Archives of Internal Medicine

ABRAMSON, DAVID I.;LANDT, HARRY;BENJAMIN, JULIEN E.

doi: 10.1001/archinte.1943.00210050003001pmid: N/A

Abstract The more general reactions of the cardiovascular system of man to the inhalation of oxygen-poor gas mixtures have been described by numerous investigators.1 They consist of an almost immediate increase in the heart rate, a slight rise in the systolic blood pressure, with no significant change in the diastolic level, and a definite augmentation in the cardiac output. With respect to alterations in the peripheral circulation, the results are not as clearcut. Freeman and his associates2 studied the rate at which blood flows through the hand during a period of acute anoxia, using the venous occlusion plethysmographic method. They found that either an increase or a decrease of rate was produced. Gellhorn and Steck,3 utilizing the same procedure and the same vascular bed, also noted apparently inconsistent results, the flow being decreased, unchanged or slightly increased. Since the circulation through the hand is affected by a variety References 1. Schneider, E. C., and Truesdell, D.: The Circulatory Responses of Man to Anoxemia , Am. J. Physiol. 71:90 ( (Dec.) ) 1924. 2. Gellhorn, E., and Lambert, E.: The Vasomotor System in Anoxia and Asphyxia , Urbana, Ill., University of Illinois Press, 1939. 3. Graybiel, A.; Missiuro, V.; Dill, D. B., and Edwards, H. T.: Experimentally Induced Asphyxiation in Cardiac Patients, with Especial Reference to Certain Hazards in Air Travel and to the Use of Asphyxiation as a Cardiac Functional Test , J. Aviation Med. 8:178 ( (Dec.) ) 1937. 4. Freeman, N. E.; Shaw, J. L., and Snyder, J. C.: Peripheral Blood Flow in Surgical Shock: Reduction in Circulation Through the Hand Resulting from Pain, Fear, Cold and Asphyxia, with Quantitative Measurements of the Volume Flow of Blood in Clinical Cases of Surgical Shock , J. Clin. Investigation 15:651 ( (Nov.) ) 1936.Crossref 5. Gellhorn, E., and Steck, I. E.: Effect of the Inhalation of Gases with a Low Oxygen and Increased Carbon Dioxide Tension on the Peripheral Blood Flow in Man , Am. J. Physiol. 124:735 ( (Dec.) ) 1938. 6. Capps, R. B.: Method for Measuring Tone and Reflex Constriction of Capillaries, Venules and Veins of the Human Hand with Results in Normal and Diseased States , J. Clin. Investigation 15:229 ( (March) ) 1936.Crossref 7. Abramson, D. I., and Ferris, E. B., Jr.: Responses of Blood Vessels in the Resting Hand and Forearm to Various Stimuli , Am. Heart J. 19:541 ( (May) ) 1940.Crossref 8. Abramson, D. I.; Zazeela, H., and Marrus, J.: Plethysmographic Studies on Peripheral Blood Flow in Man: I. Criteria for Obtaining Accurate Plethysmographic Data , Am. Heart J. 17:194 ( (Feb.) ) 1939.Crossref 9. Ferris, E. B., Jr., and Abramson, D. I.: Description of a New Plethysmograph , Am. Heart J. 19:233 ( (Feb.) ) 1940.Crossref 10. Abramson, D. I., and Fierst, S. M.: Resting Blood Flow and Peripheral Vascular Responses in Hypertensive Subjects , Am. Heart J. 23:84 ( (Jan.) ) 1942.Crossref 11. Abramson, D. I., and Fierst, S. M.: The Peripheral Vascular Response to Exercise in the Hyperthyroid State , J. Clin. Investigation 20:517 ( (Sept.) ) 1941.Crossref 12. The alpha signifies standard deviation. 13. Lennox, W. G., and Gibbs, E. L.: Blood Flow in the Brain and the Leg of Man, and the Changes Induced by Alteration of Blood Gases , J. Clin. Investigation 11:1155 ( (Nov.) ) 1932.Crossref 14. Mulinos, M. G., and Shulman, I.: The Effects of Cigarette Smoking and Deep Breathing on the Peripheral Vascular System Studied by Five Methods , Am. J. M. Sc. 199:708 ( (May) ) 1940.Crossref 15. Grollman, A.: Physiological Variations of Cardiac Output in Man: The Effect of High Altitude on Cardiac Output and Its Related Functions; Account of Experiments Conducted on Summit of Pike's Peak, Colorado , Am. J. Physiol. 93:19 ( (May) ) 1930. 16. Asmussen, E., and Chiodi, H.: The Effect of Hypoxemia on Ventilation and Circulation in Man , Am. J. Physiol. 132:426 ( (March) ) 1941. 17. Wiggers, C. J.: Cardiac Adaptions in Acute Progressive Anoxia , Ann. Int. Med. 14:1237 ( (Jan.) ) 1941.Crossref 18. Schmidt, C. F., and Comroe, J. H., Jr.: Functions of Carotid and Aortic Bodies , Physiol. Rev. 20:115 ( (Jan.) ) 1940.

ENGLISH, JOHN P.;WILLIUS, FREDRICK A.

doi: 10.1001/archinte.1943.00210050014002pmid: N/A

Abstract Several types of acute occlusion of the coronary arteries have been described.1 Interpretation of the pathologic changes associated with the more familiar form, usually accompanied by arterial thrombosis, has not resulted in a clear understanding of the basic factors involved. In recent years more emphasis has been accorded to the hemorrhage in the intimal and subintimal layers of the occluded arteries, and several authors have attached great importance to this phenomenon in the mechanism of coronary occlusion.2 This has resulted partly from a relatively new interpretation of the origin and significance of hemorrhage in the walls of small arteries.3 It had generally been considered that extravasated blood in this location either was derived from the lumen of the artery or occurred as a result of inflammatory exudation.4 Lately it has been demonstrated that in most instances intramural hemorrhage of the coronary artery arises from the vascular References 1. Benson, R. L.: The Present Status of Coronary Arterial Disease , Arch. Path. 2:876-916 ( (Dec.) ) 1926. 2. Faulkner, J. M.; Marble, H. C., and White, P. D.: The Differential Diagnosis of Coronary Occlusion and of Cholelithiasis , J. A. M. A. 83:2080-2082 ( (Dec. 27) ) 1924.Crossref 3. Hamman, L.: The Symptoms of Coronary Occlusion , Bull. Johns Hopkins Hosp. 38:273-319 ( (April) ) 1926. 4. Paterson, J. C.: Vascularization and Hemorrhage of the Intima of Arteriosclerotic Coronary Arteries , Arch. Path. 22:313-324 ( (Sept.) ) 1936 5. Capillary Rupture with Intimal Hemorrhage as a Causative Factor in Coronary Thrombosis , Paterson Arch. Path. 25:474-487 ( (April) ) 1938 6. Some Factors in the Causation of Intimal Haemorrhages and in the Precipitation of Coronary Thrombi , Canad. M. A. J. 44:114-120 ( (Feb.) ) 1941. 7. Wartman, W. B.: Occlusion of the Coronary Arteries by Hemorrhage into Their Walls , Am. Heart J. 15:459-470 ( (April) ) 1938.Crossref 8. Horn, H., and Finkelstein, L. E.: Arteriosclerosis of the Coronary Arteries and the Mechanism of Their Occlusion , Am. Heart J. 19:655-682 ( (June) ) 1940.Crossref 9. Winternitz, M. C.; Thomas, R. M., and LeCompte, P. M.: Studies in the Pathology of Vascular Disease , Am. Heart J. 14:399-404 ( (Oct.) ) 1937.Crossref 10. Nelson, M. G.: Intimal Coronary Artery Haemorrhage as a Factor in the Causation of Coronary Occlusion , J. Path & Bact. 53:105-116 ( (July) ) 1941. 11. Paterson (footnote 2 a, b and c). 12. Leary, T.: Vascularization of Atherosclerotic Lesions , Am. Heart J. 16:549-554 ( (Nov.) ) 1938. 13. Boyd, A. N.: An Inflammatory Basis for Coronary Thrombosis , Am. J. Path. 4:159-166 ( (March) ) 1928. 14. Benson.1a 15. Leary, T.: Atherosclerosis: Special Consideration of Aortic Lesions , Arch. Path. 21: 419-458 ( (April) ) 1936. 16. Paterson (footnote 2 a, b and c). 17. Horn and Finkelstein.2e 18. Leary.4a 19. The term "hemorrhagic lesion" is used in preference to "intimal hemorrhage" to avoid the assumption that hemorrhage is the cause of arterial occlusion.

