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MANAGEMENT OF SYSTEMIC ARTERIAL HYPERTENSION

MANAGEMENT OF SYSTEMIC ARTERIAL HYPERTENSION Abstract DIAGNOSIS IN A DISCUSSION of the management of arterial hypertensive disease no topic is of greater importance than proper diagnosis. Despite the fact that we do not find distinguishing characteristics for most of our patients with hypertension, the considerable prognostic and at times therapeutic value of making an etiologic diagnosis renders careful diagnostic study highly desirable. This discussion is directed mainly toward treatment of those patients who have (1) so-called "essential" hypertension or (2) hypertension from known etiologic factors but whose elevated blood pressure fails to respond to causal therapy.We believe that in order to arrive at the correct diagnosis it is desirable to have a complete history and physical examination (including blood pressure in both arms and in one thigh), roentgenograms of the heart and lungs in three or four projections, a 12-lead electrocardiogram, estimation of basal blood pressure after heavy sedation, fractional phenolsulfonphthalein test, blood urea nitrogen References 1. References 4-6. 2. References 3 and 7. 3. References 10-12. 4. References 14-16. 5. Kirkendall, W. M.; Anderson, G. A., and Lubin, R. I.: Comparison of Hypotensive and Renal Vascular Effects of Derivatives of Rauwolfia Serpentina in Man: Alseroxylon and Rescinnamine, unpublished data. 6. References 16 and 20-22. 7. References 23 and 24. 8. References 30 and 31. 9. References 16, 32, and 33. 10. References 33, 37, and 38. 11. N - phenoxyisopropyl-N-benzyl-β-chloroethylamine hydrochloride. 12. N,N-dibenzyl-β-chloroethylamine hydrochloride. 13. 6-allyl-6,7 dihydro-5H-dibenz(c,e)azepine phosphate. 14. References 43-45. 15. References 47 and 48. 16. References 35 and 50. 17. References 32 and 40. 18. Goldenberg, M.; Serlin, I.; Edwards, T., and Rapport, M. M.: Chemical Screening Methods for the Diagnosis of Pheochromocytoma: I. Nor-Epinephrine and Epinephrine in Human Urine , Am. J. Med. 16:310, 1954.Crossref 19. Smithwick, R. H.: The Effect of Sympathectomy upon the Mortality and Survival Rates of Patients with Hypertensive Cardiovascular Disease , in Hypertension, A Symposium , edited by E. T. Bell, Minneapolis, University Minnesota Press, 1951, p. 429. 20. Perera, G. A.: Hypertensive Vascular Disease: Description and Natural History , J. Chronic Dis. 1:33, 1955.Crossref 21. Bechgaard, P.: Arterial Hypertension: Follow-Up Study of 1000 Hypertonics , Acta med. scandinav. , (Supp. 172) , p. 3, 1946. 22. Frant, R., and Groen, J.: Prognosis of Vascular Hypertension: A 9-Year Follow-Up Study of 418 Cases , Arch. Int. Med. 85:727, 1950.Crossref 23. Palmer, R. S., and Muench, H.: Course and Prognosis of Essential Hypertension: Follow-Up of 453 Patients 10 Years After Original Series Was Closed , J. A. M. A. 153:1, 1953.Crossref 24. Schroeder, H. A.: Pathogenesis of Hypertension , Am. J. Med. 10:189, 1951.Crossref 25. Allen, F. M., and Sherrill, J. W.: The Treatment of Arterial Hypertension , J. Metab. Res. 2:429, 1922. 26. Kempner, W.: Treatment of Kidney Disease and Hypertensive Vascular Disease with Rice Diet , North Carolina M. J. 5:125, 1944. 27. Dole, V. P.; Dahl, L. K.; Cotzias, G. C.; Eder, H. A., and Krebs, M. E.: Dietary Treatment of Hypertension: Clinical and Metabolic Studies of Patients on the Rice-Fruit Diet , J Clin. Invest. 