Archives of Internal Medicine

MYERS, WALTER K.;KEEFER, CHESTER S.

doi: 10.1001/archinte.1935.00160210002001pmid: N/A

Abstract In cirrhosis of the liver the accumulation of fluid in the peritoneal cavity is generally associated with a high degree of portal obstruction. This has been demonstrated repeatedly, but in a most convincing manner by McIndoe.1 However, clinical observations suggest that other factors play important parts. The spontaneous variation of the amount of peritoneal fluid, the diminution of the ascites following the administration of diuretics and the changes subsequent to an alcoholic bout or an attack of dysentery are difficult to explain on the basis of portal obstruction alone. Dependent edema of varying degree is frequently observed in patients with cirrhosis of the liver and portal obstruction. The edema of these patients has been explained on a basis of increased intraabdominal pressure, causing obstruction of the venous return from the legs, or as a manifestation of cardiac failure. There are many patients concerning whom these explanations are inadequate. Edema References 1. McIndoe, A. H.: Vascular Lesions of Portal Cirrhosis , Arch. Path. 5:23 ( (Jan.) ) 1928. 2. Peters, J. P.; Eisenman, A. J., and Bulger, H. A.: The Plasma Proteins in Relation to Blood Hydration: I. In Normal Individuals and in Miscellaneous Conditions , J. Clin. Investigation 1:435 ( (June) ) 1925.Crossref 3. Wiener, H. J., and Wiener, R. E.: Plasma Proteins , Arch. Int. Med. 46:236 ( (Aug.) ) 1930.Crossref 4. Loeb, R. F.; Atchley, D. W., and Palmer, W. W.: On the Equilibrium Condition Between Blood Serum and Serous Cavity Fluids , J. Gen. Physiol. 4:591, 1922.Crossref 5. Foord, A. G.; Youngberg, G. E., and Wetmore, V.: The Chemistry and Cytology of Serous Fluids , J. Lab. & Clin. Med. 14:417 ( (Feb.) ) 1929. 6. Barnett, C. W.; Jones, R. B., and Cohn, R. B.: The Maintenance of a Normal Plasma Protein Concentration in Spite of Repeated Protein Loss by Bleeding , J. Exper. Med. 55:683 ( (May) ) 1933. 7. Bernard, E.: Dilution et concentration sanguines aprés les ponctions d'ascites: L'étape sanguine de la fonte des oedémes , Semaine d. hôp. de Paris 6:581 ( (Dec. 15) ) 1930. 8. Gilbert, A., and Cheray, M.: Diminution des substances albumineuses du sérum sanguin chez les cirrhotiques ascitiques , Mém. Soc. de biol. 63:487, 1907. 9. Grenet, H.: Diminution des albumines du sérum sanguin chez les hépatiques , Mém. Soc. de biol. 63:532, 1907. 10. Salvesen, H. A.: Variations in the Plasma Proteins in Nonrenal Conditions , Acta med. Scandinav. 72:113, 1929. 11. Abrami, P., and Robert-Wallech: Modifications du sérum sanguin du foie avec ascites: Inversion du rapport sérums-globulines , Compt. rend. Soc. de biol. 101:291 ( (May 25) ) 1929. 12. Peters, J. F., and Eisenman, A. J.: The Serum Proteins in Diseases Not Primarily Affecting the Cardiovascular System or Kidneys , Am. J. M. Sc. 186:808 ( (Dec.) ) 1933. 13. Thompson, W. H.; Ziegler, M., and McQuarrie, I.: A Comparative Study of the Inorganic Metabolism in Nephrosis and in Edema of Undetermined Origin , Am. J. Dis. Child. 44:650 ( (Sept.) ) 1932. 14. Myers, W. K., and Taylor, F. H. L.: Hypoproteinemia Probably Due to Deficient Formation of Plasma Proteins , J. A. M. A. 101:198 ( (July 15) ) 1933. 15. Jollis, quoted by Grenet.8b 16. Sawada, T.: Biochemical Investigation of the Blood in Cases of Experimental Disturbance of Liver Function , Jap. J. Gastroenterol. 3:38 ( (April) ) 1931.

GRABFIELD, G. P.;ADAMS, L. G.

doi: 10.1001/archinte.1935.00160210013002pmid: N/A

Abstract These studies were initiated in the attempt to utilize the effects of iodides and salicylates on the excretion of nitrogen and sulphur1 in the study of Bright's disease. It has been shown previously that iodides and salicylates mobilize different types of nitrogen and that the effect of iodide is produced by the mediation of the thyroid gland.2 When an attempt was made to conduct similar studies on patients with renal disease, it was observed that patients with the nephrosis syndrome showed a relationship between the amount of nitrogen and the amount of sulphur excreted in the urine similar to that exhibited by persons as an effect of the administration of iodides, whereas patients with other types of renal disease showed a totally opposed relationship between these two urinary constituents. Further studies indicated that the reaction to iodides and salicylates in patients with Bright's disease3 was different from References 1. Grabfield, G. P.: The Action of Iodides on the Nitrogen Metabolism , Boston M. & S. J. 197:1121, 1927. 2. Grabfield, G. P., and Knapp, E.: The Effect of Salicylates on the Nitrogen Metabolism with Special Reference to the Effect of the Cation of the Salt , J. Pharmacol. & Exper. Therap. 32:341, 1928. 3. Grabfield, G. P.; Flower, B.; Gray, C., and Knapp, E.: The Mechanism of the Action of Iodides on the Nitrogen Metabolism , J. Clin. Investigation 4:323, 1927. 4. Grabfield, G. P.: The Effect of Iodides on the Nitrogen and Sulphur Metabolism in Bright's Disease , J. Pharmacol. & Exper. Therap. 42:253, 1931. 5. Grabfield, G. P.: Studies on the Nitrogen and Sulphur Metabolism in Bright's Disease: I. Retention of Nitrogen and Sulphur in "Nephrosis," J. Clin. Investigation 9:311, 1930. 6. Grabfield, G. P.: Studies on the Nitrogen and Sulphur Metabolism in "Bright's Disease": II. Observations on the Nitrogen and Sulphur Excretion in Patients without Renal Edema , J. Clin. Investigation 10:309, 1931. 7. Wakefield, E. G., and Keith, N. M.: A Study of Inorganic Sulphates in Relation to Acid-Base Equilibrium in Renal Insufficiency and "Renal Acidosis," J. Clin. Investigation 9:19 ( (Aug.) ) 1930. 8. Wakefield, E. G.: Inorganic Sulphates in Renal Insufficiency , Arch. Int. Med. 44:244 ( (Aug.) ) 1929. 9. Loeb, R. F., and Benedict, E. M.: Inorganic Sulphates in Human Blood , J. Clin. Investigation 4:33, 1927. 10. Grabfield, G. P.; Driscoll, M., and Gray, M. G.: Nitrogen and Sulphur Metabolism in Bright's Disease: V. Metabolic Study of a Patient with Edema of Unknown Origin , Arch. Int. Med. 54:764 ( (Nov.) ) 1934. 11. Robison, R.: Gelatine as a Food Stuff , Biochem. J. 16:111, 1922. 12. Robison, R., and Martin, C. J.: On the Biological Value of Certain Proteins , Biochem. J. 16:407, 1922. 13. Grabfield, G. P.: Unpublished data. 14. Robison, R.: Personal communication to the authors. 15. Fowler, C. C., and Hawk, P. B.: Studies on Water Drinking: II. The Metabolic Influence of Copious Water Drinking with Meals , J. Exper. Med. 12: 388, 1910.

