls off. The nails may become thickened, ridged, and distorted. Deformity of joints with enlargement of the ends of the bones is not infrequently met with as the result of chronic neuritis. In short, we may meet with all of those trophic changes which have been described as arising from nerveirritation, and which occur in chronic neuritis as the result of compression of nerve-fibres by the contraction of the proliferated connective tissue in the nerve-trunk.
The symptom-complex varies greatly in neuritis, so that there is hardly a symptom which may not be greatly modified or even wanting in some cases—a fact, which, as we have already said, may be explained by the morbid process fixing itself exclusively or in different degrees upon one or other of the component parts of the nerve-trunk, or, it may be, upon fibres of different functional endowment. Thus pain, usually one of the most prominent symptoms of neuritis, may be quite subordinate, or even absent, in cases of neuritis acute in invasion and progress. In a case of neuritis of the ulnar nerve seen by the writer, beginning suddenly with numbness and paresis, and rapidly developing paralysis, atrophy of muscles, loss of faradic contractility, with degenerative reaction, there was no pain during the disease, which ended in recovery.7 On the other hand, in mixed nerves the sensitive fibres may be long affected, giving rise to pain and various paræsthesiæ before the motor fibres are implicated, or these last may escape altogether.
7 “Two Cases of Neuritis of the Ulnar Nerve,” Maryland Medical Journal, Sept., 1881.
The swollen condition of the nerve, so characteristic in many cases of neuritis where the perineurium is the seat of a hyperæmia, is wanting in cases where the stress of the attack is upon the nervefibres themselves. Again, the trophic changes induced in the tissues by a neuritis may predominate greatly over the sensitive or motor alterations. Thus, in the majority of cases in which herpes zoster occurs it is without pain or paræsthesia. Indeed, in chronic neuritis the symptoms show such variations in different cases that it is difficult to give a general picture of the disease sufficiently comprehensive and at the same time distinctive. The prognosis in acute neuritis is generally favorable, although it must depend in a great measure upon the persistence of the cause producing it. Thus, if it has been excited by the inflammation of neighboring organs it cannot be expected to disappear while these continue in their diseased condition. In other cases the symptoms may subside with comparative rapidity; and so great is the capacity of the nerve-fibres for regeneration that recovery may be complete and nothing remain to indicate the previous inflammation. The nerve, however, that has once suffered from neuritis shows for a long time a tendency to take on an inflammatory action from slight exciting causes. If there has resulted an atrophy of muscles, we must expect some time to elapse before they recover their functional activity and normal electric reaction.
Acute neuritis most frequently passes into the chronic form, and it may then drag on indefinitely, stubbornly resisting treatment and giving rise to permanent derangement of sensibility, loss of muscular power, or perverted nutrition. Neuritis shows a tendency to spread along the affected nerve centripetally, sometimes reaching the spinal cord, and, as it has appeared in some cases, even the brain, causing tetanus or epilepsy.
Reflex paralyses, which at one time were believed to be the not infrequent result of nerve-irritation and inflammation, affecting from a distance the functions of the spinal cord, have been shown to be the
effect of an extension of the lesion of the inflamed nerve to the cord, causing organic disease. Instances of the extension of a neuritis to distant nerves, as those of an opposite extremity, without the implication of the spinal cord (neuritis sympathica), are most probably cases of multiple neuritis, to be considered farther on.
The DIAGNOSIS of cases of traumatic neuritis can scarcely present a difficulty. Acute neuritis with spontaneous pain, swelling, and tenderness of the nerve, presents distinctive features hardly to be confounded with any other affection, although thrombosis of certain veins, as the saphenous, may present some of its symptoms. To distinguish chronic neuritis or the cases wanting those obvious symptoms just indicated (many cases of sciatica) from neuralgia is a more difficult task. The following distinctive points may be noted: In neuritis the persistent and continuous character of the pain helps us to distinguish it from the more paroxysmal exacerbations of neuralgia, and its tendency, often seen, to spread centripetally spontaneously or when pressure is made on the nerve, may be also considered as characteristic of neuritis. Cutaneous anæsthesia, paresis, and atrophy of muscles are distinctive in any case of a neuritis rather than a neuralgia. Herpes zoster and other trophic changes speak strongly for a neuritis.