SMITH, J. JAMES;FURTH, JACOB

doi: 10.1001/archinte.1943.00210050022003pmid: N/A

Abstract Cardiac failure in young persons lacking the usual features of organic heart disease or associated renal lesions has frequently been ascribed to isolated (Fiedler's) myocarditis. A study of the reported cases of isolated myocarditis indicates a heterogeneous disease group related to known and to unknown infectious or toxic agents. Some changes are frankly inflammatory, others degenerative; some are acute, others subacute or chronic. Within the past few years evidence has accumulated that dietary deficiency can cause clinically evident heart disease which hitherto may have fallen into this vaguely defined classification. With advancing knowledge it becomes desirable to dissociate this group into more sharply defined types. Recently we encountered 3 cases in which the patients died in the hospital of congestive failure of obscure origin. In all cases the patients were carefully studied during life and examined post mortem. Clinically and pathologically these cases resemble each other closely, and without recourse References 1. Dock, W.: Marked Cardiac Hypertrophy and Mural Thrombosis in the Ventricles in Beriberi Heart , Tr. A. Am. Physicians 55:61, 1940. 2. Wenckebach, K. F.: (a) Das Beri-beri Herz , Berlin, Julius Springer, 1934 3. The Riddle of the Beriberi Heart, in Contributions to the Medical Sciences in Honor of Dr. Emanuel Libman , New York, International Press, 1932, vol. 3, p. 1198. 4. Weiss, S., and Wilkins, R. W.: The Nature of the Cardiovascular Disturbances in the Nutritional Deficiency States (Beriberi) , Ann. Int. Med. 11:104, 1937.Crossref 5. Moore, R. A., and Spies, T. D.: Personal communication to the authors. 6. Steffen, A.: Zur akuten Myokarditis , Jahrb. f. Kinderh. 27:223, 1888. 7. Fiedler, A.: Ueber akute interstitielle Myokarditis. Festschrift zur Feier des 50-jahr. Bestehens des Stadtkrankenhauses zu Dresden-Friedrichstadt , Dresden, W. Baensch, 1890. 8. Sellentin, L.: Akute isolierte interstitielle Myokarditis , Ztschr. f. klin. Med. 54:298, 1904. 9. Aschoff, L.: Zur Myokarditisfrage , Verhandl. d. deutsch. path. Gesellsch. 8:46, 1904. 10. Scott, R. W., and Saphir, O.: Acute Isolated Myocarditis , Am. Heart J. 5:129, 1929.Crossref 11. Bailey, F. R., and Andersen, D. H.: Acute Interstitial Myocarditis , Am. Heart J. 6:338, 1931.Crossref 12. Rindfleisch, W.: Ein Fall von diffuser akuter Myokarditis , Inaug. Dissert., Munich. 1896 13. Thesis, Königsberg, M. Liedtke, 1898. 14. Baumgartner, H.: Ueber specifische diffuse productive Myokarditis , Frankfurt. Ztschr. f. Path. 18:91, 1916. 15. Boikan, W. S.: Myocarditis perniciosa , Virchows Arch. f. path. Anat. 282:46, 1931.Crossref 16. de la Chapelle, C. E., and Graef, I.: Acute Isolated Myocarditis , Arch. Int. Med. 47:942 ( (June) ) 1931.Crossref 17. Maslow, H. L., and Lederer, M.: Interstitial Myocarditis in a Child Nineteen Months of Age , Am. J. Dis. Child. 45:807 ( (April) ) 1933. 18. Guizzetti, P.: Per la conoscenza della miocardite dell' atassia di Friedreich , Riv. di pat. nerv. 41:545, 1933. 19. Carr, J. G., and Walsh, J. A.: Acute Infectious Myocarditis , Illinois M. J. 65:134, 1934. 20. Maxwell, E. S., and Barrett, C. C.: Acute Interstitial Myocarditis: Report of a Case Following a Severe Dermatitis Due to Sulfur Ointment , Arch. Dermat. & Syph. 29:382 ( (March) ) 1934. 21. Nelson, R. L.: Acute Diffuse Myocarditis Following Exfoliative Dermatitis , Am. Heart J. 9:813, 1934. 22. Simon, M. A., and Wolpaw, S.: Acute, Subacute and Chronic Isolated Myocarditis: Report of a Case , Arch. Int. Med. 56:1136 ( (Dec.) ) 1935. 23. Scott, R. W., and Simon, M. A.: Acute Isolated (Fiedler's) Myocarditis , Tr. A. Am. Physicians 51:374, 1936. 24. Kjaergaard, H.: Acute Myocarditis , Acta med. Scandinav. ( (supp.) ) 78:151, 1936. 25. Smith, F. M., and Stephens, R. L.: Acute, Subacute and Chronic Interstitial Myocarditis: Report of Six Cases , Tr. A. Am. Physicians 53:120, 1938. 26. Freundlich, J.: Ueber isolierte, diffuse interstitielle Myocarditis , Ztschr. f. klin. Med. 133:768, 1938. 27. Hansmann, G. H., and Schenken, J. R.: Acute Isolated Myocarditis , Am. Heart J. 15:749, 1938.Crossref 28. Magner, D.: A Case of Fatal Subacute Myocarditis of Unknown Etiology , Am. J. M. Sc. 198:246, 1939.Crossref 29. Helwig, F. C., and Wilhelmy, E. W.: Sudden and Unexpected Death from Acute Interstitial Myocarditis: A Report of Three Cases , Ann. Int. Med. 13:107, 1939.Crossref 30. Brown, C. E., and McNamara, D. H.: Acute Interstitial Myocarditis Following Administration of Arsphenamines , Arch. Dermat. & Syph. 42:312 ( (Aug.) ) 1940. 31. von Bonsdorff, B.: Less Common Causes of Heart Disease: Heart Disease of Unusual or Unknown Origin , Acta med. Scandinav. 100:320, 1939. 32. Karsner, H. T.: Human Pathology , ed. 4, Philadelphia, J. B. Lippincott Co., 1935, p. 460. 33. Sikl, H.: Eosinophile Myocarditis als idiosynkrasische-allergische Erkrankung , Frankfurt. Ztschr. f. Path. 49:283, 1936. 34. von Zalka, E.: Ueber einen seltsamen Fall von Polymyositis , Virchows Arch. f. path. Anat. 281:114, 1931. 35. Stoeckenius, W.: Beobachtungen an Todesfällen bei frischer Syphilis , Beitr. z. path. Anat. u. z. allg. Path. 68:185, 1921. 36. Taussig, H. S., and Oppenheimer, E. H.: Severe Myocarditis of Unknown Etiology , Bull. Johns Hopkins Hosp. 59:155, 1936. 37. Unpublished data. 38. Saphir, O.: Myocarditis: A General Review with an Analysis of Two Hundred and Forty Cases , Arch. Path. 32:1000 ( (Dec.) ) 1941 39. 33:80 (Jan.) 1942. 40. Levy, R. L., and Rousselot, L. M.: Cardiac Hypertrophy of Unknown Etiology in Young Adults , Am. Heart J. 9:178, 1933. 41. Levy, R. L., and von Glahn, W. C.: Further Observations on Cardiac Hypertrophy in Adults , Tr. A. Am. Physicians 52:259, 1937. 42. Levy, R. L., in discussion on Dock.1 43. Kugel, M. A., and Stoloff, E. G.: Dilatation and Hypertrophy of the Heart in Infants and in Young Children , Am. J. Dis. Child. 45:828 ( (April) ) 1933. 44. Miller, C. P.: Spontaneous Interstitial Myocarditis in Rabbits , J. Exper. Med. 40:543, 1924. 45. Thomas, R. M.; Mylon, E., and Winternitz, M. C.: Myocardial Lesions Resulting from Dietary Deficiency , Yale J. Biol. & Med. 12:345, 1940. 46. Swank, R. L.: Avian Thiamin Deficiency: A Correlation of the Pathology and Clinical Behavior , J. Exper. Med. 71:683, 1940. 47. Porto, J., and de Soldati, L.: Infarcto de miocardio aparecido en un perro en avitaminosis B1 , Rev. Soc. argent. de biol. 15:426, 1939. 48. Leblond, C. P., and Chaulin-Servinière, J.: Spontaneous Beriberi of the Monkey as Compared with Experimental Avitaminosis , Am. J. M. Sc. 203:100, 1942. 49. Keefer, C. S.: The Beriberi Heart , Arch. Int. Med. 45:1 ( (Jan.) ) 1930. 50. White, P. D.: Heart Disease , ed. 2, New York, The Macmillan Company, 1937, pp. 427-428. 51. Wearn, J. T.: Morphological and Functional Alterations of the Coronary Circulation: Harvey Lecture , Bull. New York Acad. Med. 17:754, 1941.