FRIEDMAN, GEORGE

doi: 10.1001/archinte.1935.00160210024003pmid: N/A

Abstract An analysis of the cardiovascular status of the diabetic patient involves chiefly a study of the interrelationship of arteriosclerosis and diabetes. One hundred and twenty cases in patients above the age of 39 have been observed with this in view. The data presented here deal with the incidence of the important cardiovascular variants, and with their relation to age and sex and to the severity and duration of diabetes. To these are added some observations on the clinical types of arteriosclerosis in diabetic patients and on the significance of retinitis and abnormalities of the electrocardiogram. The primary data are tabulated in table 1 and summarized in table 2. The relation to sex is shown in table 3 and to age in table 4. CARDIOVASCULAR VARIANTS Cardiac Enlargement. —The heart in nondiabetic arteriosclerotic patients is as often small as large. In the autopsy material analyzed by Cabot,1 64 per cent References 1. Cabot, Richard C.: Facts on the Heart , Philadelphia, W. B. Saunders Company, 1926, pp. 417 and 423. 2. These probably include some diabetic patients. 3. Nathanson, M. H.: Coronary Disease in One Hundred Autopsied Diabetics , Am. J. M. Sc. 183:495, 1932.Crossref 4. Warren, S.: The Pathology of Diabetes , Philadelphia, Lea & Febiger, 1930, p. 148. 5. Major, S. G.: Blood Pressure in Diabetes Mellitus . Arch. Int. Med. 44:797 ( (Dec.) ) 1929.Crossref 6. Kramer, D. W.: Hypertension and Diabetes , Am. J. M. Sc. 176:23, 1928.Crossref 7. Sherril, J. W.: Cardiovascular Disease in Diabetes Mellitus , California & West. Med. 38:73; 39:17, 1933. 8. Moore, R. F.: The Retinitis of Arteriosclerosis and Its Relation to Renal Retinitis and to Cerebral Vascular Disease , Quart. J. Med. 10:29, 1917. 9. Bessière, E.: Existe-t-il une rétinite diabétique en l'absence d'altérations rénales? Arch. d'ophth. 49:219, 1932. 10. White, Priscilla: Diabetes in Childhood and Adolescence , Philadelphia, Lea & Febiger, 1932, pp. 193 and 217. 11. Wagener, H. P., and Wilder, R. M.: The Retinitis of Diabetes Mellitus , J. A. M. A. 76:515 ( (Feb. 19) ) 1921. 12. Spalding, E. M., and Curtis, W. S.: Retinitis and Other Changes in the Eyes of Diabetics , Boston M. & S. J. 197:165, 1927. 13. Hepburn, J., and Graham, D.: An Electrocardiographic Study on One Hundred and Twenty-Three Cases of Diabetes Mellitus , Tr. A. Am. Physicians 43:86, 1928. 14. Joslin, E. P.; Dublin, L. I., and Marks, H. H.: Studies in Diabetes Mellitus: Its Incidence and the Factors Underlying Its Variations , Am. J. M. Sc. 187:433, 1934. 15. Emerson, H., and Larimore, L. D.: Diabetes Mellitus: A Contribution to Its Epidemiology Based Chiefly on Mortality Statistics , Arch. Int. Med. 34:585 ( (Nov.) ) 1924. 16. Joslin, E. P.: Diabetes: Its Control by the Individual and the State , Boston, Harvard University Press, 1931, p. 46 17. The Treatment of Diabetes Mellitus , ed. 4, Philadelphia, Lea & Febiger, 1928, p. 675 18. The Ten-Year Diabetic , Am. J. M. Sc. 175:472, 1928. 19. Joslin, E. P.; Dublin, L. I., and Marks, H. H.: Studies in Diabetes Mellitus: Characteristics and Trends of Diabetes Mortality Throughout the World , Am. J. M. Sc. 186:753, 1933. 20. John, H. J.: Diabetes: A Statistical Study of One Thousand Cases , Arch. Int. Med. 39:67 ( (Jan.) ) 1927. 21. Week. Bull., New York City Health Dept. 20:357, 1931. 22. Wendt, L. F. C., and Peck, F. B.: Diabetes Mellitus: A Review of 1,073 Cases, 1919-1929 , Am. J. M. Sc. 181:52, 1931. 