In the TREATMENT of neuritis the first indication is to get rid, as far as possible, of such conditions as may cause or keep up the inflammation, as, for instance, the proper treatment of wounds, the removal of foreign bodies, the adjustment of fractures, the reduction of dislocations, the extirpation of tumors, etc. Absolute repose of the affected part in the position of greatest relaxation and rest is to be scrupulously enforced. In acute neuritis local abstraction of blood by leeches and cups in the beginning of the affection is of the greatest advantage and should be freely employed. The application of heat along the course of the inflamed nerve has appeared to us preferable to the use of ice, although this also may be employed with excellent effect. The agonizing pain must be relieved by narcotics, and the hypodermic injection of morphia is the most efficient mode of exhibition. Salicylic acid or salicylate of sodium in large doses
contributes to control the pain. Iodide of potassium in large doses appears to act beneficially, even in cases with no syphilitic complications. In subacute or chronic neuritis local bloodletting is not as imperatively demanded as in the acute form, although it is sometimes useful. Here counter-irritation in its various forms and degrees, even to the actual cautery, is to be recommended. An excellent counter-irritation is produced by the application of the faradic current with the metallic brush. It appears from general experience that the counter-irritation has the best effect when applied at a little distance from the inflamed nerve, and not directly over its course. In the galvanic current we possess one of the very best means not only for relieving the symptoms of chronic neuritis, but for modifying the morbid processes in the nerve and bringing about a restoration to the healthy condition. Its application is best made by placing the anode or positive pole as near as possible to the seat of the disease, while the cathode or negative pole is fixed upon an indifferent spot at a convenient distance. The positive pole may be held stationary or slowly stroked along the nerve. Finally, in protracted cases nerve-stretching may be resorted to with great benefit. It probably owes its good effects to the breaking up of minute adhesions which have formed between the sheath of the nerve and the surrounding tissues, and which act as sources of irritation.
Multiple Neuritis, Multiple Degenerative Neuritis, Polyneuritis.
Cases of this important form of neuritis have been observed and recorded since 1864, but the resemblance of its symptoms to those of certain diseases of the central nervous system (poliomyelitis, Landry's paralysis, etc.) has prevented its general recognition, and it is only within the last few years that its distinctive pathological lesions have been demonstrated and its diagnosis made with considerable certainty. We can hardly overrate the importance of this in view of the great difference in gravity of prognosis between it and other diseases with which it may be confounded.
Multiple neuritis consists in a simultaneous or more or less rapidly succeeding inflammation of several or many usually bilaterally situated nerves, with a greatly preponderating, almost exclusive, lesion of the motor fibres. Commonly the disease attacks the lower extremities and progresses upward, although occasionally it has been seen to begin in the arms. It does not confine itself to the nerves of the extremities and trunk, but often involves the phrenics, causing paralysis of the diaphragm, and frequently invades one or more of the cranial nerves, notably the vagus, thus giving rise to the rapid heart-beat so often seen in the disease. In the cases of multiple neuritis observed the muscles of deglutition have never been paralyzed. The sphincter ani and bladder have likewise escaped. All degrees of acuteness are observed in the course it runs, from the cases terminating rapidly in death to those in which the disease extends over months, slowly involving nerve after nerve, until nearly all of the muscles of the body are paralyzed, when death may result or a more or less complete recovery take place. The invasion of the disease is in most cases sudden, even when its subsequent course is chronic, and is often marked by decided constitutional disturbance, as rigors, fever, delirium, albuminuria, etc. Disturbances of sensation are prominent among the initial symptoms, and are of great importance for the diagnosis of the disease. Severe, spontaneous, paroxysmal pain of a shooting, tearing character has ushered in most of the cases on record, remitting, however, during their progress. Pain is not always present, nevertheless, and cases not infrequently occur which run a painless course. In some cases which have come under the writer's notice spontaneous pain did not occur until some days after the disease was fully declared by other symptoms. More constantly present, and more characteristic of multiple neuritis, are the disturbances of sensation which show themselves in subjective feelings of numbness, tingling, pins and needles, coldness, burning, and other paræsthesiæ, which appear at its outset and continue to be present more or less during its course. Anæsthesia, not of a high degree nor at all coextensive with the paralysis of the muscles—sometimes, indeed, confined to very circumscribed areas—may be said to exist always in multiple neuritis—a fact of great diagnostic value.