29:1189, 1950.Crossref 28. The Rice Diet in the Treatment of Hypertension: A Report to the Medical Research Council , Lancet 2:509, 1950. 29. Corcoran, A. C.; Taylor, R. D., and Page, I. H.: Controlled Observations on the Effect of Low Sodium Dietotherapy in Essential Hypertension , Circulation 3:1, 1951.Crossref 30. Wilkins, R. W.; Judson, W. E., and Stanton, J. R.: Preliminary Observations on Rauwolfia Serpentina in Hypertensive Patients , Proc. New England Cardiovascular Soc. , 1951, p. 34. 31. Finnerty, F. A., Jr.: The Value of Rauwolfia Serpentina in the Hypertensive Patient , Am. J. Med. 17:629, 1954.Crossref 32. Livesay, W. R.; Moyer, J. H., and Miller, S. I.: Treatment of Hypertension with Rauwolfia Serpentina Alone and Combined with Other Drugs: Results in 84 Cases , J. A. M. A. 155:1027, 1954.Crossref 33. Wilkins, R. W.: Rauwolfia in the Treatment of Essential Hypertension , Am. J. Med. 17:703, 1954.Crossref 34. Moyer, J. H.: Cardiovascular and Renal Hemodynamic Response to Reserpine (Serpasil), and Clinical Results of Using This Agent for the Treatment of Hypertension , Ann. New York Acad. Sc. 59:82, 1954.Crossref 35. Freis, E. D.: Mental Depression in Hypertensive Patients Treated for Long Periods with Large Doses of Reserpine , New England J. Med. 251:1006, 1954.Crossref 36. Hubbard, B. A., Jr.: Reserpine , J. A.M. A. 157:468, 1955.Crossref 37. Freis, E. D.; Partenope, E. A.; Lilienfield, L. S., and Rose, J. C.: A Clinical Appraisal of Pentapyrrolidinium (M&B 2050) in Hypertensive Patients , Circulation 9:540, 1954.Crossref 38. Dennis, E.; McConn, R. G.; Ford, R. V.: Hughes, W. M.; Beazley, H. L., and Moyer, J. H.: Treatment of Hypertension: Long-Term Results with Alseroxylon (Rauwiloid) Alone and Combined with Hexamethonium Administered Orally , Postgrad. Med. 16:300, 1954. 39. Smirk, F. H.: Blood Pressure Reduction in Arterial Hypertension by Hexamethonium and Pentapyrrolidinium Salts , Am. J. Med. 17:839, 1954.Crossref 40. Wilkinson, E. L.; Backman, H., and Hecht, H. H.: Cardiovascular and Renal Adustments to a Hypotensive Agent (1-Hydrazinophthalazine; Ciba BA-5968; Apresoline) , J. Clin. Invest. 31: 872, 1952.Crossref 41. Freis, E. D.; Rose, J. C.; Higgins, T. F.; Finnerty, F. A., Jr.; Kelley, R. T., and Partenope, E. A.: The Hemodynamic Effects of Hypotensive Drugs in Man: IV. 1-Hydrazinophthalazine , Circulation 8:199, 1953.Crossref 42. Taylor, R. D.; Page, I. H., and Corcoran, A. C.: A Hormonal Neurogenic Vasopressor Mechanism , A. M. A. Arch Int. Med. 88:1, 1951.Crossref 43. Stunkard, A.; Wertheimer, L., and Redisch, W.: Studies on Hydralazine: Evidence for a Peripheral Site of Action , J. Clin. Invest. 33:1047, 1954.Crossref 44. Kirkendall, W. M., and Culbertson, J. W.: Some Effects of Hexamethonium (C-6) and 1-Hydrazinophthalazine (HP) on Kidney Circulation , J. Clin. Invest. 31:644, 1952. 45. Freis, E. D.; Rose, J. C.; Finnerty, F. A., Jr., and Partenope, E. A.: A Comparative Study of the Hemodynamic Alterations Produced by Hexamethonium and 1-Hydrazinophthalazine (Apresoline) in Hypertensive Patients , J. Clin. Invest. 32:569, 1953.Crossref 46. Hafkenschiel, J. H., and Friedland, C. K.: The Effects of 1-Hydrazinophthalazine on Cerebral Blood Flow, Vascular Resistance, Oxygen Uptake and Jugular Oxygen Tension in Hypertensive Subjects , J. Clin. Invest. 