23. Morrison, L. B., and Bogan, I. K.: Calcifications of the Vessels in Diabetes , J. A. M. A. 92:1424 ( (April 27) ) 1929. 24. Gray, P. A., and Sansum, W. D.: The Higher Carbohydrate Diet Method in Diabetes Mellitus , J. A. M. A. 100:1580 ( (May 20) ) 1933. 25. Leutenegger, F.: Diabetes Mellitus und Gefässystem , Ztschr. f. klin. Med. 119:164, 1931. 26. Bowen, B. D., and Koenig, E. C.: Arteriosclerosis and Diabetes Including a Roentgenological Study of the Lower Extremities , Bull. Buffalo Gen. Hosp. 5:31, 1927. 27. Rabinowitch, I. M.: The Cholesterol Content of Blood Plasma in Diabetes Mellitus , Arch. Int. Med. 43:363 ( (March) ) 1929.Crossref 28. Shepardson, H. C.: Arteriosclerosis in the Young Diabetic Patient , Arch. Int. Med. 45:674 ( (May) ) 1930.Crossref 29. Nathanson.3 Enklewitz, M.: Diabetes and Coronary Thrombosis , Am. Heart J. 9:386, 1934.Crossref 30. Joslin,15b pp. 375 and 678. 31. Barach, J. H.: The Incidence of Rheumatic Heart Disease Among Diabetic Patients , Am. Heart J. 2:196, 1926.Crossref 32. Penfield, W.: The Influence of the Diencephalon and Hypophysis upon General Autonomic Functions , Bull. New York Acad. Med. 9:613, 1933. 33. Joslin,15b p. 754. 34. John, H. J.: Diabetes: A Statistical Study of Two Thousand Cases , Arch. Int. Med. 42:217 ( (Aug.) ) 1928.Crossref 35. Warthin, A. S.: The Rôle of Syphilis in the Etiology of Angina Pectoris, Coronary Arteriosclerosis and Thrombosis and of Sudden Cardiac Death , Tr. A. Am. Physicians 45:123, 1930. 36. Joslin,15b p. 676. 37. Warren,4 pp. 124 and 148. 38. Wilder, R. M.: Necropsy Findings in Diabetics , South. M. J. 19:241, 1926.Crossref 39. Von Noorden, C.: Die Zuckerkrankheit und ihre Behandlung , ed. 5, Berlin, A. Hirschwald, 1910, P. 189. 40. Blotner, H.: Coronary Disease in Diabetes Mellitus , New England J. Med. 203:709, 1930.Crossref 41. Root, H. F., and Graybiel, A.: Angina Pectoris and Diabetes Mellitus , J. A. M. A. 96:925 ( (March 21) ) 1931.Crossref 42. Joslin, 15b. Levine, S. A.: Coronary Thrombosis: Its Various Clinical Features , Medicine 8:245, 1929. 43. Allbutt, T. C.: Arteriosclerosis: A Summary View , New York, The Macmillan Company, 1925 44. Diseases of Arteries Including Angina Pectoris , New York, The Macmillan Company, 1915. 45. Evans, G.: A Contribution to the Study of Arteriosclerosis , Quart. J. Med. 14:215, 1921.Crossref 46. Keith, N. M.; Wagener, H. P., and Kernohan, J. W.: The Syndrome of Malignant Hypertension , Arch. Int. Med. 41:141 ( (Feb.) ) 1928.Crossref 47. Fishberg, A. M.: Hypertension and Nephritis , Philadelphia, Lea & Febiger, 1930. 48. Klemperer, P., and Otani, S.: Malignant Nephrosclerosis (Fahr) , Arch. Path. 11:60 ( (Jan.) ) 1931. 49. Blitzsten, E. P. W., and Schram, D. L.: Diabetes: Electrocardiographic Studies , Arch. Int. Med. 36:770 ( (Dec.) ) 1925.Crossref 50. Lewis, T.: Mechanism and Graphic Registration of the Heart Beat , London, Shaw & Sons, 1925, p. 122. 51. Katz, L. N.: The Significance of the T Wave in the Electrogram and the Electrocardiogram , Physiol. Rev. 8:447, 1928. 52. Faulkner, S. M., and Hamilton, B. E.: The Electrocardiogram in Diabetic Coma , Am. Heart J. 8:691, 1933.Crossref 53. Middleton, W. S., and Oatway, W. H.: Insulin Shock and the Myocardium , Am. J. M. Sc. 181:39, 1931.Crossref 54. Soskin, S.; Katz, L. N.; Strouse, S., and Rubinfeld, S. H.: Treatment of Elderly Diabetics with Cardiovascular Disease , Arch. Int. Med. 51:122 ( (Jan.) ) 1933.Crossref 55. Smith, K. S., and Hickling, R. A.: Electrocardiographic Changes During Treatment of Severe Diabetes , Lancet 1:501, 1932.Crossref