Hyperæsthesia of the skin is frequently seen Hyperalgesia and analgesia are sometimes observed. Hyperæsthesia of the muscles is a very marked symptom in almost every case, and shows itself not only upon direct pressure being made, but also in the pain elicited by passive movements of the parts affected. Pressure upon nervetrunks does not cause pain as invariably as might have been expected from the location of the disease. Delayed sensation has been frequently observed.
Paresis of muscles, often commencing suddenly, is early seen in multiple neuritis, and increases until there is more or less complete paralysis, the most important feature of the disease. The paralyzed muscles present the flabby condition characteristic of muscles deprived of the tonic influence of the spinal cord. Atrophy, which is not commensurate, however, with the paralysis, soon begins, and may go on to an extreme degree. As the paralysis develops the tendon reflexes are lost, and there may be diminution or loss of the skin reflexes also. The paralyzed muscles lose their faradic contractility, and exhibit diminution of electric excitability to the galvanic current, and, finally, the various forms of degenerative reaction. It is remarkable that neither the impairment of sensation nor the paralysis is, as a rule, strictly confined to the areas of distribution of particular nerves, but is diffused over regions of the body. Thus in the limbs the motor and sensory symptoms are most marked at their extremities, gradually diminishing toward the trunk. In some cases multiple neuritis appears to have occasioned the inco-ordinate movements of locomotor ataxy. In the progress of the disease a rigidity and contracted condition of muscles may be developed, occasioning a fixed flexion of some of the joints. Profuse sweating, œdema of the hands and feet, trophic changes in the skin, mark at times the implication of trophic and vaso-motor nerves. Bed-sores do not occur.
The pathological changes in pure cases of multiple neuritis are found in the nerve-trunks, mainly toward their peripheral terminations, and in their muscular branches, the evidences of disease diminishing toward the larger trunks, the nerve-roots being unaffected and the
spinal cord showing no lesions. Sometimes the affected nerves present, even to the naked eye, unmistakable proof of acute inflammation. They are reddened by hyperæmia, swollen by exudation, and small extravasations of blood may be seen among their fibres. The microscope shows congestion of the blood-vessels, exudation of the white corpuscles, even to the formation of pus, alteration of the endo- and perineurium; in short, all the evidence of an interstitial inflammation, the nerve-fibres being comparatively little altered, and suffering, as it were, at second hand. In most of the cases, however, the nerves macroscopically present little or nothing giving indication of disease. The microscopic changes, however, are extensive, and pertain almost exclusively to the nerve-fibres themselves. These are altered and degenerated, giving an appearance almost precisely the same as already described in treating of the changes occurring in nerves separated by injury from the centres—Wallerian degeneration.8 There is no hyperæmia, thickening, or change in the endoneurium. So great are these differences in the microscopic appearance of the nerves in different cases of multiple neuritis that objection has been raised to classing the two varieties together, and it has been argued that we cannot with right designate the cases in which hyperæmia and other evidence of a general inflammation are absent as neuritis. It has been, however, argued—apparently, to the writer, with better reason —that the same morbid influence which at one time affects the blood-vessels, causing their congestion and the passage through their walls of the white corpuscles and the exudation of inflammation, may at another time, by a direct and isolated influence upon the nerve-fibres, cause their degeneration; in other words, that there may be a parenchymatous neuritis, which shall affect only the nervefibres. The vastly disproportionate implication of the motor fibres would point to the fact of a selective infection in multiple neuritis of certain fibres, as there is a selective infection in poliomyelitis of the motor cells of the anterior horns of the spinal gray matter
