A.M.A. Archives of Internal Medicine

GESCHICKTER, CHARLES F.;POPOVICI, ANTOINETTE

doi: 10.1001/archinte.1953.00240240003001pmid: 13103833

Abstract THE EXTENT of the concept of essential hypertension, after subtracting secondary forms related to increased cardiac output, increased intracranial pressure, and lesions of the adrenals or anomalies of the kidney, is largely determined by the standards chosen for the upper limits of normal blood pressure. Bell1 states that blood pressure of 140/90 mm. Hg or higher occurs in about 50% of men and 60% of women over the age of 40. On the other hand, Master and co-workers2 found in patients of 44 years of age and over an incidence of hypertension varying from 22 to 35%, taking as the upper limits of normal 150/100 mm. Hg. The consensus of statistics indicates that the incidence of hypertension in the general population is between 20 and 25%, if 95 mm. Hg for the diastolic pressure is taken as the dividing line between normal and abnormal. Recently Master and co-workers References 1. Bell, E. T.: Renal Diseases , Philadelphia, Lea & Febiger, 1946. 2. Master, A. M.; Garfield, C. L., and Walters, M. B.: Normal Blood Pressure and Hypertension , Philadelphia, Lea & Febiger, 1952. 3. Kountz, W. B.; Pearson, E. F., and Koenig, K. F.: Observations on Intrapleural Pressure and Its Influences on the Relative Circulation Rate in Emphysema , J. Clin. Invest. 11:1281, 1932.Crossref 4. Kountz, W. B.; Alexander, H. L., and Dowell, D.: Emphysema Simulating Cardiac Decompensation , J. A. M. A. 93:1369, 1929.Crossref 5. Christie, R. V.: The Elastic Properties of the Emphysematous Lung and Their Clinical Significance , J. Clin. Invest. 13:295, 1934.Crossref 6. Altschule, M. D.: Cardiovascular Dynamics in Patients with Angina Pectoris , Am. Heart J. 27:322, 1944.Crossref 7. Meakins, J. C.: Cardiac Asthma , Postgrad. Med. 13:89, 1953. 8. Talbot, J. H.; Castleman, B.; Smithwick, R. H.; Melville, R. S., and Pecora, I. J.: Renal Biopsy Studies Correlated with Renal Clearance Observations in Hypertensive Patients Treated by Radical Sympathectomy , J. Clin. Invest. 22:387, 1943.Crossref 9. Bull, G. M.: Postural Proteinuria , Clin. Sc. 7:77, 1948. 10. We have found that the lumbar lordosis test may be positive in the last trimester of pregnancy. 11. Christierin, C. L.; Dublin, L. I., and Marks, H. H.: Studies in Albuminuria , Proc. M. Directors A. Life Ins. America 26:160, 1940. 12. Bernoulli, D.: Hydrodynamica , Basil, Switzerland, Argentorati, 1738. 13. Ralston, H. J.; Collings, W. D.; Taylor, A. N., and Ogden, E.: Venous Return in the Absence of Cardiac Drive , Am. J. Physiol. 145:441, 1945. 14. Moyer, J. H.; Snyder, H. B.; Johnson, I.; Mills, L. C., and Miller, S. L.: Results with Oral Hexamethonium Alone and in Combination with 1-Hydrazinophthalazine (Apresoline) in the Therapy of Hypertension , Am. J. M. Sc. 225:379, 1953.Crossref

KNOWLES, HARVEY C.;ZEEK, PEARL M.;BLANKENHORN, MARION A.