NECHELES, H.;COYNE, A.

doi: 10.1001/archinte.1935.00160210048004pmid: N/A

Abstract The importance of gastric mucus as a neutralizer of gastric acidity and as a protective coating mechanism has been stressed by Heidenhain,1 Pavlov2 and his school, Zweig,3 Webster,4 Bolton and Goodhart,5 Fogelson,6 Kim and Ivy,7 Babkin and Komarov8 and a number of other workers.9 Differing views have recently been advanced by Bonis,10 Kalk and Bonis11 and Mitchell.12 The work reported here was undertaken in order to find how much visible mucus and acid is secreted by persons suffering from peptic ulcer as compared with that secreted by normal persons. It was thought that a difference in the amount of mucus secreted by the two groups might be indicative of the protective mechanism of mucus against autodigestion of the stomach or the first part of the duodenum. The improbability of a protection of the duodenum by antitrypsin has been demonstrated in earlier papers.13 Gastric mucus is secreted by the cylindric surface References 1. Heidenhain, R., in Hermann, L.: Handbuch der Physiologie , Leipzig, F. C. W. Vogel, 1883, vol. 5, p. 122. 2. Pavlov, I. P.: The Work of the Digestive Glands , London, C. Griffin & Company, 1910. 3. Zweig, W.: Arch. f. Verdauungskr. 12:364, 1906.Crossref 4. Webster, D. R.: Am. J. Physiol. 90:718, 1929. 5. Bolton, C., and Goodhart, G. W.: J. Physiol. 73:115, 1931 6. 77:287, 1933. 7. Fogelson, S. J.: Treatment of Peptic Ulcer with Gastric Mucin , J. A. M. A. 96:673 ( (Feb. 28) ) 1931.Crossref 8. Kim, M. L., and Ivy, A. C.: Prevention of Experimental Duodenal Ulcer by Feeding Neutral Gastric Acid , J. A. M. A. 97:1511 ( (Nov. 21) ) 1931.Crossref 9. Babkin, B. P., and Komarov, S. A.: Canad. J. M. A. 27:463, 1932. 10. Babkin, B. P.: Die äussere Sekretion der Verdauungsdrüsen , Berlin, Julius Springer, 1928, p. 364. 11. Bonis, A.: Ztschr. f. klin. Med. 113:611, 1930. 12. Kalk, H., and Bonis, A.: Deutsches Arch. f. klin. Med. 173:53, 1932. 13. Mitchell, T. C.: J. Physiol. 73:427, 1931. 14. Necheles, H.; Ling, J., and Fernando, F.: Am. J. Physiol. 79:1, 1926. 15. Necheles, H., and Fernando, F.: Am. J. Physiol. 79:9, 1926. 16. Necheles, H.: Chinese J. Physiol. 2:229, 1928. 17. Lim, R. K. S.: Quart. J. Micr. Sc. 66:187, 1922. 18. Brestkin, M. P., and Bickoff, K. M.: J. russe de physiol. 7:301, 1924 19. Babkin, p. 365.9 20. Webster, D. R., and Komarov, S. A.: J. Biol. Chem. 96:133, 1932. 21. Fisher, R. A.: Statistical Methods for Research Workers , New York, Oxford University Press, 1926, p. 105. 22. Vanzant, F. R.; Alvarez, W. C.; Eusterman, G. B.; Dunn, A. L., and Berkson, J.: The Normal Range of Gastric Acidity from Youth to Old Age , Arch. Int. Med. 49:345 ( (March) ) 1932.Crossref 23. Anderson, R. K.; Fogelson, S. J., and Farmer, C. J.: Proc. Soc. Exper. Biol. & Med. 31:520, 1934. 24. Dr. Fogelson informed us recently that he verified his results in a great number of additional tests. 25. Vanzant, F. R.; Alvarez, W. C.; Berkson, J., and Eusterman, G. B.: Changes in Gastric Acidity in Peptic Ulcer, Cholecystitis and Other Diseases , Arch. Int. Med. 52:616 ( (Oct.) ) 1933. 26. Winkelstein, A.: Am. J. M. Sc. 185:695 ( (May) ) 1933. 27. Palmer, W. L.: Fundamental Difficulties in the Treatment of Peptic Ulcer , J. A. M. A. 101:1604 ( (Nov. 18) ) 1933. 28. Langenskiöld, F.: Skandinav. Arch. f. Physiol. 31:1, 1913.Crossref

HALL, FRANCIS C.;MYERS, WALTER K.

doi: 10.1001/archinte.1935.00160210056005pmid: N/A

Abstract Many factors play a rôle in producing one or another form of chronic arthritis. The influence of diet has been given attention, but there have been few studies concerning its etiologic rôle. It has not been unusual to observe considerable improvement in chronic arthritis following the correction of faulty dietary habits, although frequently other therapeutic measures have been employed at the same time. The question arises of the importance of dietary factors in the causation of arthritis. An attempt is made here to reexamine the evidence for the relationship between diet and chronic arthritis, especially the possible etiologic relationship of long-continued, mildly deficient diets. An evaluation has been made of the dietary history of seventy-five patients with chronic arthritis. There were twenty-seven patients with hypertrophic (degenerative) arthritis, forty with atrophic (rheumatoid) arthritis, and eight with what has been termed chronic infectious arthritis. Six of the latter eight cases were proved References 1. Muley, K.: Ernährung in Ost und West , Ztschr. f. Ernähr. 1:361, 1931. 2. Orr, J. B., and Gilks, J. L.: Studies of Nutrition: The Physique and Health of Two African Tribes , Medical Research Council, Spec. Rep. Ser. 155, London, His Majesty's Stationery Office, 1931, p. 82. 3. Howitt, F. D., and Christie, W. F.: The Malnutrition Factor in Rheumatoid Arthritis , Lancet 2:1282, 1931.Crossref 4. Eaton, E. R., and Love, J.: Chronic Arthritis: A Study of the Dietary of Five Hundred Patients, with Results of an Experimental Course of Insulin Treatment in Twenty-Two Cases of Malnutrition , J. Am. Inst. Homeop. 26:404 ( (June) ) 1933. 5. Dawson, M. H.: Report of the Second Conference on Rheumatic Diseases , J. A. M. A. 101:1264 ( (Oct. 14) ) 1933.Crossref 6. Rinehart, J. F., and Mettier, S. R.: The Joints in Experimental Scurvy and in Scurvy with Superimposed Infection, with a Consideration of the Possible Relation of Scurvy to Rheumatic Fever , Am. J. Path. 9:952 ( (Nov.) ) 1933. 7. McCarrison, R.: Studies in Deficiency Diseases , New York, Oxford University Press, 1921. 8. Rowlands, M. J.: Rheumatoid Arthritis: Is It a Deficiency Disease? Proc. Roy. Soc. Med. 20:1711 ( (May 25) ) 1927. 9. Fletcher, A. A.: Chronic Arthritis , Canad. M. A. J. 22:320 ( (March) ) 1930. 10. Haft, H. H.: The Colonic Changes in Chronic Arthritis Compared with Other Chronic Diseases , Am. J. M. Sc. 185:811 ( (June) ) 1933.Crossref 11. Nissen, H. A.: Atonic Stasis: Clinical and Laboratory Study of Intestinal Variations in Chronic Disease , M. Clin. North America 13:269 ( (July) ) 1929. 12. Pemberton, R., and Foster, G. L.: Studies on Arthritis in the Army Based on Four Hundred Cases: III. Studies on the Nitrogen, Urea, Carbon Dioxide Combining Power, Calcium, Total Fat and Cholesterol of the Fasting Blood, Renal Function, Blood Sugar and Sugar Tolerance , Arch. Int. Med. 25:243 ( (March) ) 1920.Crossref 13. Bauer, W.; Bennett, G. A., and Short, C. L.: Speculations on the Etiology of Rheumatoid Arthritis , New England J. Med. 208:1035 ( (May 18) ) 1933.Crossref 14. Mackie, T. J.; Fraser, A. H. H.; Finkelstein, M. H., and Anderson, E. J. M.: The Influence of Nutrition on Susceptibility to a Bacterial Toxin , Brit. J. Exper. Path. 13:323, 1932.