8 Gombault's observations (Arch. de Névrologie, 1880) would seem to show that there is a difference in the lesion of the fibres in neuritis from that in simple Wallerian degeneration, inasmuch as that in the former the first alteration is seen about the
nodes of Ranvier, and occurs at points separated from each other by healthy fibre, and also in the more tardy destruction of the axis-cylinder
ETIOLOGY.—Much in the symptomatology of multiple neuritis, especially of its invasion, strongly urges us to the conclusion that it is a constitutional disease caused by an unknown morbid influence, the stress of which falls upon the nervous system. This view receives strong support from the history of the Japanese kak-ke or Indian beriberi, a disease at times epidemic in those countries, and which has the undoubted symptoms and the characteristic pathological alterations of multiple neuritis. After many acute infectious diseases neuritis of individual nerves is not uncommon, but the distinctive characteristics of multiple neuritis have, so far, been observed almost exclusively after diphtheria, to which it is not infrequently a sequel. It has been observed as the result at least occurring in intimate connection with polyarthritis, and the frequency with which it has occurred in the phthisical is remarkable. There have been not a few cases of multiple neuritis recorded as having been produced by chronic alcohol-poisoning. A well-marked case has come under the writer's observation in which the immediate cause was acute poisoning by arsenious acid, a very large amount having been taken at one dose by mistake. The poison of syphilis has been regarded as standing in a causal relation to multiple neuritis. For the rest, the exciting causes (probably acting in connection with a peculiar condition of the system) have appeared to be exposure to cold, great muscular exertion, direct mechanical injury to the nerves, as the rough jolting of a wagon, or the inflammation of a nerve which has in some unknown way extended to others.
The DIAGNOSIS of multiple neuritis in certain cases presents great difficulty, from the close resemblance of its symptoms to those of poliomyelitis. The prominent symptoms in the muscular system—viz. paralysis, atrophy, the degenerative reaction—are the same in both. It may be remarked, however, that in multiple neuritis the paralysis is more generally diffused over the muscles of the affected limbs, while in poliomyelitis it is more confined to the areas of distribution of particular nerve-branches. Pain is common to the beginning of both
diseases, but it generally passes off more quickly and completely in poliomyelitis. The persistent hyperæsthesia of the muscles is wanting in poliomyelitis. But it is in the diminution and alteration of sensation that we have the surest means of distinguishing between the two affections. This symptom seldom or never fails to show itself in multiple neuritis, although its area may be circumscribed and it may be slight in degree, while it certainly makes no part of the symptomatology of poliomyelitis. It has been asserted that the implication of the cranial nerves so often seen in multiple neuritis never occurs in poliomyelitis. When we consider the intimate connection of the anterior horns of the spinal gray matter with the motor nerve-fibres, it appears highly probable that the same morbid influence may invade both simultaneously or in quick succession, thus producing a complex of symptoms rendering a diagnosis very difficult, and probably giving rise to some confusion in the recorded symptoms of multiple neuritis. From Landry's paralysis multiple neuritis is to be distinguished by the impairment of sensibility, the loss of faradic contractility, and absence of the tendon reflex; from progressive muscular atrophy, by the loss of sensibility and the much more obvious degenerative reaction.
The PROGNOSIS of multiple neuritis is in the great majority of cases not grave, so far as life is concerned, even when there is extensive paralysis. Death may occur early in the acute form of the disease or it may take place at the end of chronic cases. When the disease proves fatal, it is from paralysis of the diaphragm and the other muscles of respiration. Where the paralysis and atrophy have been great, showing profound alteration of the nerves, a long time is required for recovery, and more or less paralysis, contracture, or defective sensibility may permanently remain.