doi: 10.1001/archinte.1953.00240240025002pmid: 13103834

Abstract IN A RECENT report by one of us1 the various concepts concerning periarteritis nodosa were discussed. The term "necrotizing angiitis" was suggested as a convenient name to use collectively for that group of vascular lesions which are characterized, in their fully developed stage, by fibrinoid necrosis and inflammatory reaction in vessel walls. The term is noncommittal in regard to etiology and is applicable to lesions in either arteries or veins of any caliber and in any location in the body. Previously reported studies on experimentally produced lesions of this nature in rats and dogs2 and observations of autopsy material in cases of necrotizing angiitis at the Cincinnati General Hospital have demonstrated the feasibility of classifying the necrotizing angiitides into at least five categories. The characteristic morphological features of the vascular lesions of each type have been described in previous reports3 and are outlined in Table 1. To References 1. Zeek, P. M.: Periarteritis Nodosa: A Critical Review , Am. J. Clin. Path. 22:777-790, 1952. 2. Smith, C. C.; Zeek, P. M., and McGuire, J.: Periarteritis Nodosa in Experimental Hypertensive Rats and Dogs , Am. J. Path. 20:721-735, 1944. 3. Smith, C. C., and Zeek, P. M.: Studies on Periarteritis Nodosa: II. The Role of Various Factors in the Etiology of Periarteritis Nodosa in Experimental Animals , Am. J. Path. 23:148-157, 1947. 4. Zeek, P. M.; Smith, C. C., and Weeter, J. C.: Studies on Periarteritis Nodosa: III. The Differentiation Between the Vascular Lesions of Periarteritis Nodosa and of Hypersensitivity , Am. J. Path. 24:889-917, 1948. 5. Zeek.1 6. Zeek, Smith, and Weeter.2c 7. Kussmaul, A., and Maier, R.: Über eine bisher nicht beschriebene eigenthümliche Arterienerkrankung (Periarteriitis nodosa) , Deutsches Arch. klin. Med. 1:484-517, 1866. 8. Boyd, L. J.: The Pulmonary Manifestations of Periarteritis Nodosa (Conclusion) , Bull. New York M. Coll. 7:94, 1944. 9. Ophüls, W.: Periarteritis Acuta Nodosa , Arch. Int. Med. 32:870-898, 1923.Crossref 10. Zeek.1 11. Zeek. Smith, and Weeter.2c 12. Goldblatt, H., and Kahn, J. R.: Studies on Experimental Hypertension: Experimental Observations on the Malignant Phase of Essential Hypertension; The Production of Intrarenal and Extrarenal Arteriolar Necrosis and Necrotizing Arteriolitis, Publication No. 13, American Associaton for the Advancement of Science, 1940, pp. 266-273. 13. Allen, A. C.: The Kidney: Medical and Surgical Conditions , New York, Grune and Stratton, Inc., 1951. 14. Zeek, P. M.: Periarteritis Nodosa and Other Forms of Necrotizing Angiitis , New England J. Med. 248:764-772, 1953.Crossref 15. Fletcher, H. M.: Über die sogenannte Periarteriitis nodosa , Beitr. Path. Anat. 11: 323-343,1892. 16. von Kahlden, C.: Über Periarteriitis nodosa , Beitr. path. Anat. 15:581-601, 1894. 17. Boyd, L. J.: The Clinical Aspects of Periarteritis Nodosa , Bull. New York M. Coll. 1:219-225, 1938. 18. Otani, S.: Malignant Nephrosclerosis and Periarteritis Nodosa, Society Transactions , Arch. Path. 16:435, 1933. 19. Helpern, M., and Trubek, M.: Necrotizing Arteritis and Subacute Glomerulonephritis in Gonococcic Endocarditis: Toxic Origin of Periarteritis Nodosa , Arch. Path. 15:35-50, 1933. 20. Zuelzer, W. W.; Charles, S.; Kurnetz, R.; Newton, W. A., Jr., and Fallon, R.: Circulatory Diseases of the Kidneys in Infancy and Childhood , A. M. A. Am. J. Dis. Child. 81:1-46,1951. 21. Boyd, L. J.: The Renal and Cardiac Manifestations of Periarteritis Nodosa , Bull. New York M. Coll. 4:176-184, 1941. 22. Rich, A. R.: The Role of Hypersensitivity in Periarteritis Nodosa As Indicated by 7 Cases Developing During Serum Sickness and Sulfonamide Therapy , Bull. Johns Hopkins Hosp. 71:123-140, 1942 23. Additional Evidence of the Role of Hypersensitivity in the Etiology of Periarteritis Nodosa , Rich Bull. Johns Hopkins Hosp. 71:375-379, 1942. 24. Black-Schaffer, B.: Pathology of Anaphylaxis Due to Sulfonamide Drugs , Arch. Path. 39:301-314, 1945. 25. More, R. H.; McMillan, G. C., and Duff, G. L.: The Pathology of Sulfonamide Allergy in Man , Am. J. Path. 22:703-725, 1946. 26. French, A. J.: Hypersensitivity in the Pathogenesis of the Histopathologic Changes Associated with Sulfonamide Chemotherapy , Am. J. Path. 22:679-702, 1946. 27. Lichtenstein, L., and Fox, L. J.: Necrotizing Arterial Lesions Resembling Those of Periarteritis Nodosa and Focal Visceral Necrosis Following Administration of Sulfathiazole , Am. J. Path. 22:665-677, 1946. 28. Peale, A. R.; Gildersleeve, N., and Lucchesi, P. F.: Periarteritis Nodosa Complicating Scarlet Fever , Am. J. Dis. Child. 72:310-319, 1946. 29. Van Wyk, J. J., and Hoffmann, C. R.: Periarteritis Nodosa: A Case of Fatal Exfoliative Dermatitis Resulting from "Dilantin Sodium," Arch. Int. Med. 81:605-611, 1948.Crossref 30. McCormick, R. V.: Periarteritis Nodosa Occurring During Propylthiouracil Therapy , J. A. M. A. 144:1453-1454, 1950.Crossref 31. Wainwright, J., and Davson, J.: The Renal Appearances in the Microscopic Form of Periarteritis Nodosa , J. Path. & Bact. 62:189-196, 1950. 32. Smith, Zeek, and McGuire.2a 33. Boyd.15 34. Meyer, P.: Über Periarteritis nodosa oder multiple Aneurysm der mittleren und kleineren Arterien , Arch. path. Anat. 74:277-319, 1878. 35. Beck, J. C.; Browne, J. S. L.; Johnson, L. G.; Kennedy, B. J., and MacKenzie, D. W.: Occurrence of Peritonitis During ACTH Administration , Canad. M. A. J. 62:423, 1950. 36. Frankel, A. L., and Rothermich, N. O.: Polyarteritis Nodosa: A Review Together with Report of a Case Due to Hydantoin Sensitization Treated with Cortisone , Ohio M. J. 47:1013-1020,1950.

PEABODY, J. WINTHROP;BUECHNER, HOWARD A.;ANDERSON, AUGUSTUS E.