32:655, 1953.Crossref 47. Taylor, R. D.; Corcoran, A. C.; Dustan, H. P., and Page, I. H.: Further Evaluation of Hydralazine in Treatment of Hypertensive Disease , A. M. A. Arch. Int. Med. 93:705, 1954.Crossref 48. Moyer, J. H.: Hydrallazine (Apresoline) Hydrochloride: Pharmacological Observations and Clinical Results in the Therapy of Hypertension , A. M. A. Arch Int. Med. 91:419, 1953.Crossref 49. Schroeder, H. A.: The Treatment of Arterial Hypertension , V. A. Technical Bulletin TB 10-102, (July 20) , 1954. 50. Freis, E. D.; Finnerty, F. A., Jr.; Schnaper, H. W., and Johnson, R. L.: The Treatment of Hypertension with Hexamethonium , Circulation 5:20, 1952.Crossref 51. Dustan, H. P.; Taylor, R. D.; Corcoran, A. C., and Page, I. H.: Rheumatic and Febrile Syndrome During Prolonged Hydralazine Treatment , J. A. M. A. 154:23, 1953.Crossref 52. Hoobler, S. W.: Treatment of Hypertension , Am. J. Med. 17:259, 1954.Crossref 53. Green, H. D.: Pharmacology of Antihypertensive Drugs , Am. J. Med. 17:70, 1954.Crossref 54. Smirk, F. H.: Practical Details of the Treatment of Hypertension by Hexamethonium Salts and by Pentamethylene 1:5-bis-N-(N-Methyl-Pyrrolidinium) Bitartrate (M. & B. 2050A) , New Zealand M. J. 60:1, 1953. 55. Schroeder, H. A.: Control of Hypertension by Hexamethonium and 1-Hydrazinophthalazine , A. M. A. Arch. Int. Med. 89:523, 1952.Crossref 56. Smirk, F. H.: Blood Pressure Reduction in Arterial Hypertension by Hexamethonium and Pentapyrrolidinium Salts , Am. J. Med. 17:839, 1954.Crossref 57. Corcoran, A. C.; Dustan, H. P.; Taylor, R. D., and Page, I. H.: Management of Hypertensive Disease , Am. J. Med. 17:383, 1954.Crossref 58. Wilbrandt, R.: Treatment of Hypertension with Hydergine: A Review of 200 Cases , Angiology 4:183, 1953.Crossref 59. Bechgaard, P., and Paulsen, L.: Dihydrogenated Ergot Alkaloids (Hydergine) in the Treatment of Essential Hypertension , Acta med. scandinav. 145:189, 1953.Crossref 60. Green, D. M.; Nelson, J. N.; Dodds, G. A., and Smalley, R. E.: Bilateral Adrenalectomy in Malignant Hypertension and Diabetes , J. A. M. A. 144:439, 1950.Crossref 61. Jeffers, W. A.; Zintel, H. A.; Hafkenschiel, J. H.; Hills, A. G.; Sellers, A. M., and Wolferth, C. C.: The Clinical Course, Following Adrenal Resection and Sympathectomy, of 82 Patients with Severe Hypertension , Ann. Int. Med. 39:254, 1953.Crossref 62. Bowers, R. F.: Bilateral Adrenalectomy for Severe Hypertension , J. A. M. A. 154:394, 1954.Crossref 63. Allen, E. V.: Sympathectomy for Essential Hypertension , Circulation 6:131, 1952.Crossref 64. Wilkins, R. W.; Culbertson, J. W., and Smithwick, R. H.: The Effects of Various Types of Sympathectomy upon Vasopressor Responses in Hypertensive Patients , Surg., Gynec. & Obst. 87:661, 1948. 65. Wilkins, R. W.; Culbertson, J. W., and Halperin, M. H.: The Hemodynamic Effects of Sympathectomy in Essential Hypertension , Ann. Int. Med. 30:291, 1949. 66. Morris, N.: Hexamethonium Compounds in the Treatment of Preeclampsia and Essential Hypertension During Pregnancy , Lancet 1:322, 1953. 67. Finnerty, F. A., Jr., and Fuchs, G. J., Jr.: Veratrum Treatment of Toxemia of Pregnancy: A Controlled Study , Am. J. Obst. & Gynec. 66: 830, 1953. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Internal Medicine American Medical Association

MANAGEMENT OF SYSTEMIC ARTERIAL HYPERTENSION

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American Medical Association
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Copyright © 1955 American Medical Association. All Rights Reserved.