KIRBY, WILLIAM M. M.;RANTZ, LOWELL A.

doi: 10.1001/archinte.1943.00210050040004pmid: N/A

Abstract The classification of hemolytic streptococci proposed by Lancefield1 in 1933 has proved an important advance in the study of streptococcic infections. Using the precipitin technic, based on the presence in hemolytic streptococci of a specific carbohydrate obtainable by acid hydrolysis, she divided these organisms into several groups, designated by the letters A to K, inclusive, and pointed out that most streptococcic infections in human beings were caused by members of her group A. Subsequent studies have confirmed this observation,2 but a good many cases have been reported in which etiologic organisms were members of certain of the other groups. Group B strains have been isolated in cases of suppurative arthritis,3 puerperal sepsis4 and endocarditis.5 Severe cases of endocarditis6 and puerperal sepsis 4a have also been ascribed to members of group G. The status of group D organisms is beyond the scope of this paper and will be References 1. Lancefield, R. C.: A Serological Differentiation of Human and Other Groups of Hemolytic Streptococci , J. Exper. Med. 57:571, 1933.Crossref 2. Rantz, L. A., and Keefer, C. S.: The Distribution of Hemolytic Streptococci, Groups A, B, and C in Human Infections , J. Infect. Dis. 68:128, 1941.Crossref 3. Hare, R.: Sources of Hemolytic Streptococcal Infection of Wounds , Lancet 1:109, 1940.Crossref 4. Rantz, L. A.: Suppurative Arthritis Due to a Hemolytic Streptococcus of the Lancefield Group B: A Case Report , Ann. Int. Med. 13:1744, 1940.Crossref 5. Lancefield, R. C., and Hare, R.: Serological Differentiation of Pathogenic and Non-Pathogenic Strains of Hemolytic Streptococci from Parturient Women , J. Exper. Med. 61:335, 1935.Crossref 6. Fry, R. M.: Fatal Infections by Hemolytic Streptococcus Group B , Lancet 1:199, 1938.Crossref 7. Rosenthal, A. H., and Stone, F. M.: Puerperal Infection with Vegetative Endocarditis , J. A. M. A. 114:840 ( (March 9) ) 1940. 8. MacDonald, I.: Fatal and Severe Human Infections with Hemolytic Streptococci Group G (Lancefield) , M. J. Australia 2:471, 1939. 9. Rantz, L. A., and Kirby, W. M. M.: Enterococcic Infections: An Evaluation of the Importance of Fecal Streptococci and Related Organisms in the Causation of Human Disease , Arch. Int. Med. 71:516 ( (April) ) 1943.Crossref 10. Longcope, W. T.: Studies of the Variations in the Antistreptolysin Titer of the Blood Serum from Patients with Hemorrhagic Nephritis: II. Observations on Patients Suffering from Streptococcal Infections, Rheumatic Fever and Acute and Chronic Hemorrhagic Nephritis , J. Clin. Investigation 15:277, 1936.Crossref 11. Long, P. H., and Bliss, E. A.: Studies upon Minute Hemolytic Streptococci: IV. Further Observations upon the Distribution of Ordinary and Minute Beta Hemolytic Streptococci in Normal and Diseased Human Beings , J. Infect. Dis. 62:52, 1938.Crossref 12. Congdon, P. M.: Streptococcal Infection in Childbirth and Septic Abortion: Source of Infection and Grouping of Hemolytic Strains , Lancet 2:1287, 1935.Crossref 13. Rosenthal and Stone.5 14. Hare, R.: The Classification of Hemolytic Streptococci from the Nose and Throat of Normal Human Beings by Means of Precipitin and Biochemical Tests , J. Path. & Bact. 41:499, 1935. 15. Plummer, H.: Serological Study of Hemolytic Streptococci , J. Bact. 30:5, 1935. 16. Rantz, L. A.: The Hemolytic Streptococci: Studies on the Carrier State in the San Francisco Area, with Notes on the Methods of Isolation and Serological Classification of These Organisms , J. Infect. Dis. 69:248, 1941. 17. Hare.2b 18. Rantz, L. A., and Jewell, M. L.: The Relationship of Serologic Groups A, B, and C of Lancefield to the Type of Hemolysis Produced by Streptococci in Poured Blood Agar Plates , J. Bact. 40:1, 1940. 19. Tillett, W. S., and Garner, R. L.: The Fibrinolytic Activity of Hemolytic Streptococci , J. Exper. Med. 58:485, 1933. 20. Myers, W. K.; Keefer, C. S., and Holmes, W. F., Jr.: The Resistance to Fibrinolytic Activity of the Hemolytic Streptococcus with Special Reference to Patients with Rheumatic Fever and Rheumatoid (Atrophic) Arthritis , J. Clin. Investigation 14:119, 1935. 21. Waaler, E.: Development of Antifibrinolytic Properties in Blood of Patients with Rheumatic Fever, Chronic Infective Arthritis, and Bacterial Endocarditis , J. Clin. Investigation 16:145, 1937. 22. Boisvert, P. L.: The Streptococcal Antifibrinolysin Test in Clinical Use , J. Clin. Investigation 19:65, 1940. 23. Tillett, W. S.: The Fibrinolytic Activity of Hemolytic Streptococci , Bact. Rev. 2:161, 1938. 24. Garner, R. L., and Tillett, W. S.: Biochemical Studies on the Fibrinolytic Activity of Hemolytic Streptococci: I. Isolation and Characterization of Fibrinolysin , J. Exper. Med. 60: 234, 1934. 25. Kirby, W. M. M., and Rantz, L. A.: The in Vitro and in Vivo Effect of Sulfonamides upon the Streptococcal Antifibrinolysin Test , J. Clin. Investigation 21:295, 1942.Crossref 26. Mote, J. R.; Massell, B. F., and Jones, T. D.: Differences in Hemolytic Streptococcal Antifibrinolysins , J. Immunol. 36:71, 1939. 27. Todd, E. W.: A Comparative Serological Study of Streptolysins Derived from Human and from Animal Infections, with Notes on Pneumococcal Hemolysin, Tetanolysin, and Staphylococcus Toxin , J. Path. & Bact. 39:299, 1934. 28. Todd, E. W.: The Differentiation of Two Distinct Serological Varieties of Streptolysin, Streptolysin O and Streptolysin S , J. Path. & Bact. 47:423, 1938. 29. Todd, E. W.: The Streptolysins of Various Groups and Types of Hemolytic Streptococci: A Serological Investigation , J. Hyg. 39:1, 1939. 30. Coburn, A. F., and Pauli, R. H.: Studies on the Immune Response of the Rheumatic Subject and Its Relationship to Activity of the Rheumatic Process: I. The Determination of Antistreptolysin Titer , J. Exper. Med. 62:129, 1935. 31. Myers, W. K., and Keefer, C. S.: Antistreptolysin Content of the Blood Serum in Rheumatic Fever and Rheumatoid Arthritis , J. Clin. Investigation 13:155, 1934. 32. Ozaki, M.: The Agglutinin Content of Placental Sera for Various Types of Group "A" Streptococci , Kitasato Arch. Exper. Med. 14:314, 1937. 33. Griffith, F.: Serological Classification of Streptococcus Pyogenes , J. Hyg. 34:542, 1935. 34. Schlesinger, B., and Signy, A. G.: Precipitin Reactions in the Blood of Rheumatic Patients Following Acute Throat Infections , Quart. J. Med. 2:255, 1933. 35. Coburn, A. F., and Pauli, R. H.: Studies on the Relationship of Streptococcus Hemolyticus to the Rheumatic Process: III. Observations on the Immunological Response of Rheumatic Subjects to Hemolytic Streptococcus , J. Exper. Med. 56:651, 1932. 36. Todd, E. W.; Laurent, L. J. M., and Hill, N. G.: An Examination of the Relationship Between Streptococcal Antitoxin and Antistreptolysin , J. Path. & Bact. 36:201, 1933.