doi: 10.1001/archinte.1953.00240240042003pmid: 13103835

Abstract DIFFUSE interstitial pulmonary fibrosis of the type originally described by Hamman and Rich1 remains a most perplexing process, which, despite its striking histological appearance, may well represent a reaction peculiar not to one but to several inciting factors. Obscure in etiology and supposedly rare in occurrence, this syndrome is nevertheless so conspicuous by the extent of pulmonary involvement, so vicious in its relentless, usually unresponsive course, and so often fatal in its outcome that it is not surprising to note the current display of interest in the subject, as a growing number of case reports and a recent editorial in The Journal of the American Medical Association attest.2 Contrary to an erroneous concept being perpetuated in the literature, the original paper by Hamman and Rich appeared not in 1944 but in 1935.1 Fully nine years elapsed before they published what has come to be regarded as the References 1. Hamman, L., and Rich, A. R.: Fulminating Diffuse Interstitial Fibrosis of the Lungs , Tr. Am. Clin. & Climatol. A. 51:154-163, 1935. 2. Acute Diffuse Interstitial Fibrosis of the Lungs, Editorial , J. A. M. A. 151:215 ( (Jan. 17) ) 1953. 3. Hamman, L., and Rich, A. R.: Acute Diffuse Interstitial Fibrosis of the Lungs , Bull. Johns Hopkins Hosp. 74:177-212 ( (March) ) 1944. 4. Eder, H.; Hawn, C. V., and Thorn, G. W.: Report of a Case of Acute Interstitial Fibrosis of the Lungs , Bull. Johns Hopkins Hosp. 76:163-171 ( (April) ) 1945. 5. Potter, B. P., and Gerber, I. E.: Acute Diffuse Interstitial Fibrosis of the Lungs: Report of 3 Cases , Arch. Int. Med. 82:113-124 ( (Aug.) ) 1948. 6. Beams, A. J., and Harmos, O.: Diffuse Progressive Interstitial Fibrosis of the Lungs , Am. J. Med. 7:425-430 ( (Sept.) ) 1949. 7. Peabody, J. W.; Peabody, J. W., Jr.; Hayes, E. W., and Hayes, E. W., Jr.: Idiopathic Pulmonary Fibrosis: Its Occurrence in Identical Twin Sisters , Dis. Chest 18:330-344 ( (Oct.) ) 1950. 8. Golden, A., and Tullis, I. F., Jr.: Diffuse Interstitial Fibrosis of the Lungs , Mil. Surgeon 105:130-137 ( (Aug.) ) 1949. 9. Ferrari, M.; Caubarrère, N. L.; Bottinelli, M. D.; Mendilaharsu, C., and Giudice, D.: Neumofibrosis interstitial evoluticia: Una nueva entidad? Hoja tisiol. 9:207 ( (Sept.) ) 1949 10. abstracted Am. Rev. Tuberc. 61:89 ( (May) ) 1950. 11. Peabody, H. D., Jr.; Moersch, H. J., and Edwards, J. E.: Clinically Indeterminate Pulmonary Fibrosis: A Pathologic Study , J. Thoracic Surg. 21:519-531 ( (May) ) 1951. 12. Heppleston, A. G.: Chronic Diffuse Interstitial Fibrosis of the Lungs , Thorax 6:426-432 ( (Dec.) ) 1951. 13. Rubin, E. H.; Kahn, B. S., and Pecker, D.: Diffuse Interstitial Fibrosis of the Lungs , Ann. Int. Med. 36:827-844 ( (March) ) 1952. 14. Cox, T. R., and Kohl, J. M.: Diffuse Fibrosing Interstitial Pneumonitis (Interstitial Fibrosis of the Lungs) , Am. J. Clin. Path. 22:770-776 ( (Aug.) ) 1952. 15. Callahan, W. P., Jr.; Sutherland, J. C.; Fulton, J. K., and Kline, J. R.: Acute Diffuse Interstitial Fibrosis of the Lungs , A. M. A. Arch. Int. Med. 90:468-482 ( (Oct.) ) 1952. 16. MacMillan, J. M.: Familial Pulmonary Fibrosis , Dis. Chest 20:426-436 ( (Oct.) ) 1951. 17. Kneeland, Y., and Smetana, H. F.: Current Bronchopneumonia of Unusual Character and Undetermined Etiology , Bull. Johns Hopkins Hosp. 67:229-267 ( (Oct.) ) 1940. 18. Katz, H. L., and Auerbach, O.: Diffuse Interstitial Fibrosis of the Lungs (Report of a Case with Unusual Features) , Dis. Chest 20:366-377 ( (Oct.) ) 1951. 19. Tumulty, P. A.; Berthrong, M., and Harvey, A. M.: A Peculiar Pneumonia Associated with Retinal Cytoid Bodies , Bull. Johns Hopkins Hosp. 88:239-263 ( (March) ) 1951. 20. Spain, D. M.: Patterns of Pulmonary Fibrosis as Related to Pulmonary Function , Ann. Int. Med. 33:1150-1163 ( (Nov.) ) 1950. 21. Humphreys, E. M.: Chronic Progressive Pulmonary Fibrosis , M. Clin. North America 35:169-173 ( (Jan.) ) 1951. 22. Geever, E. F.; Neubuerger, K. T., and Rutledge, E. K.: Atypical Pulmonary Inflammatory Reactions , Dis. Chest 19:325-338 ( (March) ) 1951.Crossref 23. Scadding, J. G.: Chronic Lung Disease with Diffuse Nodular or Reticular Radiographic Shadows , Tubercle 33:352-365 ( (Dec.) ) 1952.Crossref 24. Peabody, J. W., and Peabody, J. W., Jr.: Diffuse Progressive Interstitial Pulmonary Fibrosis: Considerations in the Differential Diagnosis , Dis. Chest , to be published. 25. Auerbach, S. H.; Mims, O. M., and Goodpasture, E. W.: Pulmonary Fibrosis Secondary to Pneumonia , Am. J. Path. 28:69-87 ( (Jan.-Feb.) ) 1952. 26. Geever, Neubuerger, and Rutledge.11 27. Young, J. S.: Epithelial Proliferation in the Lung of The Rabbit, Brought about by Intrapleural Injection of Solutions of Electrolytes: A Physico-Chemical Interpretation of the Phenomenon , J. Path. & Bact. 38:363-381 ( (April) ) 1930. 28. Sante, L. R., and Wyatt, J. P.: Roentgenological and Pathological Observations in Antigenic Pneumonitis: Its Relationship to the Collagen Diseases , Am. J. Roentgenol. 66:527-545 ( (Oct.) ) 1951. 29. Breckenridge, R. L.: Personal communication to the authors. 30. Footnote 4d 31. e 32. f 33. h 34. i. 35. Footnote 4c 36. d 37. e. 38. Hamman and Rich.1 39. Hamman and Rich.3 40. Rubin, Kahn, and Pecker.4i 41. Kneeland and Smetana.6 42. Peabody and Peabody.13 43. Footnote 4i 44. j 45. k. 46. To be reported in detail by Dr. M. M. Schecter. 47. Dobson, R. L.; Weaver, J. C., and Lewis, L.: Beryllium Granulomatosis Complicated by Tuberculosis: Report of a Case Treated with ACTH , Ann. Int. Med. 38:312-325 ( (Feb.) ) 1953. 48. Keeton, R. W.; Best, W. R.; Hick, F. K.; Montgomery, M. M., and Samter, M.: Dramatic Respiratory Symptoms Induced by Sudden Withdrawal of ACTH , J. A. M. A. 146: 615-616 ( (June 16) ) 1951. 49. Chaves, A. D., and Abeles, H.: Disseminated Nodular Pulmonary Infiltrations of an Indeterminate Nature in Apparently Healthy Persons , Am. Rev. Tuberc. 65:129-141 ( (Feb.) ) 1952. 50. Silverman, J. J., and Talbot, T. J.: Diffuse Interstitial Pulmonary Fibrosis Camouflaged by Hypermetabolism and Cardiac Failure: Antemortem Diagnosis with Biopsy and Catheterization Studies , Ann. Int. Med. 38:1326-1338 ( (June) ) 1953. 51. Golden, A., and Bronk, T. T.: Diffuse Interstitial Fibrosis of Lungs: A Form of Diffuse Interstitial Angiosis and Reticulosis of the Lungs , A. M. A. Arch. Int. Med. 92:606-615 ( (Nov.) ) 1953.