The TREATMENT consists, at the outset, in rest and position, the local abstraction of blood (in cases where the nerve-trunk is swollen and tender), and the administration of such drugs as we suppose act favorably upon the inflammation of the nerves. Salicylic acid or salicylate of sodium seem to act beneficially in relieving the severe pains in the outset of the disease. Iodide of potassium, gradually
increased until large doses are taken, has, in the experience of the writer, seemed to beneficially modify the course of multiple neuritis. The necessary relief of pain is best obtained by hypodermic injections of morphia, supplemented by heat applied to the affected nerves. To these means may be added rubbing with chloroform and applying to the painful parts cloths dipped in a 5 per cent. solution of carbolic acid. After the acute stage has been passed and in chronic cases, just as soon as we have reason to suppose that the degenerative process in the nerves has come to a standstill, we possess in the use of electricity the means of hastening the regeneration of the nerve-fibres, strengthening the paralyzed muscles, and restoring the sensation. The galvanic current is to be preferred, and it is to be applied to the crippled nerves and muscles —sometimes stable for its electrolytic action, sometimes interrupted to obtain its exciting and stimulating effect. The excitement to nerves and muscles by the use of the faradic current has also its uses in hastening recovery. Protracted treatment and much patience are required to overcome contractions and restore the nerves and muscles, and the effects of the disease may be seen for a long time in the weakness and diminished electric reaction of the muscles.
Anæsthesia of Peripheral Origin.
A prominent and important symptom of the lesion of peripheral nerves is the diminution and loss of cutaneous sensibility. Besides the anæsthesia caused by the affections of the fibres themselves, which has been touched upon in the preceding pages, it may be produced by morbid states of the peripheral end-organs or cutaneous terminations of the nerves. Cold applied to a nerve-trunk may produce alterations which for days after cause numbness and paræsthesia in the surface to which it is distributed, and the application of cold to the surface of the body, as we know from common observation, causes blunting of the cutaneous sensations, especially that of touch. In this way, from exposure to the atmosphere at low temperatures, to cold winds, or by the immersion
of the body in cold water, the end-organs of the nerves in the skin are morbidly affected, and anæsthesia results, the so-called rheumatic anæsthesia. Many substances, as acids, notably carbolic acid, alkalies, narcotics, etc., act upon the cutaneous end-organs in a way to destroy their capacity for receiving or transmitting impressions and produce a more or less persistent anæsthesia of the skin. In the anæsthesia so often observed in the hands and forearms of washerwomen we have an example of the action probably of several of these causes, as the frequent plunging of the hands into cold water and the action upon the skin of alkalies and alkaline soaps. The diminution or interruption of the circulation through the skin, as in ischæmia from spasm of the minute arteries due to an affection of the vaso-motor nerves, is also a cause of cutaneous anæsthesia. In lepra anæsthetica (Spedalskhed) the cutaneous anæsthesia is dependent upon a neuritis of the minute branches in the skin. The local anæsthesia met with so often in syphilis, though its pathology is doubtful, is not improbably sometimes caused by an affection of the peripheral nerves (neuritis?) and their end-organs. After many acute diseases, diphtheria, typhoid fever, etc., we have cutaneous anæsthesia in connection with muscular paralysis, the cause of both being a neuritis. The patient is made aware of the loss of sensation by some interference with his usual sensations and movements. If he puts a glass to his lips, the sensation is as if a bit were broken out of the rim; his accustomed manipulations are awkward, because of the want of distinct appreciation of the objects he holds; he fumbles in buttoning his clothes or he stumbles unless looking to his steps. An examination, nevertheless, almost always reveals that the anæsthesia is greater than would have been supposed from the subjective feelings of the patient; indeed, cases occur in which he is not aware of an existing defect of sensation. But a careful examination is not only required to determine the extent, but by it alone can we arrive at a knowledge of the quality of the anæsthesia —viz. whether there is a loss of all of the different kinds of sensation, whether they are affected in an unequal degree, or whether some have entirely escaped. Thus we must test for the acuteness of the simple sense of touch by comparing the sensations elicited by the