ISSN
0888-2479
DOI
10.1001/archinte.1955.00250100107012
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Abstract

Abstract DIAGNOSIS IN A DISCUSSION of the management of arterial hypertensive disease no topic is of greater importance than proper diagnosis. Despite the fact that we do not find distinguishing characteristics for most of our patients with hypertension, the considerable prognostic and at times therapeutic value of making an etiologic diagnosis renders careful diagnostic study highly desirable. This discussion is directed mainly toward treatment of those patients who have (1) so-called "essential" hypertension or (2) hypertension from known etiologic factors but whose elevated blood pressure fails to respond to causal therapy.We believe that in order to arrive at the correct diagnosis it is desirable to have a complete history and physical examination (including blood pressure in both arms and in one thigh), roentgenograms of the heart and lungs in three or four projections, a 12-lead electrocardiogram, estimation of basal blood pressure after heavy sedation, fractional phenolsulfonphthalein test, blood urea nitrogen References 1. References 4-6. 2. References 3 and 7. 3. References 10-12. 4. References 14-16. 5. Kirkendall, W. M.; Anderson, G. A., and Lubin, R. I.: Comparison of Hypotensive and Renal Vascular Effects of Derivatives of Rauwolfia Serpentina in Man: Alseroxylon and Rescinnamine, unpublished data. 6. References 16 and 20-22. 7. References 23 and 24. 8. References 30 and 31. 9. References 16, 32, and 33. 10. References 33, 37, and 38. 11. N - phenoxyisopropyl-N-benzyl-β-chloroethylamine hydrochloride. 12. N,N-dibenzyl-β-chloroethylamine hydrochloride. 13. 6-allyl-6,7 dihydro-5H-dibenz(c,e)azepine phosphate. 14. References 43-45. 15. References 47 and 48. 16. References 35 and 50. 17. References 32 and 40. 18. Goldenberg, M.; Serlin, I.; Edwards, T., and Rapport, M. M.: Chemical Screening Methods for the Diagnosis of Pheochromocytoma: I. Nor-Epinephrine and Epinephrine in Human Urine , Am. J. Med. 16:310, 1954.Crossref 19. Smithwick, R. H.: The Effect of Sympathectomy upon the Mortality and Survival Rates of Patients with Hypertensive Cardiovascular Disease , in Hypertension, A Symposium , edited by E. T. Bell, Minneapolis, University Minnesota Press, 1951, p. 429. 20. Perera, G. A.: Hypertensive Vascular Disease: Description and Natural History , J. Chronic Dis. 1:33, 1955.Crossref 21. Bechgaard, P.: Arterial Hypertension: Follow-Up Study of 1000 Hypertonics , Acta med. scandinav. , (Supp. 172) , p. 3, 1946. 22. Frant, R., and Groen, J.: Prognosis of Vascular Hypertension: A 9-Year Follow-Up Study of 418 Cases , Arch. Int. Med. 85:727, 1950.Crossref 23. Palmer, R. S., and Muench, H.: Course and Prognosis of Essential Hypertension: Follow-Up of 453 Patients 10 Years After Original Series Was Closed , J. A. M. A. 153:1, 1953.Crossref 24. Schroeder, H. A.: Pathogenesis of Hypertension , Am. J. Med. 10:189, 1951.Crossref 25. Allen, F. M., and Sherrill, J. W.: The Treatment of Arterial Hypertension , J. Metab. Res. 2:429, 1922. 26. Kempner, W.: Treatment of Kidney Disease and Hypertensive Vascular Disease with Rice Diet , North Carolina M. J. 5:125, 1944. 27. Dole, V. P.; Dahl, L. K.; Cotzias, G. C.; Eder, H. A., and Krebs, M. E.: Dietary Treatment of Hypertension: Clinical and Metabolic Studies of Patients on the Rice-Fruit Diet , J Clin. Invest. 