HED, RAGNAR

doi: 10.1001/archinte.1953.00240240061004pmid: 13103836

Abstract MYOGLOBINURIA is, as the name suggests, excretion of muscle coloring matter in the urine. It is not an illness sui generis but only a symptom of a disease process in the muscles, just as hematuria is indicative of a morbid change in the urogenital apparatus. One can distinguish four different types of myoglobinuria.1 Traumatic myoglobinuria, which may be caused by (a) Crush injury (b) High voltage accident (c) Arterial occlusion with ischemia Myositis myoglobinurica Haff disease Paroxysmal myoglobinuria Crush injury is a syndrome2 which was already described in 1916, but during the last war more interest has been taken in it. In widely spread traumatic muscle injuries myoglobin may be found in the urine. Then a renal injury arises, with oliguria, isosthenuria, and azotemia. The mortality rate is high, and the patients often die on the 7th to the 10th day. By study of microscopic sections one finds the musculature discolored References 1. Biörck, G.: On Myoglobin and Its Occurrence in Man , Acta med. scandinav. , (Supp. 226) , p. 1, 1949. 2. Bywaters, E. G.; Delory, G.; Rimington, C., and Smiles, J.: Myohaemoglobin in the Urine of Air Raid Casualties with Crushing Injury , Biochem. J. 35:1164-1168, 1941. 3. Bywaters, E. G., and Beall, D.: Crush Injuries with Impairment of Renal Function , Brit. M. J. 1:427-432, 1941.Crossref 4. Günther, H.: Kasuistische Mitteilung über Myositis myoglobinurica , Arch. path. Anat. 251:141-149, 1924.Crossref 5. Paul, F.; Über einen Fall von paralytischer Hämoglobinurie beim Menschen , Wien. Arch. inn. Med. 7:531-554, 1924. 6. Berlin, R.: Haff Disease in Sweden , Acta med. scandinav. 129:560-572, 1948.Crossref 7. Bywaters, E. G., and Dible, J. H.: Acute Paralytic Myohæmoglobinuria in Man , J. Path. & Bact. 55:7-15, 1943. 8. Debré, R.; Gernez, C., and Sée, G.: Crises myopathiques paroxystiques avec hémoglobinurie , Bull. Soc. méd. hôp. Paris 58:1640-1649, 1934. 9. Hittmair, A.: Haemoglobinuria paroxysmalis paralytica , Wien. klin. Wchnschr. 38:431-434, 1925. 10. Huber, J.; Florand, J.; Lièvre, A., and Néret, M.: Crises myopathiques paroxystiques avec hémoglobinurie , Bull. Soc. méd. hôp. Paris 62:725-730, 1938. 11. Kreutzer, F. L.; Strait, L., and Kerr, W. J.: Spontaneous Myohemoglobinuria in Man , Arch. Int. Med. 81:249-259, 1948. 12. Louw, A., and Nielsen, H. E.: Paroxysmal Paralytic Hemoglobinuria , Acta med. scandinav. 117:424-436, 1944. 13. de Langen, C. D.: Myoglobin and Myoglobinuria , Acta med. scandinav. 124:213-226, 1946. 14. Millikan, G. A.: Muscle Haemoglobin , Physiol. Rev. 19:503-523, 1939. 15. Scherwin, J.: Myoglobinuria paralytica , Nord. med. 24:460, 1945. 16. Meyer-Betz, F.: Beobachtungen an einen eigenartigen mit Muskellähmungen verbundenen Fall von Hämoglobinurie , Deutches Arch. klin. Med. 101:85, 1916. 17. Theorell, H., and de Duve, C.: Crystalline Human Myoglobin from Heart Muscle and Urine , Arch. Biochem. 12:113-124, 1947. 18. Bang, O.: Klinische Urobilinstudien in Sonderheit an normalen und "lebergesunden" Personen: Die Wirkung kohlehydratknapper Kost auf die Urobilinausscheidung; Die Urobilinurie der Diabetiker , Acta med. scandinav. , (Supp. 29) , pp. 9-203, 1929. 19. Burch, G. E., and Ray, C. T.: Lower Nephron Syndrome , Ann. Int. Med. 31:750-772, 1949. 20. Lucké, B.: Lower Nephron Nephrosis (Renal Lesions of Crush Syndrome, of Burns, Transfusions, and Other Conditions Affecting Lower Segments of Nephrons) , Mil. Surgeon 99:371-396, 1946.

McVAY, LEON V.;SPRUNT, DOUGLAS H.