SOFFER, LOUIS J.;COHN, CLARENCE

doi: 10.1001/archinte.1943.00210050050005pmid: N/A

Abstract GENERAL CONSIDERATIONS In 1891 Recklinghausen1a described a curious disease of bone characterized by destruction and repair, marked softening of the bones and the presence of odd cysts. He recognized the similarity of his cases to that described by Engel1b some twenty-seven years previously. Recklinghausen was not aware of any endocrine disorder associated with the bony changes which he described. As a matter of fact, during the course of the next number of years many pathologists2 noted tumors of the parathyroid glands in the presence of certain kinds of bone disease but failed to grasp the etiologic relationship between the two. Erdheim3 was probably the first to recognize more than a casual relationship between the bony changes and the hyperplasia of the parathyroid glands in cases of osteomalacia, although his explanation of the observed phenomena later proved to be inadequate. It is easy to understand the early References 1. von Recklinghausen, F., in Festschrift Rudolf Virchow zu seinen 71 . Geburtstage, gewidmet von den früheren und jetzigen Assistenten des Berliner pathologischen Instituts, Berlin, G. Reimer, 1891. 2. Engel, G.: Ein Fall von zystoider Entartung des ganzen Skeletts, Inaug. Dissert., Giessen, F. C. Pietsch, 1864. 3. Dawson, J. W., and Struthers, J. W.: Generalized Osteitis Fibrosa with Parathyroid Tumor and Metastatic Calcification, Including a Critical Discussion of the Pathologic Processes Underlying Osseous Dystrophies , Edinburgh M. J. 30:421, 1923. 4. Erdheim, J., cited by Biedl. A.: Innere Sekretion , ed. 2, Berlin, Urban & Schwarzenberg, 1913, pt. 1, p. 108. 5. MacCallum, W. G.: Tumor of the Parathyroid Glands , Bull. Johns Hopkins Hosp. 16:87, 1905. 6. Collip, J. B.: The Parathyroids , Medicine 5:1, 1926.Crossref 7. Klemperer, P.: Parathyroid Hyperplasia and Bone Destruction in Generalized Carcinomatosis , Surg., Gynec. & Obst. 36:11, 1923. 8. Castleman, B., and Mallory, T. B.: Pathology of the Parathyroid Glands in Hyperparathyroidism: Study of Twenty-Five Cases , Am. J. Path. 11:1, 1935. 9. Albright, F.: Hyperparathyroidism Due to Idiopathic Hypertrophy of Parathyroid Tissue: Follow-Up Report on Six Cases , Tr. A. Am. Physicians 52:171, 1937. 10. Greenwald, I., and Gross, J.: The Effect of Thyroparathyroidectomy in Dogs upon the Excretion of Calcium, Phosphorus and Magnesium , J. Biol. Chem. 66:185, 1925 11. The Effect of the Administration of a Potent Parathyroid Extract upon the Excretion of Nitrogen, Phosphorus, Calcium and Magnesium, with Some Remarks on the Solubility of Calcium Phosphate in Serum and the Pathogenesis of Tetany , Greenwald J. Biol. Chem. 66:217, 1925. 12. Mandl, G,: Klinisches und Experimentelles zur Frage der lokalisierten und generalisierten Ostitis fibrosa , Arch. f. klin. Chir. 143:245, 1926. 13. Albright, F.; Bauer, W.; Ropes, W., and Aub, J.: Studies in Calcium and Phosphorus Metabolism: IV. The Effects of the Parathyroid Hormone , J. Clin. Investigation 7:139, 1929. 14. Hueper, W.: Metastatic Calcifications in the Organs of the Dog After Injections of Parathyroid Extract , Arch. Path. 3:14 ( (Jan.) ) 1927. 15. Bauer, W.; Aub, J. C., and Albright, F.: Studies of Calcium and Phosphorus Metabolism: V. A Study of the Bone Trabeculae as a Readily Available Reserve Supply of Calcium , J. Exper. Med. 19:145, 1929. 16. Jaffe, H. L.: Hyperparathyroidism , Arch. Path. 16:63 ( (July) ); 236 (Aug.) 1933. 17. Bulger, H. A.; Dixon, H. A., and Barr, D. P.: The Functional Pathology of Hyperparathyroidism , J. Clin. Investigation 9:143, 1931. 18. Halverson, J. O.; Mohler, H. K., and Bergeim, O.: The Calcium Content of the Blood Serum in Certain Pathological Conditions , J. Biol. Chem. 32:171, 1927. 19. Scriver, W. de M.: Observations on the Excretion of Calcium in Two Cases of Nephrosis Treated with Parathyroid Extract , J. Clin. Investigation 6:115, 1928. 20. Hetényi, G., and Nógráde, S. V.: Ueber die Kalkausscheidung der gesunden und kranken Niere , Klin. Wchnschr. 6:1308, 1925. 21. Jaffe, H. L.: Hyperparathyroidism , Bull. New York Acad. Med. 16:291 ( (May) ) 1940. 22. Wilder, R. M.: Hyperparathyroidism: Tumor of the Parathyroid Glands Associated with Osteitis Fibrosa , Endocrinology 13:231 ( (May) ) 1929. 23. Bergstrand, H.: Parathyroideastudien: II. Ueber Tumoren und hyperplastische Zustände der Nebenschilddrüsen , Acta med. Scandinav. 54:539, 1921. 24. Hubbard, R. S., and Wentworth, J. A.: A Case of Metastatic Calcification Associated with Chronic Nephritis and Hyperplasia of the Parathyroids , Proc. Soc. Exper. Biol. & Med. 18:307, 1921. 25. Pappenheimer, A. M., and Wilens, S. L.: Enlargement of the Parathyroid Glands in Renal Disease , Am. J. Path. 11:73, 1935. 26. Shelling, D. H., and Remsen, D.: Renal Rickets , Bull. Johns Hopkins Hosp. 57:158, 1935. 27. Shelling, D. H.: The Parathyroids in Health and Disease , St. Louis, C. V. Mosby Company, 1935. 28. Anderson, W. A. D.: Hyperparathyroidism and Renal Disease , Arch. Path. 27:753 ( (April) ) 1939. 29. Downs, R. S., and Scott, V.: Hyperparathyroidism with Adenoma Causing Renal Failure and Secondary Hyperparathyroidism , Arch. Int. Med. 67:658 ( (March) ) 1941. 30. Ginzler, A. M., and Jaffe, H. L.: Osseous Findings in Chronic Renal Insufficiency in Adults , Am. J. Path. 17:292, 1941. 31. Thompson, D. L., and Collip, J. B.: The Parathyroid Glands , Physiol. Rev. 12:309, 1932. 32. Jaffe.14 33. Snapper, I.: Different Features of the Syndrome of Hyperparathyroidism , Acta med. Scandinav. 103:321, 1940. 34. Albright, F.; Aub, J. C., and Bauer, W.: Hyperparathyroidism: Common and Polymorphic Condition as Illustrated by Seventeen Proved Cases from One Clinic , J. A. M. A. 102:1276 ( (April 21) ) 1934. 35. Gutman, A. B.; Tyson, T. L., and Gutman, E. B.: Serum Calcium, Inorganic Phosphorus, and Phosphatase Activity in Hyperparathyroidism, Paget's Disease, Multiple Myeloma and Neoplastic Disease of the Bones , Arch. Int. Med. 57:379 ( (Feb.) ) 1936. 36. The preparation used in the cases reported was one meeting the standards for solution of parathyroid U. S. P. 37. Rowntree, L. G.: Progress Relative to Diseases of the Ductless Glands , Pennsylvania M. J. 36:646, 1933.

ADCOCK, JOHN D.

doi: 10.1001/archinte.1943.00210050070006pmid: N/A

Abstract The occurrence of interstitial emphysema of the lung with air within the mediastinum as a result of thoracic trauma has been recognized for a long time. It has, of course, been described by many observers following medical and surgical maneuvers involving the lungs and pleura and associated with foreign bodies in the bronchial tree. The occurrence of mediastinal air and subcutaneous air has also been described as a complication of many pulmonary diseases, including tuberculosis, influenza, bronchopneumonia of various types and asthma. It has been known to occur when the intrabronchial pressures were elevated by the use of positive pressure anesthesia and during the efforts of labor. Hamman,1 however, was the first to report the condition in healthy persons without antecedent trauma or disease. It was in 1934, in a paper discussing the diagnosis of coronary occlusion, that Hamman presented2 cases of spontaneous mediastinal emphysema which simulated coronary References 1. Hamman, L.: Remarks on the Diagnosis of Coronary Occlusion , Ann. Int. Med. 8: 417-431 ( (Oct.) ) 1934.Crossref 2. Hamman, L.: Spontaneous Interstitial Emphysema of the Lungs , Tr. A. Am. Physicians 52:311-319, 1937. 3. Hamman, L.: Spontaneous Mediastinal Emphysema (Henry Sewall Lecture) , Bull. Johns Hopkins Hosp. 64:1-21 ( (Jan.) ) 1939. 4. Scott, A. M.: The Significance of the Anginal Syndrome in Acute Spontaneous Pneumomediastinum , Lancet 1:1327-1330 ( (June 5) ) 1937.Crossref 5. Morey, J. B., and Sosman, M. C.: Spontaneous Mediastinal Emphysema, with Report of a Case Associated with Spontaneous Pneumothorax , Radiology 32:19-22 ( (Jan.) ) 1939.Crossref 6. McGuire, J., and Bean, W. B.: Spontaneous Interstitial Emphysema of the Lungs , Am. J. M. Sc. 197:502-509 ( (April) ) 1939.Crossref 7. Kirshner, J. J.: Spontaneous Pneumothorax: Aetological Considerations , Am. Rev. Tuberc. 40:477-481 ( (Oct.) ) 1939. 8. Wolff, B. P.: Spontaneous Interstitial Emphysema of the Lungs: Report of an Additional Case , Ann. Int. Med. 13:1250-1252 ( (Jan.) ) 1940.Crossref 9. Caldwell, H. W.: Spontaneous Mediastinal Emphysema , J. A. M. A. 116:301-302 ( (Jan. 25) ) 1941.Crossref 10. Matthews, E.: Spontaneous Mediastinal Emphysema , New Orleans M. & S. J. 93:523-524 ( (April) ) 1941. 11. Pinckney, M. M.: Mediastinal Emphysema and Idiopathic Spontaneous Pneumothorax , Virginia M. Monthly 68:315-319 ( (June) ) 1941. 12. Gumbiner, B., and Cutler, M. M.: Spontaneous Pneumomediastinum in the Newborn , J. A. M. A. 117:2050-2053 ( (Dec. 13) ) 1941. 13. Macklin, C. C.: Pneumothorax with Massive Collapse from Experimental Local Overinflation of the Lung Substance , Canad. M. A. J. 36:414-420 ( (April) ) 1937 14. Transport of Air Along Sheaths of Pulmonic Blood Vessels from Alveoli to Mediastinum: Clinical Implications , Arch. Int. Med. 64:913-926 ( (Nov.) ) 1939. 15. Fisher, J. H., and Macklin, C. C.: Pulmonic Interstitial and Mediastinal Emphysema: Report of a Fatal Case in Which the Emphysema Occurred in a Child as a Result of the Aspiration of Peanut Fragments , Am. J. Dis. Child. 60:102-115 ( (July) ) 1940. 16. Macklin, C. C.: Spontaneous Mediastinal Emphysema: A Review and Comment , M. Rec. 150:5-7 ( (July 5) ) 1939. 17. Torrey, R. C., and Grosh, L. C.: Acute Pulmonary Emphysema Observed During the Epidemic of Influenzal Pneumonia at Camp Hancock, Georgia , Am. J. M. Sc. 157:170 ( (Feb.) ) 1919. 18. Lister, W. A.: Pericardial Knock Associated with Spontaneous Pneumothorax , Lancet 2:1225 ( (Dec. 26) ) 1928.