29:1189, 1950.Crossref 28. The Rice Diet in the Treatment of Hypertension: A Report to the Medical Research Council , Lancet 2:509, 1950. 29. Corcoran, A. C.; Taylor, R. D., and Page, I. H.: Controlled Observations on the Effect of Low Sodium Dietotherapy in Essential Hypertension , Circulation 3:1, 1951.Crossref 30. Wilkins, R. W.; Judson, W. E., and Stanton, J. R.: Preliminary Observations on Rauwolfia Serpentina in Hypertensive Patients , Proc. New England Cardiovascular Soc. , 1951, p. 34. 31. Finnerty, F. A., Jr.: The Value of Rauwolfia Serpentina in the Hypertensive Patient , Am. J. Med. 17:629, 1954.Crossref 32. Livesay, W. R.; Moyer, J. H., and Miller, S. I.: Treatment of Hypertension with Rauwolfia Serpentina Alone and Combined with Other Drugs: Results in 84 Cases , J. A. M. A. 155:1027, 1954.Crossref 33. Wilkins, R. W.: Rauwolfia in the Treatment of Essential Hypertension , Am. J. Med. 17:703, 1954.Crossref 34. Moyer, J. H.: Cardiovascular and Renal Hemodynamic Response to Reserpine (Serpasil), and Clinical Results of Using This Agent for the Treatment of Hypertension , Ann. New York Acad. Sc. 59:82, 1954.Crossref 35. Freis, E. D.: Mental Depression in Hypertensive Patients Treated for Long Periods with Large Doses of Reserpine , New England J. Med. 251:1006, 1954.Crossref 36. Hubbard, B. A., Jr.: Reserpine , J. A.M. A. 157:468, 1955.Crossref 37. Freis, E. D.; Partenope, E. A.; Lilienfield, L. S., and Rose, J. C.: A Clinical Appraisal of Pentapyrrolidinium (M&B 2050) in Hypertensive Patients , Circulation 9:540, 1954.Crossref 38. Dennis, E.; McConn, R. G.; Ford, R. V.: Hughes, W. M.; Beazley, H. L., and Moyer, J. H.: Treatment of Hypertension: Long-Term Results with Alseroxylon (Rauwiloid) Alone and Combined with Hexamethonium Administered Orally , Postgrad. Med. 16:300, 1954. 39. Smirk, F. H.: Blood Pressure Reduction in Arterial Hypertension by Hexamethonium and Pentapyrrolidinium Salts , Am. J. Med. 17:839, 1954.Crossref 40. Wilkinson, E. L.; Backman, H., and Hecht, H. H.: Cardiovascular and Renal Adustments to a Hypotensive Agent (1-Hydrazinophthalazine; Ciba BA-5968; Apresoline) , J. Clin. Invest. 31: 872, 1952.Crossref 41. Freis, E. D.; Rose, J. C.; Higgins, T. F.; Finnerty, F. A., Jr.; Kelley, R. T., and Partenope, E. A.: The Hemodynamic Effects of Hypotensive Drugs in Man: IV. 1-Hydrazinophthalazine , Circulation 8:199, 1953.Crossref 42. Taylor, R. D.; Page, I. H., and Corcoran, A. C.: A Hormonal Neurogenic Vasopressor Mechanism , A. M. A. Arch Int. Med. 88:1, 1951.Crossref 43. Stunkard, A.; Wertheimer, L., and Redisch, W.: Studies on Hydralazine: Evidence for a Peripheral Site of Action , J. Clin. Invest. 33:1047, 1954.Crossref 44. Kirkendall, W. M., and Culbertson, J. W.: Some Effects of Hexamethonium (C-6) and 1-Hydrazinophthalazine (HP) on Kidney Circulation , J. Clin. Invest. 31:644, 1952. 45. Freis, E. D.; Rose, J. C.; Finnerty, F. A., Jr., and Partenope, E. A.: A Comparative Study of the Hemodynamic Alterations Produced by Hexamethonium and 1-Hydrazinophthalazine (Apresoline) in Hypertensive Patients , J. Clin. Invest. 32:569, 1953.Crossref 46. Hafkenschiel, J. H., and Friedland, C. K.: The Effects of 1-Hydrazinophthalazine on Cerebral Blood Flow, Vascular Resistance, Oxygen Uptake and Jugular Oxygen Tension in Hypertensive Subjects , J. Clin. Invest. 