doi: 10.1001/archinte.1953.00240240069005pmid: 13103837

Abstract THE PROBLEMS of present-day medicine are rapidly becoming those of an aging population. Virtual eradication of many common infectious diseases together with the development of improved standards of nutrition, general hygiene, employment, and housing have resulted in progressive lengthening of human life. Today it is estimated that more than 7,000,000 persons in the United States are over 65 years of age; probably 1,000,000 have passed the 80-year mark.1 This represents an increase of 30% in the past 10 years. A natural consequence of this development has been an increasing emphasis on those conditions which primarily afflict elderly persons. One of the principal problems in geriatric medicine concerns the management of chronic respiratory diseases, such as chronic bronchitis, bronchial asthma, pulmonary emphysema, and bronchiectasis. It should be emphasized that these conditions also occur in the younger age groups. Until recently pulmonary emphysema was accepted as an utterly hopeless condition usually References 1. Pepper, O. H. P.: Geriatrics: Past, Present and Future , Am. J. M. Sc. 223:589, 1952.Crossref 2. Baldwin, E. deF.; Cournand, A., and Richards, D. W., Jr.: Pulmonary Emphysema , Medicine 28:201, 1949.Crossref 3. Westcott, R. N.; Fowler, N. O.; Scott, R. C.; Hauenstein, V. D., and McGuire, J.: Anoxia and Human Pulmonary Vascular Resistance , J. Clin. Invest. 30:957, 1951.Crossref 4. Donald, K. W., and Christie, R. V.: The Respiratory Response to Carbon Dioxide and Anoxia in Emphysema , Clin. Sc. 8:33, 1949. 5. Allan, W. B.: The Benefit of Respiratory Exercises in the Emphysematous Patient , Am. J. M. Sc. 224:320, 1952.Crossref 6. Gaensler, E. A., and Carter, M. G.: Ventilation Measurements in Pulmonary Emphysema Treated with Pneumoperitoneum , J. Lab. & Clin. Med. 35:945, 1950. 7. Carter, M. G.; Gaensler, E. A., and Kyllonen, A.: Pneumoperitoneum in the Treatment of Pulmonary Emphysema , New England J. Med. 243:549, 1950. 8. Comroe, J. H., Jr., and Schmidt, C. F.: Part Played by Reflexes from Carotid Body in Chemical Regulation of Respiration in Dog , Am. J. Physiol. 121:75, 1938. 9. Comroe, J. H., Jr.; Bahnson, E. R., and Coates, E. O., Jr.: Mental Changes Occurring in Chronically Anoxemic Patients During Oxygen Therapy , J. A. M. A. 143:1044, 1950. 10. Barach, A. L.: The Effect of Low and High Oxygen Tensions on Mental Functioning , J. Aviation Med. 12:30, 1941. 11. Wilson, R. H.; Borden, C. W.; Ebert, R. V., and Wells, H. S.: A Comparison of the Effect of Voluntary Hyperventilation in Normal Persons, Patients with Pulmonary Emphysema, and Patients with Cardiac Disease , J. Lab. & Clin. Med. 36:119, 1950. 12. Barach, A. L.; Bickerman, H. A., and Beck, G. J.: Antibiotic Therapy in Infections of the Respiratory Tract , A.M.A. Arch. Int. Med. 90:808, 1952. 13. Myers, J. A., and McKinlay, C. A.: The Chest and the Heart , Ed. 1, Springfield, Ill., Charles C Thomas, Publisher, 1948. 14. Lorenz, T. H.: Bronchiectasis: A Study of 220 Proved Cases , Am. J. M. Sc. 221:522, 1951. 15. Stone, P. J.; Schwartz, A.; Newman, W.; Feltman, J. A., and Lovelock, F. J.: Precipitation by Pulmonary Infection of Acute Anoxia, Cardiac Failure and Respiratory Acidosis in Chronic Pulmonary Disease: Pathogenesis and Treatment , Am. J. Med. 14:14, 1953. 16. McVay, L. V., Jr., and Stern, T. N.: An Effective and Economical Method for Treatment of Acute Nontuberculosis Bacterial Pneumonia , Antibiotics & Chemother. 2:215, 1952. 17. Gocke, T. M.; Collins, H. S., and Finland, M.: Aureomycin Treatment of Pneumococcic Pneumonia , Arch. Int. Med. 84:857, 1949. 18. Collins, H. S.; Gocke, T. M., and Finland, M.: Aureomycin Therapy of Nonpneumococcic and Nontuberculosis Bacterial Pulmonary Infections , Arch. Int. Med. 84:875, 1949. 19. Dowling, H. F.; Lepper, M. H.; Hussey, H. H.; Caldwell, E. R., and Spies, H. W.: The Treatment of Pneumococcic Pneumonia with Aureomycin , J. Lab. & Clin. Med. 35:215, 1950. 20. McVay, L. V., Jr., and Carroll, D. S.: Aureomycin in the Treatment of Systemic North American Blastomycosis , Am. J. Med. 12:289, 1952. 21. McVay, L. V., Jr., and Sprunt, D. H.: Bacteroides Infections , Ann. Int. Med. 36:56, 1952 22. A Long Term Evaluation of Aureomycin in, the Treatment of Amebiasis , South. Med. J. 45:183, 1952.Crossref 23. McVay, L. V., Jr.; Guthrie, F., and Sprunt, D. H.: Aureomycin in the Treatment of Actinomycosis , New England J. Med. 245:91, 1951.Crossref 24. McVay, L. V., Jr., and Sprunt, D. H.: A Study of Moniliasis in Aureomycin Therapy ,. Proc. Soc. Exper. Biol. & Med. 78:759, 1951. 25. All preparations employed in this study were obtained through the courtesy of the Lederle Laboratories Division, American Cyanamid Company, Pearl River, N. Y. 26. McVay and Stern.10 27. Price, C. W.; Randall, W. A., and Welch, H.: Bacteriological Studies of Aureomycin , Ann. New York Acad. Sc. 51:211, 1948. 28. Bliss, E. A., and Todd, H. P.: A Comparison of 8 Antibiotic Agents, in Vivo and in Vitro , J. Bact. 58:61, 1949. 29. The formula of the placebo capsules, expressed in milligrams per capsule, was anhydrous dicalcium phosphate, 689; magnesium stearate, 10; liquid petrolatum, 13; F. D. and C. yellow No. 5 dye, 1. Subsequently the formula was altered to anhydrous dicalcium phosphate, 360; magnesium stearate,10 and liquid petrolatum, 10. 30. Wilhelm, W. F., and Tillisch, J. H.: Relation of Sedimentation Rate to Age , Med. Clin. North America 35:1209, 1951. 31. Riseman, J. E. F., and Brown, M. G.: The Sedimentation Rate in Angina Pectoris and Coronary Thrombosis , Am. J. M. Sc. 194:392, 1937. 32. Fredberg, A. S.; Blumgart, H. L.; Zoll, P. M., and Schlesinger, M. J.: Coronary Failure: The Clinical Syndrome of Cardiac Pain Intermediate Between Angina Pectoris and Acute Myocardial Infarction , J. A. M. A. 138:107, 1948. 33. Wilson, R. H.; Borden, C. W., and Ebert, R. V.: Adaptation to Anoxia in Chronic Pulmonary Emphysema , A. M. A. Arch. Int. Med. 88:581, 1951. 34. Cartwright, G. E.; Lauritsen, M. A.; Jones, P. J.; Merrill, I. M. and Wintrobe, M. M.: The Anemia of Infection: I. Hypoferremia, Hypercupremia, and Alterations in Porphyrin Metabolism in Patients , J. Clin. Invest. 25:65, 1946. 35. Wilson, Borden, and Ebert.19 36. Karel, L., and Roach, E. S.: A Dictionary of Antibiosis , New York, Columbia University Press, 1951. 37. Paine, T. F., Jr.; Collins, H. S., and Finland, M.: Laboratory Studies with Aureomycin , Ann. New York Acad. Sc. 51:228, 1948.