FARBER, JASON E.;MARGULIS, AARON E.

doi: 10.1001/archinte.1943.00210050078007pmid: N/A

Abstract For centuries physicians have witnessed the tragic instance of a child born with multiple fractures of the bones. Lobstein,1 in 1833, designated this condition as Ostepsathyrosis, a descriptive term derived from Greek, meaning friable bones. In 1849, Vrolik reported a similar condition, which he named osteogenesis imperfecta, implying defective formation of bone as the cause. Spurway,2 in 1896, reported the first instance in which the condition of fragile bones (fragilitas ossium) was associated with blue scleras. Bronson,3 in 1917, and van der Hoeve and de Kleyn,4 in 1918, added to the syndrome the third feature, deafness. Key,5 in 1926, referred to the syndrome as "hereditary hypoplasia of the mesenchyme" and called attention to the hypotonicity of the ligaments with hypermobile joints. In 1928 Bell6 collected 75 pedigrees including 489 cases of this abnormality. The condition is not so rare as is generally thought. Recent literature7 has shown renewed References 1. Lobstein, J. G.: Traité d'anatomie pathologique , Paris, F. G. Lerrault, 1833, vol. 2, p. 204. 2. Spurway, J.: Hereditary Tendency to Fracture , Brit. M. J. 2:844 ( (Sept. 26) ) 1896.Crossref 3. Bronson, E.: On Fragilitas Ossium and Its Association with Blue Sclerotics and Otosclerosis , Edinburgh M. J. 18:240 ( (April) ) 1917. 4. van der Hoeve, J., and de Kleyn, A.: Blaue Sclera, Knochenbrüchigkeit und Schwerhörigkeit , Arch. f. Ophth. 95:81 ( (Jan.) ) 1918. 5. Key, J. A.: Brittle Bones and Blue Sclera: Hereditary Hypoplasia of the Mesenchyme , Arch. Surg. 13:523 ( (Oct.) ) 1926.Crossref 6. Bell, J.: Blue Sclerotics and Fragility of Bone , in Pearson, K.: Treasury of Human Inheritance , London, Cambridge University Press, 1928, vol. 2, pt. 3, sect. 24. 7. Hills, R. G., and McLanahan, S.: Brittle Bones and Blue Sclerae in Five Generations , Arch. Int. Med. 59:41 ( (Jan.) ) 1937.Crossref 8. Dessoff, J.: Blue Sclerotics, Fragile Bones and Deafness , Arch. Ophth. 12:60 ( (July) ) 1934.Crossref 9. Takahashi, T.: Beitrag zur Kenntnis der blauen Sclera , Arch. f. Ophth. 115:206, 1925. 10. Dessoff.7b 11. Rados, A., and Rosenberg, L. C.: Relation Between Blue Scleras and Hyperparathyroidism , Arch. Ophth. 16:8 ( (July) ) 1936.Crossref 12. Aub, J. C., and Farquharson, R. F.: Studies of Calcium and Phosphorus Metabolism in Various Metabolic and Bone Diseases , J. Clin. Investigation 11:235 ( (Jan.) ) 1932.Crossref 13. Zucker, T. F., and Matzner, M. J.: On the Pharmacological Action of the Antirachitic Active Principle of Cod Liver Oil , Proc. Soc. Exper. Biol. & Med. 21:186, 1923-1924. 14. Hunter, D.: A Case of Osteogenesis Imperfecta , Lancet 1:9 ( (Jan. 1) ) 1927. 15. Tauber, M.: Beitrag zum Calciumstoffwechsel bei Osteogenesis imperfecta , Monatschr. f. Kinderh. 36:12, 1927. 16. Aub and Farquharson.10 17. Sindler, A.: Der Stoffwechsel bei Osteogenesis imperfecta , Ztschr. f. Kinderh. 42:85, 1926. 18. Stevenson, G. H., and Cuthbertson, D. P.: Blue Sclerotics and Associated Defects: Study of Four Families, with Notes on Their Mineral Metabolism , Lancet 2:782 ( (Oct. 10) ) 1931.

HOYOS, JORGE MENESES;QUESADA, J. J.

doi: 10.1001/archinte.1943.00210050086008pmid: N/A

Abstract For a proper interpretation of roentgenograms of the chest, an exact knowledge of the relations between the cardiac silhouette and the large vessels and chambers of the heart is necessary. Many interesting studies of this subject have been made and published by Keith,1 Dietlen, Roessler,2 Parkinson3 Vaquez and Bordet,4 Delherm and Thoyer Rozat, and Laubry, Cottenot, Routier and Heim de Balsac,5 but only the method followed by the last group has seemed to us quite convincing. With a similar procedure, we have tried to determine clearly the relations that normally exist between the contour of the cardiac shadow in roentgen films and the different chambers and large vessels of the heart. ROENTGENOGRAPHIC METHOD In Juarez Hospital, of Mexico City, sodium iodide solution was injected into the large vessels and the chambers of the hearts of several cadavers. Roentgenograms were then taken of the chests of References 1. Keith, S.: Lancet 1:1466 ( (June 27) ) 1936.Crossref 2. Roessler, H.: Clinical Roentgenology of the Cardiovascular System: Anatomy-Physiology-Pathology-Experiments and Clinical Application , Springfield, Ill., Charles C Thomas, Publisher, 1937 3. Atlas of Cardioroentgenology , Roessler, 1940. 4. Golden, R.: Diagnostic Roentgenology , New York, Thomas Nelson & Sons, 1937. 5. Parkinson, J.: Lancet 1:1337 ( (June 13) ) 6. 1391 (June 20) 1936. 7. Vaquez, H., and Bordet, E.: Radiologie du coeur et des vaisseaux de la base , Paris, Masson & Cie, 1928. 8. Laubry, C.; Cottenot, P.; Routier, D., and Heim de Balsac, R.: J. de radiol. et d'électrol. 19:193 ( (May) ) 9. 561 (Oct.) 1935 10. Presse méd. 102:2071 ( (Dec. 21) ) 1935 11. Radiologie clinique du coeur et des gros vaisseaux , Paris, Masson & Cie, 1939.

