Showing papers in "JAMA Internal Medicine in 1916"
TL;DR: Means has found that the range of normal variation from the average is smaller and the apparent depression of metabolism in obesity is much less marked when the linear formula, instead of Meeh's formula, is used to determine surface area.
Abstract: Since the publication of Paper 5 of this series the so-called "Linear Formula" has been used in the study of a large number of individuals. Practically all of the subjects of respiration experiments in the Sage calorimeter have been measured in this way, and in addition Means1of Boston has used it as a factor in determining his normal base line of metabolism and the extent of the pathological variations. Means has found that the range of normal variation from the average is smaller and that the apparent depression of metabolism in obesity is much less marked when the linear formula, instead of Meeh's formula, is used to determine surface area. The accuracy of the linear formula has been shown in Paper 9 of this series. In order to correct the slight error in the factor for the arms, and also in order to clear up a few points
3,647 citations
Journal Article•
3,516 citations
TL;DR: The experiments to be described in this paper were undertaken in an attempt to determine the normal path or paths of conduction of the cardiac impulse from its origin in the upper part of the sino-auricular node to the right auricle and to the auriculoventricular node.
Abstract: The experiments to be described in this paper were undertaken in an attempt to determine the normal path or paths of conduction of the cardiac impulse from its origin in the upper part of the sino-auricular node to the right auricle and to the auriculoventricular node. The problem was attacked in two ways : first, by an attempt to map out the path of the spread of electronegativity from the sino-auricular node to surrounding parts in the intact heart ; and second, the determination of the influence on conduction from the sino-auricular node to the right auricle and auriculoventricular node produced by a gradual and progressive isolation of the sino-auricular node from the surrounding tissues. So far as we have been able to find, no previous work has been done in which the sino-auricular node has been gradually isolated from the surrounding tissues in the heart in situ, with the exception
58 citations
TL;DR: It is now a well-known and generally recognized fact that acidosis may occur in the course of nephritis, particularly in the terminal stages, and it has been suggested that lactic acid may be responsible for the acidosis.
Abstract: It is now a well-known and generally recognized fact that acidosis may occur in the course of nephritis, particularly in the terminal stages. Among the evidences of acidosis are a diminished carbon dioxid tension of the alveolar air, an increased hydrogen ion concentration of the blood or serum, a diminution of the alkali reserve and of the oxygen combining power of the hemoglobin. It is not yet clear on what this acidosis depends. It is surely not due to an accumulation of the acetone bodies, for they do not appear in the urine nor are they increased in the blood. It has been suggested that lactic acid may be responsible for the acidosis. The studies of Lewis, Ryffell and others 1 have shown that lactic acid is not increased in the blood in sufficient amount to account for the acidosis. There is no direct evidence nor, so far as
55 citations
TL;DR: This author recognized very clearly that before any conclusions could be drawn as to whether a person of a given age and sex had a normal amount of hemoglobin, it was first necessary to determine the norm for that age andsex.
Abstract: To the thoughtful clinician it has long been a matter of keen regret that the very examination of the blood which is perhaps most frequently made in routine practice, namely, the estimation of the percentage of hemoglobin, is the one from which we generally derive the most unsatisfactory results. Aside from the very glaring defects in some of the instruments in common use, this has been due to the fact that we have had few accurate data as to the variations in the amount of hemoglobin at different ages. What knowledge we possess on the subject dates from the work of Leichtenstern. 1 This author recognized very clearly that before any conclusions could be drawn as to whether a person of a given age and sex had a normal amount of hemoglobin, it was first necessary to determine the norm for that age and sex. In addition to
53 citations
TL;DR: It has been conclusively shown that in typical cases the numerical counts of the formed elements of the blood, the erythrocytes and the leukocytes are within normal limits and the blood platelets may be somewhat increased.
Abstract: Hemophilia on account of its striking nature was early recognized as a clinical entity, and has been the subject of many observations. Many theories as to its causation have been advanced. With the development of methods for the study of the blood it has been possible to discard most of the theories concerning this interesting disease. It has been conclusively shown that in typical cases the numerical counts of the formed elements of the blood, the erythrocytes and the leukocytes are within normal limits. The blood platelets may be somewhat increased. It has also been shown in typical cases that certain active principles of the blood that participate in clotting occur in normal amounts. The hemophilic blood serum1contains the normal amount of thrombin, the active coagulating principle, and this thrombin behaves in an entirely normal fashion. It has further been shown that the hemophilic blood clot,
36 citations
TL;DR: The ventricular portion of the electrocardiogram is composed of a series of waves and is initiated by a group of three waves, the so-called Q, R, S group, which is constant in normal individuals in records obtained by the three leads of Einthoven.