MOSENTHAL, HERMAN O.;BRUGER, MAURICE

doi: 10.1001/archinte.1935.00160210064006pmid: N/A

Abstract Tests for renal function are of two types: those that determine the power of the kidney to dilute and concentrate the urine and those that measure the ability of the kidney to eliminate the renal excretory products. Those of the first group, which includes the various tests for specific gravity, are well established and adequate; those of the second are not completely satisfactory. Beside the use of the dye tests, which are not specific, the measure of renal excretion usually is attempted by a determination of the amount of urea or nonprotein nitrogen in the blood. These estimations demonstrate how much of these substances is actually retained, but not the degree of the impairment of renal function. This is especially true when the figures for the blood chemistry determinations are low; it is not then certain whether renal function is normal or impaired, since the level of the nonprotein nitrogen References 1. Mosenthal, H. O., and Hiller, A.: The Relation of the Nonprotein Nitrogen to the Urea Nitrogen of the Blood , J. Urol. 1:74, 1917. 2. Möller, E.; McIntosh, J. F., and Van Slyke, D. D.: Studies of Urea Excretion: II. Relationship Between Urine Volume and the Rate of Urea Excretion by Normal Adults , J. Clin. Investigation 6:427, 1928Crossref 3. Van Slyke, D. D.: Determination of Urea by Gasometric Measurement of the Carbon Dioxide Formed by the Action of Urease , J. Biol. Chem. 73:695, 1927. 4. Folin, O., and Wu, H.: A System of Blood Analysis , J. Biol. Chem. 38:81, 1919. 5. Bruger, M., and Mosenthal, H. O.: Urea Clearance Test as an Index of Renal Function: III. Studies of Patients with Bright's Disease , Arch. Int. Med. 50:544 ( (Oct.) ) 1932.Crossref 6. Nepveux, F., and Hiernaux, A.: Valeur du rapport azotémique , Médecine 8:757 ( (July) ) 1927. 7. Folin, O., and Svedberg, A.: Diffusible Nonprotein Constituents of Blood and Their Distribution Between Plasma and Corpuscles , J. Biol. Chem. 88:715, 1930. 8. Peters, J. P., and Van Slyke, D. D.: Quantitative Clinical Chemistry , Baltimore, Williams & Wilkins Company, 1931, vol. 1, p. 272.

DIECKMANN, WILLIAM J.;MICHEL, HERBERT L.

doi: 10.1001/archinte.1935.00160210073007pmid: N/A

Abstract That vascular tension is an important factor in the mechanism of the toxemias of pregnancy was postulated many years ago. Cohnheim,1 in 1880, seems to have been the first to express the view that albuninuria and anuria in eclampsia might be due to a spasm of the renal vessels. In 1918, Volhard2 advanced the hypothesis that a generalized arterial spasm accounted for the hypertension, convulsions and renal symptoms in eclampsia. Heynemann3 also assumed that a general arterial spasm produced the symptoms. Various attempts to demonstrate vascular spasm have been more or less successful. Hinselmann4 (1924) noted the capillary changes in the finger-nail beds. He assumed that the capillary stasis and the dilatation were secondary to an arteriolar spasm. Subsequent observations of the nicking of retinal arteries and veins and the beading and the contractions of these vessels have indicated that the vascular spasm is probably general. References 1. Cohnheim, J.: Vorlesungen über allgemeine Pathologie , Berlin, A. Hirschwald, 1880. 2. Volhard, F.: Die doppelseitigen haematogenen Nierenerkrankungen (brighl'sche Krankheit) , Berlin, Julius Springer, 1918. 3. Heynemann, quoted by Fahr, in Hinselmann.4 4. Hinselmann, H.: Die Eklampsie , Bonn, F. Cohen, 1924. 5. Adair, F. L.: Analysis of a Series of Nonconvulsive Cases of Toxemias of Pregnancy , Am. J. Obst. & Gynec. 26:530 ( (Oct.) ) 1933. 6. deSnoo, K.: Blood Pressure in the Pregnant , Monatschr. f. Geburtsh. u. Gynäk. 57:235 ( (April) ) 1922. 7. Kylin, E.: Die Hypertoniekrankheiten , Berlin, Julius Springer, 1926. 8. Stieglitz, E. J.: Personal communication. 9. Hines, E. A., Jr., and Brown, G. E.: Standard Stimulus for Measuring Vasomotor Reactions: Its Application in the Study of Hypertension , Proc. Staff Meet., Mayo Clin. 7:332 ( (June 8) ) 1932. 10. Bernard, C.: Lecons sur les propriétés physiologiques et les altérations pathologiques des liquides de l'organisme , Paris, J. B. Bailliére, 1859. 11. Eckhard: Beitr. z. Anat. u. Physiol. 4:155, 1869. 12. Ustimovitsch: Ber. ü. d. Verhandl. d. k. sächs. Gesellsch. d. Wissensch. z. Leipzig, Math.-phys. Cl. 22:430, 1870. 13. Spiegler, R., and Schol, W.: Die galvanische Nerven-Muskelerregbarkeit in der Schwangerschaft und bei Toxikosen , Arch. f. Gynäk. 141:651, 1930.