KEITH, NORMAN M.;KING, HARRY E.;OSTERBERG, ARNOLD E.

doi: 10.1001/archinte.1943.00210050095009pmid: N/A

Abstract The fact that during each day a normal person ingests by mouth and excretes in the urine and stool several grams of potassium had led to use of the expression "potassium balance." Since approximately 80 per cent of the output of potassium is excreted by the kidney, it has usually been assumed that the renal parenchyma possesses a special ability to excrete this ion. Indeed, the rapid renal excretion of potassium after the ingestion of a considerable amount of a potassium salt has been suggested as a reason for the nontoxic effect of potassium on the normal organism. If renal excretion is seriously impaired, as it may be in the presence of renal disease, it might be suspected that retention of potassium in the blood serum analogous to retention of other excretory constituents of the urine would occur. In animals with experimentally produced lesions of the kidneys, including bilateral nephrectomy, References 1. Noguchi, I.: Untersuchungen über den Mineralstoffwechsel in Nierenkranken , Arch. f. exper. Path. u. Pharmakol. 108:73-77, 1925.Crossref 2. Beckmann, K.; Bass, E.; Dürr, R., and Drosihn, G.: Stoffwechsel und Blutveränderungen nach Nierenextirpation. Ionenvirschiebungen und Säure-Blasengleichgewicht nach Nierenexstirpation , Ztschr. f. d. ges. exper. Med. 51:333-341, 1926.Crossref 3. Mark, R. E., and Kohl-Egger, E.: Kalium-Kalziumspiegel im Serum nach Harnstoffgabe , Zentralbl. f. inn. Med. 48:578-584 ( (June) ) 1927. 4. Hartwich, A., and Hessel, G.: Der Kalium-, Calcium- und Kochsalzspiegel bei den verschiedenen Formen der experimentellerzeugten Urämie , Klin. Wchnschr. 7:67-69 ( (Jan. 8) ) 1928.Crossref 5. Nicholson W. M., and Schechter, A. J.: Cardiac Arrhythmia After Bilateral Ureteral Ligation in the Dog , Bull. Johns Hopkins Hosp. 60:346-357, 1937. 6. Bolliger, A., and Breh, F.: Ueber die Mineralstoffveränderungen des Blutes bei experimenteller Nephritis, mit spezieller Berücksichtigung des Kalium-Kalziumspiegels im Serum , Zentralbl. f. inn. Med. 49:825-831 ( (Sept.) ) 1928. 7. Meyers, V. C., and Short, J. J.: The Potassium Content of Normal and Some Pathological Human Bloods , J. Biol. Chem. 48:83-92 ( (Sept.) ) 1921. 8. Zondek, H.; Petow, H., and Siebert, W.: Zur Frage der Funktionsstörung der Niere , Klin. Wchnschr. 1:2172-2174 ( (Oct. 28) ) 1922.Crossref 9. Wilkins, L., and Kramer, B.: Studies on the Potassium Content of Human Serum , Arch. Int. Med. 31:916-922 ( (June) ) 1923.Crossref 10. Briggs, A. P.: A Study of the Inorganic Elements of Blood Plasma , J. Biol. Chem. 57:351-357 ( (Sept.) ) 1923. 11. Nelken, L., and Steinitz, H.: Ueber den Gehalt des Blutserums an Calcium und Kalium bei Nierenkrankheiten , Ztschr. f. klin. Med. 103:317-341, 1926. 12. Salvesen, H. A.: Variations in the Serumelectrolytes in Diseases of Renal Origin with Special Reference to the Cause of Renal Acidosis , Acta med. Scandinav. 69:126-186, 1928.Crossref 13. Green, C. H.; Wakefield, E. G.; Power, M. H., and Keith, N. M.: The Electrolyte Distribution and the Acid-Base Equilibrium in the Serum in Cases of Nephritis and Nephritic Acidosis , Biochem. J. 26:1377-1382, 1932. 14. Hoffman, W. S., and Jacobs, H. R. D.: The Partition of Potassium Between the Serum and Corpuscles in Health and Disease , J. Lab. & Clin. Med. 19:633-644 ( (March) ) 1934. 15. Atchley, D. W.; Loeb, R. F.; Benedict, E. M., and Palmer, W. W.: Physical and Chemical Studies of Human Blood Serum: II. Study of Twenty-Nine Cases of Nephritis , Arch. Int. Med. 31:611-615 ( (April) ) 1923. 16. Observations in all 33 cases were extremely valuable, but for purposes of conservation of space the data for only 12 appear in extenso in tables 2 and 3. 17. Dr. A. H. Baggenstoss, of the section on pathologic anatomy of the Mayo Clinic, made the pathologic observations. 18. Rabinowitch, I. M.: On the Relative Proportions of Sodium, Potassium, Calcium and Magnesium in Blood Plasma in Renal Disease , J. Biol. Chem. 62:667-673 ( (Jan.) ) 1925. 19. The blood obtained from patients in this study was withdrawn from a vein in the elbow, in the morning, before the ingestion of food. 20. Furey, E. D.: Normal Variations in Proteins and Certain Inorganic Elements of the Blood Serum , Proc. Staff Meet., Mayo Clin. 13:730-732 [ (Nov. 16) ] 1938). 21. Rathery, F., and Bertoliatti, J.: Variations du taux du potassium dans le sang et diabète sucré , Compt. rend. Soc. de biol. 116:1346-1349, 1934. 22. McQuarrie, I.; Thompson, W. H., and Anderson, J. A.: Effects of Excessive Ingestion of Sodium and Potassium Salts on Carbohydrate Metabolism and Blood Pressure in Diabetic Children , J. Nutrition 11:77-101 [ (Jan.) ] 1936 23. tetany,2c 24. wound shock,25 25. Rusk, H. A.; Weichselbaum, T. E., and Somogyi, M., with the technical assistance of Simms, E.: Changes in Serum Potassium in Certain Allergic States , J. A. M. A. 112:2395-2398 [ (June 10) ] 1939. 26. Hoffman and Jacobs2h 27. Footnote deleted on proof. 28. Hoff, H. E.; Smith, P. K., and Winkler, A. W.: The Cause of Death in Experimental Anuria , J. Clin. Investigation 20:607-624 ( (Nov.) ) 1941.Crossref 29. In case 32 the electrocardiogram showed on the seventh hospital day an intraventricular conduction defect with a QRS complex of 0.16 second. On the patient's first day in the hospital the QRS complex was of normal duration, and it seems possible that the change might be attributed to an increase in the concentration of potassium in the serum, as has been suggested in case 15 (table 4). Further support to this suggestion was the absence of any demonstrable myocardial lesions on histologic examination. Dr. H. B. Burchell interpreted these electrocardiographic tracings. 30. Cushny, A. R.: The Secretion of Urine , London, Longmans, Green & Co., 1917. 31. Meissner, G.: Bericht über Versuche die Urämie betreffend , Ztschr. f. rat. Med. 26:225-249, 1866. 32. Voit, C.: Ueber das Verhalten des Kreatins, Kreatinins und Harnstoffs im Thierkörper , Ztschr. f. Biol. 4:77-162, 1868. 33. Feltz, V., and Ritter, E.: De l'urémie expérimentale , Paris, Berges, Levrault & Cie, 1881. 34. Olmer, D.; Payan, L., and Berthier, J.: Le potassium du sérum sanguin dans l'insuffisance rénale , Compt. rend. Soc. de biol. 87:867-869 ( (Sept. 15) ) 1922. 35. Scholtz, H. G.: Ueber den Calcium- und Kaliumgehalt im Blutserum und die Ultrafiltierbarkeit dieser Minerale bein Niereninsuffizienz , Deutsches Arch. f. klin. Med. 172:472-482, 1932. 36. Rosenberg, E. F.; Keith, N. M., and Wagener, H. P.: Diffuse Arterial Disease with Hypertension: Two Unusual Cases of Contrasting Types , Arch. Int. Med. 62:461-481 ( (Sept.) ) 1938.Crossref 37. Snapper, I.: Chinese Lessons to Western Medicine , New York, Interscience Publishers, Inc., 1941. 