MOYER, JOHN H.;HANDLEY, CARROLL A.;SEIBERT, RICHARD A.;SNYDER, HARVEY B.

doi: 10.1001/archinte.1953.00240240083006pmid: 13103838

Abstract ALTHOUGH mercurials exhibit diuretic properties when given orally,1 the diuresis produced has generally been considered to be inadequate and inferior to that obtained following use of the parenteral route,2 and for this reason the oral route of administration has not been very popular. However, several recently synthesized mercurial diuretics have been shown to exhibit greater diuretic potency than meralluride (Mercuhydrin).3 With the development of more active compounds it seemed worth while to investigate the diuretic potential of these three experimental mercurials when administered by the oral route. The three compounds under investigation are (1) Neohydrin (3-chloromercuri-2-methoxypropylurea [1347Ex]), (2) 3-carboxymethyl-mercaptomercuri-2-methoxypropylurea (1353 Ex), and (3) 3-(a-carboxyethylmercaptomercuri)-2-methylpropylurea (1431Ex). Observations were made on the effect of oral administration of these compounds on water and electrolyte excretion in both normal subjects and in patients with cardiac failure. In addition, mercury excretion studies were performed on patients and on dogs. METHODS AND MATERIALS Clinical observations were References 1. Dickens, K. L.: Oral Administration of Mercurial Diuretics in the Treatment of Congestive Heart Failure , New Orleans M. & S. J. 94:344, 1942. 2. Batterman, R. C.; DeGraff, A. C., and McCormack, J. E.: The Effectiveness and Safety of Mercupurin Administered Orally in the Treatment of Congestive Heart Failure , J. A. M. A. 124:1243, 1944. 3. Batterman, R. C.; DeGraff, A. C., and Shoss, H. M.: Further Observations on the Use of Mercupurin Administered Orally , Am. Heart J. 31:431, 1946. 4. Dickens.1a 5. Handley, C. A.; Chapman, D. W., and Moyer, J. H.: Some Pharmacological Properties of Three New Mercurial Diuretics , Proc. Soc. Exper. Biol. & Med. 78:433, 1951. 6. Moyer, J. H.; Handley, C. A., and Seibert, R. A.: Clinical Diuretic Studies on Three New Mercurial Compounds , Am. Heart J. 44:281, 1952. 7. Clarke, D. A.; Modell, W.; Greiner, T.; Kwit, N. T.; Gluck, J. L., and Gold, H.: The Dosage Response Curve for Comparison of Mercurial Diuretics , Am. J. M. Sc. 220:156, 1950. 8. Moyer, J. H.; Handley, C. A., and Wilford, I.: Results Over a Two-Year Period on Three Experimental Diuretics Administered Orally to Patients with Cardiac Failure , Am. Heart J. 44:608, 1952. 9. Snyder, H. B.; Moyer, J. H., and Handley, C. A.: Clinical Results in the Treatment of Heart Failure and Observations on Water, Electrolyte and Mercury Excretion , M. Rec. & Ann. , to be published. 10. Goldman, B. R., and Steigmann, F.: Experiences with a New Oral Mercurial , Proc. Central Soc. Clin. Res. 25:34, 1952. 11. Handley, C. A.; Moyer, J. H., and Thomas, J. R.: The Effects from Prolonged Administration of Three Mercurial Derivatives of 2-Methoxy-Propylurea in Dogs , Proc. Soc. Exper. Biol. & Med. , to be published.

KAMPMEIER, R. H.;SHAPIRO, JOHN L.

doi: 10.1001/archinte.1953.00240240092007pmid: 13103839

Abstract THINKING relative to the so-called "collagen diseases" has been in the main in terms of entities or syndromes. The instances are not uncommon, however, in which the clinical picture begins as one syndrome, only to alter its course within months or years, to assume the picture of another. If the basic pathologic picture is kept in mind these transitional or intermediary manifestations are not disturbing. Furthermore, it is becoming more evident that medical thinking must include not only progressive vascular disease but also a disease of remissions and relapses. This is not a new concept but needs reemphasis. Osler1 in his three papers on the visceral manifestations in "erythema exudativum multiforme," published between 1895 and 1903, in which he included 29 case reports, described patients whose conditions unquestionably would fall today into the categories of periarteritis nodosa and disseminated lupus. That Osler was aware of the possibility of remissions References 1. Osler, W.: On the Visceral Complications of Erythema Exudativum Multiforme , Am. J. M. Sc. 110:629 ( (Dec.) ) 1895Crossref 2. The Visceral Lesions of the Erythema Group , Brit. J. Dermat. 12:227 ( (July) ) 1900 3. On the Visceral Manifestations of the Erythema Group of Skin Diseases , Tr. A. Am. Physicians 18:599, 1903. 4. Klotz, O.: Periarteritis Nodosa , J. M. Res. 37:1 ( (Sept.) ) 1917. 5. Arkin, A.: A Clinical and Pathological Study of Periarteritis Nodosa , Am. J. Path. 6:401 ( (July) ) 1930. 6. Blaisdell, E. R., and Porter, J. E.: Healed Stage of Periarteritis Nodosa , New England J. Med. 227:1087 ( (June 24) ) 1941.Crossref 7. Goodman, M. J.: Periarteritis Nodosa with Recovery: Report of an Unusual Case Apparently due to Sensitivity to Sulfadazine , Ann. Int. Med. 28:181 ( (Jan.) ) 1948.Crossref 8. King, F. H.: Protracted Course in Periarteritis Nodosa , J. Mt. Sinai Hosp. 15:97 ( (July-Aug.) ) 1948. 9. Klein, S. P.: Periarteritis Nodosa: Study of Chemistry and Recovery, with Report of 2 Cases , Arch. Int. Med. 84:983 ( (Dec.) ) 1949.Crossref 10. Plaut, A.: Asymptomatic Focal Arteritis of Appendix: 88 Cases , Am. J. Path. 27:247 ( (March-April) ) 1951.