CHEW, WILLIAM B.;STETSON, RICHARD P.;VAN S. SMITH, GEORGE;SMITH, O. WATKINS

doi: 10.1001/archinte.1935.00160210084008pmid: N/A

Abstract In another communication1 observations were reported on seven patients with hemophilia in whom no demonstrable improvement in the coagulation of the blood or in the clinical state resulted from the oral and parenteral administration of various ovarian and estrogenic substances. The failure to enhance the coagulability of the blood in hemophilia by the administration of an estrogenic substance has been noted by Blaylock,2 who observed a slight increase in the coagulation time of the blood of his patient with hemophilia one week after starting daily subcutaneous injections of an "ovarian preparation obtained from the fetal fluid of cattle." Brown and Albright3 similarly observed no beneficial effect in one patient with hemophilia who was given injections of large amounts of estrogenic substance over a period of three days. More recently, Brem and Leopold4 have reported negative observations on the coagulation time and clinical state of a patient References 1. Stetson, R. P.; Forkner, C. E.; Chew, W. B., and Rich, M. L.: The Negative Effect of Prolonged Administration of Ovarian Substance in Hemophilia , J. A. M. A. 102:1122 ( (April 7) ) 1934.Crossref 2. Blaylock, A.: Amputation of Arm of Patient with Hemophilia , J. A. M. A. 99:1777 ( (Nov. 19) ) 1932.Crossref 3. Brown, R. L., and Albright, F.: Estrin Therapy in a Case of Hemophilia , New England J. M. 209:630 ( (Sept. 28) ) 1933.Crossref 4. Brem, J., and Leopold, J. S.: Ovarian Therapy: Relationship of the Female Sex Hormone to Hemophilia , J. A. M. A. 102:200 ( (Jan. 23) ) 1934.Crossref 5. Birch, C. L.: (a) Hemophilia , Proc. Soc. Exper. Biol. & Med. 28:752 ( (April) ) 1931 6. Hemophilia , J. A. M. A. 99:1566 ( (Nov. 5) ) 1932. 7. Foord, A. G., and Dysart, B. R.: Treatment of Hemophilia by an Ovarian Extract by Birch's Method , J. A. M. A. 98:1444 ( (April 23) ) 1932. 8. Kimm, H. T., and Van Allen, C. M.: Hemophilia: Prevention and Treatment of Bleeding with Ovarian Extract , J. A. M. A. 99:991 ( (Sept. 17) ) 1932. 9. White, C. E.: Treatment of Hemophilia with Theelin , J. Oklahoma M. A. 25:304 ( (July) ) 1932. 10. Hirst, J. C.: The Influence of Female Sex Hormones upon Blood Coagulation of the Newborn , Am. J. Obst. & Gynec. 26:217 ( (Aug.) ) 1933. 11. Spoto, J. S.: Treatment of Hemophilia with Ovarian Extract , J. Florida M. A. 20:9 ( (July) ) 1933. 12. Hynek, K.: Nouvelles considérations sur l'hémophilie , Ann. de méd. 14:122 ( (Aug.) ) 1923. 13. Neihans, P.: Treatment of Hemophilia , Schweiz. med. Wchnschr. 60:18 ( (Jan. 4) ) 1930. 14. Birch, C. L.: Hemophilia and the Female Sex Hormone , J. A. M. A. 97:244 ( (July 25) ) 1931. 15. Mazer, C., and Goldstein, L.: Clinical Endocrinology of the Female , Philadelphia, W. B. Saunders Company, 1933. 16. Smith, G. V., and Smith, O. W.: Studies on the Urinary Excretion of Estrin, with Especial Reference to the Effect of the Luteinizing Hormone and Progestin , Am. J. Physiol. 98:578 ( (Nov.) ) 1931. 17. Smith, G. V., and Rock, J.: Dysfunctional Uterine Bleeding , Surg., Gynec. & Obst. 57:100 ( (July) ) 1933. 18. Frank, R. T.: Rôle of the Female Sex Hormone , J. A. M. A. 97:1852 ( (Dec. 19) ) 1931. 19. The numbers correspond to those assigned the patients in our previous report.1 20. Wiedemer, quoted by Mills, C. A.: Hemophilia , J. Lab. & Clin. Med. 17: 932 ( (June) ) 1932.

FEIGENBAUM, JACOB;HOWAT, DAVID

doi: 10.1001/archinte.1935.00160210098009pmid: N/A

Abstract When you can measure what you are speaking about and express it in numbers, you know something about it, but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind.— Lord Kelvin. We shall see that the connection between physical diseases and the external configuration of the body is less close than has been assumed....—Jonathan Hutchinson: The Pedigree of Disease, London, 1884. Since the publication of our first paper on this subject1 an opportunity was taken of reviewing the literature dealing with this subject in greater detail. After a thorough search of the older literature it was surprising to find how little attention had actually been paid to the matter in what could be considered a useful sense. The most plausible reason for this appears to be that for many centuries the subject was confused by References 1. Feigenbaum, J., and Howat, D.: The Relation Between Physical Constitution and the Incidence of Disease , J. Clin. Investigation 13:122, 1934.Crossref 2. Cicero: De officiis, paragraphs 3, 33 and 117. 3. A New English Dictionary on Historical Principles , edited by James A. H. Murray, New York, Oxford University Press, 1893, vol. 2. 4. Celsus, cited by Huxham.6 5. Celsus, Aurelius Cornelius: On Medicine , London, E. Cox, 1831, vol. 1, p. 34. 6. Huxham, John: An Essay on Fevers to Which is Now Added a Dissertation on the Malignant Ulcerous Sore-throat , ed. 4, London, J. Hinton, 1764, p. 27. 7. Hunter, John: The Works of John Hunter with Notes , edited by J. F. Palmer, London, Longman, Rees, Orme, Brown, Green and Longman, 1835, vol. 1, p. 34. 8. Hunter,7 p. 303. 9. Hunter,7 p. 304. 10. Hunter,7 p. 306. 11. Hunter,7 p. 308. 12. Draper, G.: Human Constitution: A Consideration of Its Relationship to Disease , Philadelphia, W. B. Saunders Company, 1924. 13. This footnote was deleted by the author. 14. Smith, Millard: A Study of One Hundred and Two Cases of Atrophic Arthritis , New England J. Med. 206:103, 1932.Crossref 15. Hess, A. F., and Blackberg, S. N.: Constitutional Factors in the Etiology of Rickets , Am. J. Physiol. 102:8, 1932. 16. Young, Matthew: A Study of Rheumatic and Asthmatic Children with Special Reference to Physical Type , J. Hyg. 33:435, 1933.Crossref

BARNES, ARLIE R.