38. Treatment during this period in case 10 consisted of ingestion of a diet containing approximately 2,000 calories, 60 Gm. of protein and 3 to 5 Gm. of sodium chloride. The intake of fluid averaged 2,000 to 3,000 cc.; 1,000 cc. of this daily intake of fluid often was injected intravenously and contained 100 Gm. of dextrose or 9 Gm. of sodium chloride, or both substances in these amounts. After these therapeutic measures polyuria, improvement in renal function and a decrease in serum potassium took place. Similar treatment was carried out in many other cases of this series without demonstrable effect on the concentration of potassium in the blood serum. In addition, blood was transfused to several of our patients. In case 15, in which severe uremia was present, blood was transfused on the third hospital day. Estimation of the potassium content of the serum next morning revealed a high value, of 27.8 mg. per hundred cubic centimeters. Four days later it had increased to 40.9 mg. We do not think that the transfused blood had a causal relation to the increase in serum potassium, because in a subsequent case the values for serum potassium before and after transfusion of blood were identical. In neither this patient's case (case 15) nor in others did we make a systematic study of the effect of transfusion on the constituents of the blood. Our available data failed to reveal any constant change in the potassium content of serum due to the transfusion of blood. 39. Macallum, A. B.: The Ancient Factors in the Relations Between Blood Plasma and the Kidneys , Tr. Coll. Physicians, Philadelphia 39:286-299, 1917. 40. The normal range was calculated by taking the quotients resulting from dividing the minimal and maximal normal serum potassium values by the maximal and minimal normal serum sodium values respectively; for example, 17 divided by 359 = 0.047 and 21.3 by 315 = 0.068. 41. Thomson, W. A. R.: The Effect of Potassium on the Heart in Man , Brit. Heart J. 1: 269-282 ( (Oct.) ) 1939.Crossref 42. Keith, N. M., and Binger, M. W.: Diuretic Action of Potassium Salts , J. A. M. A. 105:1584-1590 ( (Nov. 16) ) 1935.Crossref 43. Scudder, J.: Shock: Blood Studies as a Guide to Therapy , Philadelphia, J. B. Lippincott Company, 1940. 44. Zwemer, R. L., and Truszkowski, R.: Factors Affecting Human Potassium Tolerance , Proc. Soc. Exper. Biol. & Med. 35:424-426 ( (Dec.) ) 1936. 45. Zwemer, R. L.; Sims, E. A. H., and Coggeshall, L. T.: Plasma Potassium Level During Malaria Infection in Monkeys and Man , Am. J. Trop. Med. 20:687-701 ( (Sept.) ) 1940. 46. Since pus cells frequently were present in the urinary sediment in our cases, and since these cells contain intracellular potassium, the question arose as to whether the presence of such cells in the urine augmented the actual quantity of potassium excreted by the kidneys. The urine was especially examined in 5 cases with regard to this point. In case 9 the concentration of potassium in the urine was very low, yet the sediment contained large numbers of leukocytes. In case 27 clearance was estimated twice; in one specimen of urine there were no leukocytes; in the other 20 to 50 cells to a field were found with the high power lens. Yet the concentrations of potassium in the two specimens were practically identical. We then analyzed a sample of well shaken urine and also a sample of the same urine obtained from the upper portion of the tube after rapid centrifuging for several minutes. The concentration of potassium was the same in the two samples. The results of this experiment, carried out on urine from 5 patients, were similar. There were never more than a few erythrocytes in the sediment; so their presence would not have altered the concentration of potassium. The foregoing evidence is convincing that the concentration of potassium in the urine was not increased by the presence of leukocytes. 47. Winkler, A. W.; Hoff, H. E., and Smith, P. K.: The Toxicity of Orally Administered Potassium Salts in Renal Insufficiency , J. Clin. Investigation 20:119-126 ( (March) ) 1941. 48. Blumenfeldt, E.: Beiträge zur Kaliausscheidung unter normalen und pathologischen Verhältnissen , Ztschr. f. exper. Path. u. Therap. 12:523-528 ( (Feb. 22) ) 1913. 49. MacKay, E. M., and Butler, A. M.: Studies of Sodium and Potassium Metabolism: The Effect of Potassium on the Sodium and Water Balances in Normal Subjects and Patients with Bright's Disease , J. Clin. Investigation 14:923-939 ( (Nov.) ) 1935. 50. Van Slyke, D. D.; Stillman, E.; Möller, E.; Ehrich, W.; McIntosh, J. F.; Leiter, L.; MacKay, E. M.; Hannon, R. R.; Moore, N. S., and Johnston, C.: Observations on the Courses of Different Types of Bright's Disease, and on the Resultant Changes in Renal Anatomy , Medicine 9:257-386 ( (Sept.) ) 1930. 51. Falconer, M. A.; Osterberg, A. E., and Bargen, J. A.: Intestinal Obstruction in Man: Alterations in the Serum Bases and Their Significance , Arch. Surg. 38:869-885 ( (May) ) 1939. 52. Addis, T., and Lew, W.: Diet and Death in Acute Uremia , J. Clin. Investigation 18:773-775 ( (Nov.) ) 1939. 53. Smillie, W. G.: Potassium Poisoning in Nephritis , Arch. Int. Med. 16:330-339 ( (Aug.) ) 1915. 54. Bergman, H. C., and Drury, D. R.: A Study of Acute Renal Insufficiency , J. Clin. Investigation 18:777-781 ( (Nov.) ) 1939. 55. Beall, D.; Bywaters, E. G. L.; Belsey, R. H. R., and Miles, J. A. R.: A Case of Crush Injury with Renal Failure , Brit. M. J. 1:432-434 ( (March 22) ) 1941. 56. Wilks, and Taylor, A. S.: Case in Which Large Quantity of Nitrate of Potash Was Taken Medicinally: Elimination of the Salt by the Urine , Guy's Hosp. Rep. 9:173-179, 1863. 57. Footnote deleted on proof. 58. Keith, N. M.; Osterberg, A. E., and Burchell, H. B.: Some Effects of Potassium Salts in Man , J. Pharmacol. & Exper. Therap. 72:22-23 ( (May) ) 1941 59. Some Effects of Potassium Salts in Man , Ann. Int. Med. 16:879-892 ( (May) ) 1942. 60. Keith, N. M., and Osterberg, A. E.: The Excretion of Potassium by the Kidney , Am. J. Physiol. 129:395-396 ( (May) ) 1940. 61. Keith, N. M.; Osterberg, A. E., and King, H. E.: The Excretion of Potassium by the Normal and Diseased Kidney , Tr. A. Am. Physicians 55:219-222, 1940. 62. Gamble, J. L.; Ross, G. S., and Tisdall, F. F.: The Metabolism of Fixed Base During Fasting , J. Biol. Chem. 57:633-695 ( (Oct.) ) 1923. 63. Winkler, A. W., and Smith, P. K.: The Apparent Volume of Distribution of Potassium Injected Intravenously , J. Biol. Chem. 124:589-598 ( (Aug.) ) 1938. 64. Winkler, A. W.; Hoff, H. E., and Smith, P. K.: Toxicity of Potassium in Adrenalectomized Dogs , Am. J. Physiol. 133:494-495 ( (June) ) 1941. 65. McQuarrie, I.; Johnson, R. M., and Ziegler, M. R.: Plasma Electrolyte Disturbance in Patient with Hypercorticoadrenal Syndrome Contrasted with That Found in Addison's Disease , Endocrinology 21:762-772 ( (Nov.) ) 1937. 66. Willson, D. M.; Power, M. H., and Kepler, E. J.: Alkalosis and Low Plasma Potassium in a Case of Cushing's Syndrome: A Metabolic Study , J. Clin. Investigation 19:701-707 ( (Sept.) ) 1940. 67. Fenn, W. O.: The Rôle of Potassium in Physiological Processes , Physiol. Rev. 20: 377-415 ( (July) ) 1940. 68. McCance, R. A., and Widdowson, E. M.: Alkalosis with Disordered Kidney Functions: Observations on a Case , Lancet 2:247-249 ( (July 31) ) 1937.