STARR, PAUL;LIEBHOLD-SCHUECK, RUTH

doi: 10.1001/archinte.1953.00240240116008pmid: 13103840

Abstract STUDIES of synthetic sodium /-thyroxine demonstrate that as an oral medication in dosage of 0.5 mg. or less daily it is calorigenic and clinically active.1 In similar dosage it has been shown to reduce the uptake of radioactive iodine.2 Triiodothyronine, recently identified, synthesized, and demonstrated in human serum,3 also has been shown to be clinically effective4 and to be several times as potent as thyroxine.5 Curiosity as to the possible effect of sodium d-thyroxine led us to carry out tests with this substance. It was difficult to obtain. Dr. Leonard Ginger, of the Baxter Laboratories, Inc., Morton Grove, Ill., the source of the levo form used in our clinical studies, produced it for us. It has already been demonstrated by Greer6 that inorganic iodine in amounts equal to that in these medications has no effect upon uptake of radioactive iodine. We have, however, carried out a few tests at four-dose References 1. Hart, D. F., and Maclagen, N. F.: Oral Thyroxine in Treatment of Myxoedema , Brit. M. J. 1:512 ( (March 4) ) 1950.Crossref 2. Morgans, M. E.; Oldham, A. K., and Trotter, W. R.: The Effect of Exogenous Thyroxine on Radiodine Uptake in Normal Subjects and in Cases of Thyrotoxicosis in Remission , J. Endocrinol. 8:250 ( (July) ) 1952.Crossref 3. Gross, J., and Pitt-Rivers, R.: The Identification of 3:5:3′ L-Triiodothyronine in Human Plasma , Lancet 1:439 ( (March 1) ) 1952.Crossref 4. Gross, J.; Pitt-Rivers, R., and Trotter, W. R.: Effect of 3:5:3′ L-Triiodothyronine in Myxoedema , Lancet 1:1044 ( (May 24) ) 1952.Crossref 5. The triiodothyronine used in these studies was synthesized by the Glaxo Laboratories and provided through the courtesy of Dr. Arthur Heming, of Smith, Kline & French Laboratories. 6. Greer, M. A.: The Effect on Endogenous Thyroid Activity of Feeding Desiccated Thyroid to Normal Human Subjects , New England J. Med. 244:385 ( (March 15) ) 1951.Crossref 7. Radioactive iodine received from the Atomic Energy Commission, Oak Ridge, Tenn. 8. Reineke, E. P., and Turner, C. W.: The Relative Thyroidal Potency of /- and d, /-Thyroxine , Endocrinology 36:200 ( (March) ) 1945.Crossref 9. Asper, S. P., Jr.; Selenkow, H. A., and Plamondon, C. A.: The Metabolic Activity of 3:5:3′ /-Triiodothyronine in Myxedema, presented at the 45th Annual Meeting of the American Society of Clinical Investigation, Atlantic City, N. J., May 4, 1953. 10. Rawson, R. W.; Rall, J. E.; Pearson, O. H.; Robbins, J.; Poppell, H. F., and West, C. D.: L-Triiodothyronine Versus /-Tetraiodothyronine (/'-Thyroxine): A Comparison of Their Metabolic Effects in Human Myxedema, Presented at the 66th Annual Meeting of the Association of American Physicians, Atlantic City, N. J., May 5-6, 1953. 11. Blackburn, C. M.; McConahey, W. M.; Keating, F. R., Jr., and Albert, A.: Comparative Calorigenic Effect of /-Tri-Ido-Thyronine and /-Thyroxine Given Intravenously to Myxedematous Patients, Presented at the 35th Annual Meeting of the Endocrine Society, New York, May 28-30, 1953. 12. Heppel, L. A., and Porterfield, V. T.: Enzymatic Dehalogenation of Certain Brominated and Chlorinated Compounds , J. Biol. Chem. 176:763 ( (Nov.) ) 1948. 13. Roche, J.; Michel, R.; Michel, O., and Lissitzky, S.: Enzymatic Dehalogenation of Iodized Amino Acids in Thyroid and Thyroxinemia , Compt. rend. Soc. biol. 145:288 ( (Feb.) ) 1951. 14. Enzymatic Dehalogenation of Iodotyrosine by Thyroid Tissue: On Its Physiological Role , Biochim. biophys. acta 9:161, 1952.Crossref

WAKERLIN, G. E.

doi: 10.1001/archinte.1953.00240240125009pmid: 13103841

Abstract THE PATHOGENESIS of essential hypertension is still unknown, although progress toward an answer has been made in the past 20 years. According to one view, hypertension is a sign of disease, as are fever and leucocytosis, and "essential" is expressive of our ignorance of its pathogenesis; on this basis, essential hypertension should be regarded as a term comparable to "fever of unknown origin." This view suggests that essential hypertension may be a genus composed of several still undifferentiated species or types of hypertension, which formerly included the hypertensions due to pheochromocytomas, adrenocortical tumors, and renal abnormalities. Another view regards essential hypertension as a definite disease entity with varied manifestations chiefly dependent upon the body areas of localization and degree of progress of the underlying vascular disease process. While this concept is held by a minority of those working in the field, presently available evidence is as supportive of a single References 1. Smirk, F. H.: Pathogenesis of Essential Hypertension , Brit. M. J. 1:791, 1949.Crossref 2. Thomas, C. B.: The Heritage of Hypertension , Am. J. Sc. 224:367, 1953.Crossref 3. Greisman, S. E.: Reactivity of Capillary Bed of Nailfold to Circulating Epinephrine and Nor-Epinephrine in Patient with Normal Blood Pressure and with Essential Hypertension , J. Clin. Invest. 31:782, 1952.Crossref 4. Kowalski, H. J.; Hoobler, S. W.; Malton, S. D., and Lyons, R. H.: Measurement of Vasoconstrictor Tone in the Extremities in Hypertension , Circulation 8:82, 1953.Crossref 5. Taylor, R. D., and Page, I. H.: On the Origin and Properties of a Cerebral Pressor Substance (CPS) , Am. J. Physiol. 170:321, 1952. 6. Birchall, R.; Tuthill, S. W.; Jacobs, W. S.: Trautman, W. J., Jr., and Findley, T.: Renal Excretion of Water, Sodium and Chloride: Comparison of the Responses of Hypertensive Patients with Those of Normal Subjects, Patients with Specific Adrenal or Pituitary Defects, and a Normal Subject Primed with Various Hormones , Circulation 7:258, 1953.Crossref 7. Davies, D. F.; Olsen, N. S., and Schroeder, H. A.: Pressor Substances in Arterial Hypertension: IV. Quantitative and Qualitative Studies of Pherentasin , Circulation 5:380, 1952.Crossref 8. Shorr, E.: The Participation of Hepatorenal Factors in Experimental Renal Hypertension: Hypertension, A symposium , edited by E. T. Bell, Minneapolis, University of Minnesota Press, 1951, p. 92. 9. Kahn, J. R.; Skeggs, L. T., Jr.; Shumway, N. P., and Wisenbaugh, P. E.: The Assay of Hypertensin from the Arterial Blood of Normotensive and Hypertensive Human Beings , J. Exper. Med. 95:523, 1952.Crossref 10. Wakerlin, G. E.; Bird, R. B.; Brennan, B. B.; Frank, M. H.; Kremen, S.; Kuperman, I., and Skom, J. H.: Treatment and Prophylaxis of Experimental Renal Hypertension with "Renin," J. Lab. & Clin. Med. 41:708, 1953. 11. Kuperman, I., and Wakerlin, G. E.: Treatment of Experimental Renal Hypertension in Dogs with Antirenin , Fed. Proc. 12:80, 1953. 12. Skeggs, L. T.; Kahn, J. R., and Shumway, N. P.: The Isolation of Hypertensin from the Circulating Blood of Normal Dogs with Experimental Renal Hypertension by Dialysis in an Artificial Kidney , Circulation 3:384, 1951. 13. Katz, J.; Skom, J. H., and Wakerlin, G. E.: Treatment of Spontaneous Hypertension in Dogs with Semipurified Hog Renin, Program of the 26th Scientific Sessions of the American Heart Association, Atlantic City, April 9-12, 1953, p. 70. 14. Goldblatt, H.: Haas, E., and Lanfrom, H.: Antirenin in Man and Animals , Trans. A. Am. Physicians 64:122, 1951. 15. Helmer, O. M.; Shipley, R. E.; Pierce, J. D., and Kohlstaedt, K.: Antibodies Against Renin and "Sustained Pressor Principle" Produced by Injections of Kidney Extracts, abstracted. J. Lab. & Clin. Med. 33:1484, 1948. 16. Blacket, R. B.; Deporter, A.; Pickering, G. W.; Sellers, A. L., and Wilson, G. M.: Hypertension Produced in the Rabbit by Long Continued Infusions of Renin , Clin. Sc. 9:223, 1950. 17. Burns, R. O., and Wakerlin, G. E.: Protection Against Hypertension, Arteriolonecrosis, and Death by Hog Renal Extracts in Experimental Malignant Hypertension , Circulation Res. , to be published. 18. Grollman, A.: Effect of Increasing the Extracellular Fluid Volume on the Arterial Blood Pressure of the Normal, Hypertensive, and Nephrectomized Dog , Am. J. Physiol. 173:364, 1953. 19. Kezdi, P.: Sinoaortic Regulatory System: Role in Pathogenesis of Essential Malignant Hypertension , A. M. A. Arch. Int. Med. 91:26, 1953. 20. A Symposium on Essential Hypertension: An Epidemiologic Approach , Commonwealth of Massachusetts, Boston, Wright & Potter Printing Co., 1951. 21. Page, I. H.: The Renin-Angiotonin Pressor System, Hypertension, A Symposium , edited by E. T. Bell, Minneapolis, University of Minnesota Press, 1951, p. 66. 22. Braun-Menendez, E.: Experimental Hypertension, Hypertension, A Symposium , edited by E. T. Bell, Minneapolis, University of Minnesota Press, 1951, p. 177. 23. Sevy, R. W., and Wakerlin, G. E.: Endocrine Factors in Experimental Renal Hypertension , Am. J. Physiol. 172:129, 1953. 24. Ohler, E. A., and Wakerlin, G. E.: Amines in Experimental Hypertensions. Circulation Res. 1:122, 1953.n