doi: 10.1001/archinte.1935.00160210110010pmid: N/A

Abstract The number of clinical, pathologic and experimental observations published on coronary occlusion, its effect and its recognition attest the interest that exists in the subject and its importance as a clinical problem. The very multiplicity of these observations gives rise to the need for their critical evaluation and integration. It is the purpose of this article to make such an integration. ANATOMIC CONSIDERATIONS The first requisite to an understanding of the problem of coronary occlusion is a certain fundamental knowledge of the anatomy of the coronary arteries in the heart of man. The work of Whitten,1 Gross2 and Spalteholz3 on the coronary circulation covers the subject exhaustively. The anterior descending branch of the left coronary artery supplies the anterior portion of the left ventricle and apex and the anterior two thirds of the interventricular septum and gives off a few branches to supply a narrow zone of References 1. Whitten, M. B.: The Relation of the Distribution and Structure of the Coronary Arteries to Myocardial Infarction , Arch. Int. Med. 45:383 ( (March) ) 1930.Crossref 2. Gross, Louis: The Blood Supply to the Heart in Its Anatomical and Clinical Aspects , New York, Paul B. Hoeber, Inc., 1921. 3. Spaltecholz, Werner: Die Arterien der Herzwand , Leipzig, S. Hirzel, 1924. 4. Levine, S. A.: Coronary Thrombosis: Its Various Clinical Features , Medicine 8:245 ( (Sept.) ) 1929.Crossref 5. Barnes, A. R., and Ball, R. G.: The Incidence and Situation of Myocardial Infarction in 1,000 Consecutive Postmortem Examinations , Am. J. M. Sc. 183:215 ( (Feb.) ) 1932.Crossref 6. Parkinson, John, and Bedford, D. E.: Successive Changes in the Electrocardiogram After Cardiac Infarction (Coronary Thrombosis) , Heart 14:195 ( (Aug.) ) 1928. 7. Gilchrist, A. R., and Ritchie, W. T.: The Ventricular Complexes in Myocardial Infarction and Fibrosis , Quart. J. Med. 23:273 ( (April) ) 1930.Crossref 8. Clerc, A.: Anomalies électrocardiographiques au cours de l'oblitération coronarienne , Presse méd. 35:499 ( (April 20) ) 1927. 9. Eppinger, H., and Rothberger, C. J.: Zur Analyse des Elektrokardiogramms , Wien. klin. Wchnschr. 22:1091 ( (Aug. 5) ) 1909. 10. Samojloff, A.: Weitere Beiträge zur Elektrophysiologie des Herzens , Arch. f. d. ges. Physiol. 135:417 ( (Dec. 5) ) 1910.Crossref 11. Danielopolu, D.: L'angine de poitrine et l'angine abdominale , Paris, Masson & Cie, 1927. 12. Gold, Harry; de Graff, A. C., and Edward D. J.: On the R-T Interval in Experimental Coronary Occlusion , Proc. Soc. Exper. Biol. & Med. 23:664 ( (May) ) 1926. 13. Lewis, Thomas: The Experimental Production of Paroxysmal Tachycardia and the Effects of Ligation of the Coronary Arteries , Heart 1:98, 1909-1910. 14. Otto, H. L.: The Extracardial Nerves: An Experimental Study of Coronary Obstruction , Am. Heart J. 4:64 ( (Oct.) ) 1928. 15. Smith, F. M.: The Ligation of Coronary Arteries with Electrocardiographic Studies , Arch. Int. Med. 22:8 ( (July) ) 1918. 16. Smith, F. M.: Further Observations on the T-Wave of the Electrocardiogram of the Dog Following the Ligation of the Coronary Arteries , Arch. Int. Med. 25:673 ( (June) ) 1920. 17. Otto, H. L.: The Action of Cold upon the T-Wave of the Electrocardiogram , J. Lab. & Clin. Med. 14:718 ( (May) ) 1929. 18. Smith, F. M.: Some Observations on the Effects of Heat and Cold on the Ventricles and the T Deflection of the Electrocardiogram , Heart 10:391, 1923. 19. Wilson, F. N., and Herrmann, G. R.: An Experimental Study of Incomplete Bundle-Branch Block and of the Refractory Period of the Heart of the Dog , Heart 8:229 ( (May) ) 1921. 20. Eppinger and Rothberger.7b 21. Otto, H. L.: The Effect of Obstruction of Coronary Arteries upon the T-Wave of the Electrocardiogram , Am. Heart J. 4:346 ( (Feb.) ) 1929. 22. Daly, I. De B.: The Influence of Mechanical Conditions of the Circulation on the Electrocardiogram , Proc. Roy. Soc. Med. 5:279, 1923-1924. 23. Otto, H. L.: The Extracardial Nerves: III. Further Observations upon the Relation of the Extracardial Nerves to Heart-Block , Am. Heart J. 4:59 ( (Oct.) ) 1928. 24. Otto, H. L.: The Ventricular Electrocardiogram: An Experimental Study , Arch. Int. Med. 43:335 ( (March) ) 1929. 25. Eppinger and Rothberger.7b 26. Otto.10a 27. Smith.10b 28. Wilson and Herrmann.10c 29. Otto, H. L.: The Effect of a Sudden Increase in the Intracardiac Pressure upon the Form of the T-Wave of the Electrocardiogram , J. Lab. & Clin. Med. 14:643 ( (April) ) 1929. 30. Daly.12 31. Otto.14 32. Eppinger and Rothberger.7b 33. Barnes, A. R., and Whitten, M. B.: Study of the R-t Interval in Myocardial Infarction , Am. Heart J. 5:142 ( (Dec.) ) 1929. 34. Barnes, A. R., and Mann, F. C.: Electrocardiographic Changes Following Ligation of the Coronary Arteries of the Dog , Am. Heart J. 7:477 ( (April) ) 1932. 35. Feil, H. S.; Katz, L. N.; Moore, R. A., and Scott, R. W.: The Electrocardiographic Changes in Myocardial Ischemia , Am. Heart J. 6:522 ( (Feb.) ) 1931. 