SARASON, ERNEST L.

doi: 10.1001/archinte.1943.00210050122010pmid: N/A

Abstract With the extraction of an active substance by Swingle and Pfiffner1 and Hartman and Brownell2 in 1930 and the more recent isolation of potent crystalline compounds by Reichstein3 and Kendall and his associates,4 great advances have been made in the knowledge of the physiology of the cortex of the adrenal gland. The effects of its hormones are reasonably well known today. The influence of systemic disease on the morphologic appearance of the gland is, however, not widely recognized. The latter, described by many, could not have been appreciated without the benefit of the more recent advances in the knowledge of the physiology of the gland. An attempt will be made in this paper to establish correlations between changes in the morphologic aspects of the cortex and various systemic diseases. MATERIAL Adrenal glands were obtained from 110 routine autopsies performed at the New Haven Hospital (one to References 1. Swingle, W. W., and Pfiffner, J. J.; An Aqueous Extract of the Suprarenal Cortex Which Maintains the Life of Bilaterally Adrenalectomized Cats , Science 71:321, 1930.Crossref 2. Hartman, F. A., and Brownell, K. A.: The Hormone of the Adrenal Cortex , Science 72:76, 1930.Crossref 3. Reichstein, R.: Ueber Cortin, das Hormon der Nebennierenrinde , Helvet. chim. acta 19:29, 1936.Crossref 4. Kendall, E. C.; Mason, H. L.; Hoehn, W. M., and McKenzie, B. F.: Studies in the Chemistry of the Suprarenal Cortex , Proc. Staff Meet., Mayo Clin. 12:136, 1937. 5. Schmorl, G.: Die pathologisch-histologischen Untersuchungsmethoden , Leipzig, F. C. W. Vogel, 1934. 6. Kiyokawa, W.: Die Nebennieren bei Tuberkulose , Frankfurt. Ztschr. f. Path. 29:287, 1923. 7. Materna, A.: Das Gewicht der Nebennieren , Zentralbl. f. allg. Path. u. path. Anat. 33:62, 1922 8. Das Gewicht der Nebennieren , Ztschr. f. Konstitutionslehre 19:1, 1923.Crossref 9. Kraus, E. J.: Chronischer Hirndruck, Hypophyse und Nebennierenrinde , Frankfurt. Ztschr. f. Path. 52:255, 1938. 10. Scheel, O.: Ueber Nebennieren , Virchows Arch. f. path. Anat. 192:494, 1918.Crossref 11. Schilf, D.: Die quantitativen Beziehungen der Nebennieren zum übrigen Körper , Ztschr. f. Konstitutionslehre 8:507, 1923. 12. Jaffe and Sternberg, cited by Dietrich and Siegmund.13 13. Dietrich, A., in Henke, F., and Lubarsch, O.: Drüsen mit innerer Sekretion, in Handbuch der speziellen pathologischen Anatomie und Histologie , Berlin, Julius Springer, 1926, vol. 8, p. 964. 14. Dietrich, A., and Siegmund, H., in Henke, F., and Lubarsch, O.: Drüsen mit innerer Sekretion , in Handbuch der speziellen pathologischen Anatomie und Histologie , Berlin, Julius Springer, 1926, vol. 8. 15. Mulon, P.: Note sur la capsule surrénale du mouton, considérations histo-physiologiques , Bibliog. anat. 22:30, 1912. 16. Landau, M.: Die Nebennierenrinde , Jena, Gustav Fischer, 1915. 17. Zwemer, R. L.: A Study of Adrenal Cortex Morphology , Am. J. Path. 12:107, 1936. 18. Bennett, H. S.: Life History and Secretion of Cell of Adrenal Cortex of Cat , Am. J. Anat. 67:151, 1940.Crossref 19. Liebegott, G., in discussion on Bleumer, H.: Glycogenspeicher Krankheit , Verhandl. d. deutsch. path. Gesellsch. 31:18, 1938. 20. Benecke, E.: Hyperinsulinismus und Glykogenspeicherung beim Icterus familiaris gravis , Zentralbl. f. allg. Path. u. path. Anat. 72:401, 1939. 21. Fraenkel, E.: Ueber die blutgefässchädigende Wirkungen des Grippeerregers , Centralbl. f. allg. Path. u. path. Anat. 33:104, 1923. 22. Thomas, E.: Ueber die Nebennieren der Kinder und ihre Veränderungen bei Infektionskrankheiten , Beitr. z. path. Anat. u. z. allg. Path. 50:283, 1911. 23. Dietrich, A.: Die Nebennieren bei den Wundinfektionskrankheiten. Zentralbl. f. allg. Path. u. path. Anat. 29:169, 1918. 24. Goormaghtigh, N.: Sur le fonctionnement de la capsule surrénale humaine dans les gangrènes gazeuses , Compt. rend. Soc. de biol. 81:14, 1918. 25. Deucher, G.: Veränderungen der Nebennierenrinde bei Peritonitis und Sepsis , Arch. f. klin. Chir. 125:578, 1923. 26. Kawamura, D.: Die Cholesterinesterverfettung , Jena, Gustav Fischer, 1911. 27. Albrecht, H., and Weltmann, O.: Ueber das Lipoid der Nebennierenrinde , Wien. klin. Wchnschr. 24:483, 1911. 28. Hueck, E.: Ueber experimentell erzeugte Veränderungen im Lipoidgehalt der Neben-nierenrinde und ihre Beziehungen zum Cholesteringehalt des Blutes , Verhandl. d. deutsch. path. Gesellsch. 15:251, 1912. 29. Wülfing, M.: Die Veränderungen der Nebennierenrinde bei Infektionskrankheiten. Virchows Arch. f. path. Anat. 253:239, 1924.Crossref 30. Ball, H. A., and Samuels, L. T.: Adrenal Weights in Tumor-Bearing Rats. Proc. Soc. Exper. Biol. & Med. 38:441, 1938. 31. Kolosko, A.: Ueber Befunde an den Nebennieren bei Verbrennungstod , Vrtljschr. f. gerichtl. Med. ( (supp. 1) ) 47:217, 1914. 32. Napp, O.: Ueber den Fettgehalt der Nebenniere , Virchows Arch. f. path. Anat. 182:314, 1905. 33. Pfeiffer, H.: Ueber Veränderungen des Nebennierenorgans nach nervösen und tokischen Störungen , Ztschr. f. d. ges. exper. Med. 10:1, 1920. 34. Nakata, T.: Das Verhalten der Nebenniere und Milz bei Verbrennung mit besonderer Berücksichtigung der Todesursache , Beitr. z. path. Anat. u. z. allg. Path. 73:439, 1925. 35. Niemeyer, R.: Ueber Nebennierenveränderungen bei experimentellen Vergiftungen und bei Verbrühungen , Ztschr. f. d. ges. exper. Med. 14:346, 1921. 36. Kamniker, K.: Beitrag zur Kenntnis der Nebennierenblutungen , Frankfurt. Ztschr. f. Path. 35:487, 1927. 37. Wohl, M. G.; Burns, J. C., and Clark, J. H.: Adrenal Gland in Dogs with High Intestinal Obstruction , Proc. Soc. Exper. Biol. & Med. 33:543, 1936. 38. Wohl, M. G.; Burns, J. A., and Pfeiffer, G.: High Intestinal Obstruction in the Dog Treated with Extract of Adrenal Cortex , Proc. Soc. Exper. Biol. & Med. 36:549, 1937. 39. Scudder, J.; Zwemer, R. L., and Truszkowski, R.: Potassium in Acute Intestinal Obstruction , Surgery 1:74, 1937. 40. Peters, J. P., and Van Slyke, D. D.: Quantitative Clinical Chemistry , Baltimore, Williams & Wilkins Company, 1931, vol. 1. 41. Talbot, J. H.; Lever, W. F., and Consolazio, W. B.: Metabolic Studies on Patients with Pemphigus , J. Invest. Dermat. 3:31, 1940. 42. Stoesser, A. V.: Potassium Chloride Therapy and Serum Potassium in Infantile Eczema , Proc. Soc. Exper. Biol. & Med. 49:332, 1942. 43. Maclean, A.: The Suprarenal Glands in Diphtheria , J. Hyg. 37:345, 1937. 44. Nitschke, A., and Krätschell, B.: Blutveränderungen bei der toxischen Diphtherie und ihre Beziehung zum Nebennieren-Ausfall , Klin. Wchnschr. 17:374, 1938. 45. Stenger, K.: Blutveränderungen bei schweren Infektionskrankheiten und bei Verbrennungen. Ihre Beziehung zur Nebennierenschädigung , Klin. Wchnschr. 18:576, 1939. 46. Long, C. N. H.; Katzin, B., and Fry, E. G.: Adrenal Cortex and Carbohydrate Metabolism , Endocrinology 26:309, 1940. 47. Levin, L., and Leathem, J. H.: The Relation of the Pituitary, Thyroid and Adrenal Glands to the Maintenance of Normal Serum Albumin and Globulin Levels , Am. J. Physiol. 136:306, 1942. 48. Jackson, C. M.: Effects of Acute and Chronic Inanition upon the Relative Weights of the Various Organs and Systems of Adult Albino Rats , Am. J. Anat. 18:15, 1915.Crossref 49. Mulinos, M. G., and Pomerantz, L.: Hormonal Influences on Weight of Adrenal in Inanition , Am. J. Physiol. 132:368, 1941. 50. Sarason, E. L.: Morphologic Changes in the Rat's Adrenal Cortex Under Various Experimental Conditions , Arch. Path. 35:373 ( (March) ) 1943. 51. Engel, F., and Tepperman, S. J.: To be published. 52. Whitehead, R.: Cortical Proliferation in the Mouse Suprarenal After Peptone , Brit. J. Exper. Path. 13:200, 1932. 53. Oberndorfer, S.: Gynäkologische Gesellschaft in München , München. med. Wchnschr. 52:777, 1905. 54. Hutinel, V.: Les lésions des capsules surrénales dans la scarlatine , Arch. f. Kinderh. 60-61:397, 1913. 55. Kovacs, J.: Beiderseitige akute Nebennierenblutung bei Influenza , Frankfurt. Ztschr. f. Path. 38:387, 1929. 56. Furuta, S.: Morbus Addisonii durch arterielle Embolien der Nebennieren , Virchows Arch. f. path. Anat. 251:553, 1924.Crossref 57. Simmonds, M.: Ueber Nebennierenblutungen , Virchows Arch. f. path. Anat. 170: 242, 1903.Crossref 58. Goldzieher, M.: The Adrenals , New York, The Macmillan Company, 1929. 59. Virchow, R.: Berliner medicinische Gesellschaft , Berl. klin. Wchnschr. 9:95, 1864. 60. Josué, O.: Capsules surrénales, hypertension artérielle, athérome , Bull. et mém. Soc. méd. d. hôp. de Paris 21:139, 1904. 61. Thomas, E.: Ueber Veränderungen der Nebennieren, bei Schrumpfnieren , Beitr. z. path. Anat. u. z. allg. Path. 44:228, 1910. 62. Rinehart, J. F.; Williams, O. O., and Cappeller, W. D.: Adenomatous Hyperplasia of the Adrenal Cortex Associated with Essential Hypertension , Arch. Path. 32:169 ( (Aug.) ) 1941. 63. Durlacher, S. H.: Unpublished data.