ENGLAND, DONALD L.

doi: 10.1001/archinte.1953.00240240133010pmid: 13103842

Abstract SYPHILITIC aortic aneurysms may pursue a variety of courses and, although the condition is uncommon, rupture of an aortic aneurysm into the superior vena cava produces a quite dramatic clinical picture. Hunter1 in 1757 discussed aortic aneurysms in the chest and arteriovenous aneurysms in the arm, but the first case of an aortic aneurysm rupturing into the superior vena cava was reported in 1833.2 A review of the literature from 1833 to the present time has disclosed a total of 117 cases.3 Three authors4 have presented excellent statistical analyses of the clinical and pathologic features. These reviews reveal that rupture of an aortic aneurysm into the superior vena cava usually occurs in males during the fourth or fifth decades. Symptoms begin with the sudden onset of a moderate to severe superior vena cava obstruction syndrome. Physical examination presents the striking appearance of moderately severe edema, venous distention, and cyanosis sharply References 1. Hunter, W.: The History of an Aneurysm of the Aorta: With Some Remarks on Aneurysms in General , Med. Obs. Soc. Phys. Lond. 1:323, 1757. 2. Beevor: Case Reported Before the Middlesex Medical Society , Lancet 1:800, 1832-1833 3. Interesting Pathological Facts , Beevor Lancet 2:63, 1832-1833. 4. Pepper, W., and Griffith, J. P.: Varicose Aneurysms of the Aorta and Superior Vena Cava , Am. J. M. Sc. 100:329, 1890.Crossref 5. Woolley, P. G.: A Series of Ruptured Aortic Aneurysms , Am. J. Syph. 1:426, 1917. 6. Shennan, T.: Spontaneous Arteriovenous Aneurysm in the Thorax , Edinburgh M. J. 32:325 7. 32:410, 1925. 8. House, S. J., and Goodpasture. E. W.: Spontaneous Arteriovenous Aneurysm in the Thorax , Am. Heart J. 3:682, 1928.Crossref 9. Armstrong, E. L.; Coggin, C. B., and Hendrickson, H. S.: Spontaneous Arteriovenous Aneurysms of the Thorax: Review of the Literature; With a Report of 2 Cases , Arch. Int. Med. 63:298, 1939.Crossref 10. Hussey, H. H.; Katz, S., and Yater, W. M.: The Superior Vena Caval Syndrome: Report of 35 Cases , Am. Heart J. 31:1, 1946.Crossref 11. Wunderman, D. C.: A Report of a Case of Aortic Aneurysm Rupturing into the Superior Vena Cava , South. M. J. 39:813. 1946.Crossref 12. Murnaghan, D. P.: Rupture of an Aortic Aneurysm into the Superior Vena Cava with Obstruction , Canad. M. A. J. 59:370, 1948. 13. Danaraj, T. J.: A Case of Arteriovenous Aneurysm , Brit. M. J. 1:1124, 1949.Crossref 14. Alex, M.: Rupture of an Aortic Aneurysm into the Superior Vena Cava , Am. Heart J. 39:455, 1950.Crossref 15. Sirota, J. H.: Spontaneous Perforation of an Aortic Aneurysm into the Superior Vena Cava with Survival for 136 Days , Am. Heart J. 39:782, 1950.Crossref 16. Clinical Pathological Conference: Superior Vena Caval Obstruction from a Ruptured Aneurysm , J. Kansas M. Soc. 52:20, 1951. 17. Marchand, E. J.; Heitmancik, M. R., and Herrmann, G. R.: Extracardiac Arteriovenous Fistulas in the Thorax , Am. Heart J. 42:682. 1951.Crossref 18. Beevor.2 19. Footnote 3c, e, and j.