32:655, 1953.Crossref 47. Taylor, R. D.; Corcoran, A. C.; Dustan, H. P., and Page, I. H.: Further Evaluation of Hydralazine in Treatment of Hypertensive Disease , A. M. A. Arch. Int. Med. 93:705, 1954.Crossref 48. Moyer, J. H.: Hydrallazine (Apresoline) Hydrochloride: Pharmacological Observations and Clinical Results in the Therapy of Hypertension , A. M. A. Arch Int. Med. 91:419, 1953.Crossref 49. Schroeder, H. A.: The Treatment of Arterial Hypertension , V. A. Technical Bulletin TB 10-102, (July 20) , 1954. 50. Freis, E. D.; Finnerty, F. A., Jr.; Schnaper, H. W., and Johnson, R. L.: The Treatment of Hypertension with Hexamethonium , Circulation 5:20, 1952.Crossref 51. Dustan, H. P.; Taylor, R. D.; Corcoran, A. C., and Page, I. H.: Rheumatic and Febrile Syndrome During Prolonged Hydralazine Treatment , J. A. M. A. 154:23, 1953.Crossref 52. Hoobler, S. W.: Treatment of Hypertension , Am. J. Med. 17:259, 1954.Crossref 53. Green, H. D.: Pharmacology of Antihypertensive Drugs , Am. J. Med. 17:70, 1954.Crossref 54. Smirk, F. H.: Practical Details of the Treatment of Hypertension by Hexamethonium Salts and by Pentamethylene 1:5-bis-N-(N-Methyl-Pyrrolidinium) Bitartrate (M. & B. 2050A) , New Zealand M. J. 60:1, 1953. 55. Schroeder, H. A.: Control of Hypertension by Hexamethonium and 1-Hydrazinophthalazine , A. M. A. Arch. Int. Med. 89:523, 1952.Crossref 56. Smirk, F. H.: Blood Pressure Reduction in Arterial Hypertension by Hexamethonium and Pentapyrrolidinium Salts , Am. J. Med. 17:839, 1954.Crossref 57. Corcoran, A. C.; Dustan, H. P.; Taylor, R. D., and Page, I. H.: Management of Hypertensive Disease , Am. J. Med. 17:383, 1954.Crossref 58. Wilbrandt, R.: Treatment of Hypertension with Hydergine: A Review of 200 Cases , Angiology 4:183, 1953.Crossref 59. Bechgaard, P., and Paulsen, L.: Dihydrogenated Ergot Alkaloids (Hydergine) in the Treatment of Essential Hypertension , Acta med. scandinav. 145:189, 1953.Crossref 60. Green, D. M.; Nelson, J. N.; Dodds, G. A., and Smalley, R. E.: Bilateral Adrenalectomy in Malignant Hypertension and Diabetes , J. A. M. A. 144:439, 1950.Crossref 61. Jeffers, W. A.; Zintel, H. A.; Hafkenschiel, J. H.; Hills, A. G.; Sellers, A. M., and Wolferth, C. C.: The Clinical Course, Following Adrenal Resection and Sympathectomy, of 82 Patients with Severe Hypertension , Ann. Int. Med. 39:254, 1953.Crossref 62. Bowers, R. F.: Bilateral Adrenalectomy for Severe Hypertension , J. A. M. A. 154:394, 1954.Crossref 63. Allen, E. V.: Sympathectomy for Essential Hypertension , Circulation 6:131, 1952.Crossref 64. Wilkins, R. W.; Culbertson, J. W., and Smithwick, R. H.: The Effects of Various Types of Sympathectomy upon Vasopressor Responses in Hypertensive Patients , Surg., Gynec. & Obst. 87:661, 1948. 65. Wilkins, R. W.; Culbertson, J. W., and Halperin, M. H.: The Hemodynamic Effects of Sympathectomy in Essential Hypertension , Ann. Int. Med. 30:291, 1949. 66. Morris, N.: Hexamethonium Compounds in the Treatment of Preeclampsia and Essential Hypertension During Pregnancy , Lancet 1:322, 1953. 67. Finnerty, F. A., Jr., and Fuchs, G. J., Jr.: Veratrum Treatment of Toxemia of Pregnancy: A Controlled Study , Am. J. Obst. & Gynec. 66: 830, 1953.

Journal

A.M.A. Archives of Internal MedicineAmerican Medical Association

Published: Apr 1, 1955

References