36. Wood, F. C., and Wolferth, C. C.: Experimental Coronary Occlusion: Inadequacy of the Three Conventional Leads for Recording Characteristic Action Current Changes in Certain Sections of the Myocardium; An Electrocardiographic Study , Arch. Int. Med. 51:771 ( (May) ) 1933. 37. Elkin, D. C., and Phillips, H. S.: Stab Wound of the Heart: Electrocardiographic Studies of Two Cases , J. Thoracic Surg 1:113 ( (Dec.) ) 1931. 38. Crawford, J. H.; Roberts, G. H.; Abramson, D. I., and Cardwell, J. C.: Localization of Experimental Ventricular Myocardial Lesions by the Electrocardiogram , Am. Heart J. 7:627 ( (June) ) 1932. 39. Haney, H. F.; Borman, M. C., and Meek, W. J.: The Relation Between the Position of Experimental Myocardial Lesions in the Dog and the Changes in the Rs-T Segment of the Electrocardiogram , Am. J. Physiol. 106:64, 1933. 40. Fowler, W. M.; Rathe, H. W., and Smith, F. M.: The Electrocardiographic Changes Following the Ligation of the Small Branches of the Coronary Arteries , Am. Heart J. 8:370 ( (Feb.) ) 1933. 41. Wood, F. C.; Wolferth, C. C., and Livezly, M. M.: Angina Pectoris: The Clinical and Electrocardiographic Phenomena of the Attack and Their Comparison with the Effects of Experimental Temporary Coronary Occlusion , Arch. Int. Med. 47:339 ( (March) ) 1931. 42. Crawford, Roberts, Abramson and Cardwell.23 43. Haney, Borman and Meek.24 44. Pardee, H. E. B.: An Electrocardiographic Sign of Coronary Artery Obstruction , Arch. Int. Med. 26:244 ( (Aug.) ) 1920. 45. Pardee, H. E. B.: Heart Disease and Abnormal Electrocardiograms with Special Reference to the Coronary T-Wave , Am. J. M. Sc. 169:270, 1925. 46. Barnes, A. R.: Electrocardiographic Localization of Myocardial Infarcts , M. Clin. North America 14:671 ( (Nov.) ) 1930. 47. Barnes and Whitten.18 48. Cohn, A. E., and Swift, H. F.: Electrocardiographic Evidence of Myocardial Involvement in Rheumatic Fever , J. Exper. Med. 39:1 ( (Jan.) ) 1924. 49. Rothschild, M. A.; Sacks, B., and Libman, E.: The Disturbances of the Cardiac Mechanism in Subacute Bacterial Endocarditis and Rheumatic Fever , Am. Heart J. 2:356 ( (April) ) 1927. 50. Levy, R. L., and Golden, Ross: The Treatment of Rheumatic Carditis by Roentgen Irradiation of the Heart , Am. Heart. J. 4:127 ( (Dec.) ) 1928. 51. Katz, L. N.; Feil, H. S., and Scott, R. W.: The Electrocardiogram in Pericardial Effusion: II. Experimental , Am. Heart J. 5:77 ( (Oct.) ) 1929. 52. Scott, R. W.; Feil, H. S., and Katz, L. N.: The Electrocardiogram in Pericardial Effusion: I. Clinical , Am. Heart J. 5:68 ( (Oct.) ) 1929. 53. Wood, J. E., Jr., and White, P. D.: The Electrocardiogram in Uremia and Severe Chronic Nephritis with Nitrogen Retention , Am. J. M. Sc. 169:76, 1925. 54. Cooksey, W. B., and Freund, H. A.: Serial Electrocardiographic Studies in Coronary Thrombosis , Am. Heart J. 6:608 ( (Feb.) ) 1931. 55. Sigler, L. H.: Acute Coronary Occlusion. A Clinical and Electrocardiographic Study of Twenty Cases , Ann. Int. Med. 4:969 ( (Feb.) ) 1931.Crossref 56. Wilson, F. N.; Barker, P. S.; Macleod, A. G., and Klostermeyer, L. L.: The Electrocardiogram in Coronary Thrombosis , Proc. Soc. Exper. Biol. & Med. 29:1006 ( (May) ) 1932. 57. Wilson, F. N.; Macleod, A. G.; Barker, P. S.; Johnston, F. D., and Klostermeyer, L. L.: The Electrocardiogram in Myocardial Infarction with Particular Reference to the Initial Deflections of the Ventricular Complex , Heart 16: 155 ( (June) ) 1933. 58. Wilson, Barker, Macleod and Klostermeyer.35 59. Barnes, A. R.: Correlation of Initial Deflections of Ventricular Complex of Acute Myocardial Infarction , Am. Heart J. 9:728 ( (Aug.) ) 1934. 60. Barnes, A. R.: Q and T Types of Electrocardiograms: Their Comparative and Complementary Value in Indicating Occurrence of Acute Myocardial Infarction , Am. Heart J. 9:722 ( (Aug.) ) 1934. 61. Wood, F. C.; Bellet, Samuel; McMillan, T. M., and Wolferth, C. C.: Electrocardiographic Study of Coronary Occlusion; Further Observations on the Use of Chest Leads , Arch. Int. Med. 52:752 ( (Nov.) ) 1933. 62. Wood and Wolferth.21 63. Bell, A., and Pardee, H. E. B.: Coronary Thrombosis: Report of Two Cases with Electrocardiographic Localization of the Thrombus in the Right or Left Coronary Arteries , J. A. M. A. 94:1555 ( (May 17) ) 1930. 64. Rose, W. J., and Myers, Frank: Electrocardiographic Diagnosis of the Artery Occluded in Cardiac Infarction , Proc. Soc. Exper. Biol. & Med. 27:681 ( (April) ) 1930. 65. Wilson; Barker, Macleod and Klostermeyer.35c 66. Wolferth, C. C.: Diseases of the Heart and Blood Vessels , Progrés méd. 3:109 ( (Sept.) ) 1931. 67. Barnes, A. R.: Electrocardiographic Pattern Observed Following Acute Coronary Occlusion Complicated by Pericarditis; Report of Cases , Am. Heart. J. 9:734 ( (Aug.) ) 1934. 68. Burton, J. A. G.; Cowan, John; Kay, J. H.; Marshall, A. J.; Rennie, J. K.; Ramage, J. H., and Teacher, J. H.: Four Cases of Fibrosis of the Myocardium with Electrocardiographic and Postmortem Examinations , Quart. J, Med. 23:293 ( (April) ) 1930. 69. Barnes, A. R., and Whitten, M. D.: Study of T-Wave Negativity in Predominant Ventricular Strain , Am. Heart J. 5:14 ( (Oct.) ) 1929. 70. Padilla, T., and Cossio. P.: El electrocardiograma ventricular en el infarto miocardico , Semana méd. 36:813, 1929.