contact of small surfaces of unequal size, as the point and head of a pin or pencil, observing the appreciation by touch of the patient for different substances, as woollen, silk, linen, cloth, or comparing the sensation of the anæsthesic part with the same part on the opposite healthy side of the body. The sense of locality and space may be examined by placing at the same instant upon the skin of the patient, his eyes being closed, two points (the anæsthesiometer or the points of a compass), and observing his capacity for appreciating the impression as double. As there is an enormous difference of acuteness of the space-sense in the skin of different parts of the body (see textbooks of physiology)—ranging from the tip of the tongue, where the touch of two points separated 1.2 mm. gives a double sensation, to the thigh, where the points must be separated 77 mm. to be felt as two—we must be careful to consider in making the examination the normal space-perception of the region. Care must be taken not to repeat the test too often, as a rapid education of the surface to a more delicate appreciation of the impressions is the result. In certain abnormal conditions from spinal disease we have a condition of polyæsthesia in which the impression of one point is felt as two or more. The sense by which we appreciate the pressure of objects must be tested by placing upon the surface to be examined, in succession, objects of different weight, care being taken to have the area which touches the skin and the temperature the same in each. The parts to be tested must be firmly supported, and all muscular contraction on the part of the patient prevented. The temperature sense is examined by the application of hot and cold water or bodies of different temperature. We sometimes meet with a perversion of this sense in which the application of a cold surface to the skin gives the sensation of warmth, and the contrary. In testing the sense of temperature and the sense of pressure it is not the absolute capacity of appreciating on the part of the patient that we investigate, but the power of discriminating between different degrees of temperature or pressure. The sense of pain must likewise be tested, since morbid conditions occur in which it may be caused more readily than is normal by exciting the cutaneous nerves, and that, too, in parts which have in a great measure or quite lost the sense of touch; or, on the other hand, touch may be retained, while
irritation of the skin can excite no feeling of pain (analgesia). We have in the faradic current an excellent means of testing the cutaneous sensibility, inasmuch as it excites the skin over the various parts of the body about equally, and it can be employed in very gradually increasing or decreasing strength. Its effects on the affected part must be compared with those produced on the healthy surface of other parts of the patient's body or on healthy individuals.
Frequently accompanying cutaneous anæsthesia, but constituting no part of it, are various paræsthesiæ, as formication, pins and needles, burning, etc. Pain, sometimes of great intensity, is not infrequently connected with it (anæsthesia dolorosa). The paræsthesiæ and pain are the result of irritation in some portion of the conducting tracts, and, together with the trophic changes so often seen in connection with nerve-injuries, they have been already considered under that head.
It is a very important point to make the diagnosis between central and peripheral anæsthesia, but it is often a matter of great difficulty, and sometimes not to be made at all. The history of the case must be carefully considered, and an examination made for symptoms of brain or spinal disease, the existence of nerve lesions, or if there is a history of toxic influences, etc. In peripheral anæsthesia the reflexes which may be normally excited from the affected surface are wanting, in contradistinction to anæsthesia of central origin, in which they are most generally retained or even increased. Concomitant trophic changes speak strongly for a peripheral origin, as do also paralysis and atrophy of muscles. Loss of some of the forms of sensation, with retention of others—i.e. partial paralysis of sensation —indicate a central origin.
The TREATMENT of peripheral anæsthesia must look, in the first place, to removal, if possible, of its cause, and the treatment of diseased conditions, if any exist, of the nerve-trunks, as neuritis, mechanical injuries, etc. Local applications of a stimulating character may be advantageously used upon the anæsthesic parts. By far the most effective stimulant to the diseased nerves is the faradic or galvanic