Abstract: Constancy of form is one of the most striking characteristics of electrocardiograms obtained at various times from the same individual. Any change in form is therefore of interest, as it indicates some alteration in the passage of the impulse of contraction through the heart or some change in the manner of the muscular contraction. Changes in heart rate and in the force of contraction are not, as a rule, accompanied by definite alterations in the form of the electrocardiogram. The ventricular portion of the electrocardiogram is composed of a series of waves and is initiated by a group of three waves, the so-called Q, R, S group. Of these, only the R wave is constant in normal individuals in records obtained by the three leads of Einthoven. There are at present differences of opinion as to the functional activity of the ventricles responsible for this group of waves.
36 citations
TL;DR: Heart block is ordinarily understood to be a condition in which there is impairment in the conduction of impulses from auricles to ventricles, but if the delay is sufficient or if the heart rate is rapid, an impulse may occasionally fail to reach the ventricle, giving partial heart block.
Abstract: Heart block is ordinarily understood to be a condition in which there is impairment in the conduction of impulses from auricles to ventricles. The first stage of this process is represented by a mere delay in the conduction time recognized by an increase in the a-c interval in jugular tracings and in the P-R time in electrocardiograms. In this condition all impulses reach the ventricle; but if the delay is sufficient or if the heart rate is rapid, an impulse may occasionally fail to reach the ventricle, giving partial heart block. Finally, there is a condition in which none of the auricular impulses reach the ventricle, and the auricles and ventricles each beat of their own rhythm and independently of one another. These three stages may be termed, first,delayed conduction, second, partial heart block, and third, complete heart block. The cause of this disturbance in
35 citations
TL;DR: To those who are accustomed to think in terms of the energy requirement, exophthalmic goiter stands outas the disease of increased metabolism, and the increased metabolism stands out as the chief symptom of hyperthyroidism.
Abstract: TABLE OF CONTENTS Introduction. Previous studies of the respiratory exchanges. Methods of experiment. Case histories. Discussion of Results: The basal metabolism in exophthalmic goiter. The respiratory quotients. Direct and indirect calorimetry. The water elimination through skin and lungs. Specific dynamic action of protein and dextrose. The effects of treatment. Observations on a cretin. Therapeutic applications. Summary and conclusions. To those who are accustomed to think in terms of the energy requirement, exophthalmic goiter stands outpar excellenceas the disease of increased metabolism, and the increased metabolism stands out as the chief symptom of hyperthyroidism. The determination of the heat production seems to afford the best index of the severity and course of the disease. There is great need of some purely objective test in hyperthyroidism to indicate the effect of treatment, since psychotherapy
34 citations
TL;DR: In the present paper it is the intention to lay emphasis on those cases in which the permeability of the kidney is not sufficiently low, in which only the concentration of the uric acid of the blood should be raised.
Abstract: In an earlier communication1attention was called to the practical value of the estimation of the creatinin of the blood in nephritis. It was pointed out that an appreciable retention of creatinin indicated a grave impairment in the functional condition of the kidney, for the reason that creatinin is normally the most readily eliminated of the three nitrogenous waste products—uric acid, urea and creatinin. In contrast to creatinin, however, uric acid is apparently eliminated by the kidney with difficulty. It is, therefore, not surprising that conditions of moderately decreased kidney permeability should be encountered, in which only the concentration of the uric acid of the blood should be raised. This appears to be the case in gout and early interstitial nephritis. In the present paper it is our intention to lay emphasis on those cases in which the permeability of the kidney is not sufficiently
28 citations
TL;DR: It is becoming increasingly evident that the group termed "the hemorrhagic diseases" includes a large number of abnormal conditions, and that, at the present time, it is a fruitless task to attempt to unravel the various entities embraced by the clinical conditions which are assembled under this general head.
Abstract: It is becoming increasingly evident that the group termed "the hemorrhagic diseases" includes a large number of abnormal conditions, and that, at the present time, it is a fruitless task to attempt to unravel the various entities embraced by the clinical conditions which are assembled under this general head. This is due partly to the fact that the physiology of the coagulation of the blood is still incompletely understood, partly because of the impossibility of analyzing the various factors concerned in coagulation, and in part because these hemorrhagic states have been incompletely observed from a clinical point of view. Indeed, the knowledge and the methods which are at our disposal have by no means been fully and intensively applied to solving the problems which these cases present. There are two hemorrhagic states which stand out in relief—true hemophilia of the hereditary type, found almost exclusively in males and
TL;DR: The ventricles occasionally escape from the control of the sinuauricular node through the independent action of their own center of stimulus production in the atrioventricular junctional tissues, and two types of ventricular escape should be recognized.
Abstract: The ventricles occasionally escape from the control of the sinuauricular node through the independent action of their own center of stimulus production in the atrioventricular junctional tissues. Two types of such ventricular escape should be recognized : first, that which is dependent primarily on a depression of the pacemaker in the sinuauricular node; and second, that which is dependent primarily on an excitation of the pacemaker in the atrioventricular node. As one would anticipate, examples of the first type are occasionally seen, while instances of the second type appear to be decidedly rare, though both conditions may be more common than we realize at present. The two factors, depression of the sinu-auricular node and the excitation of the atrioventricular node, may be found in a single case. The differentiation between the two types must be based largely on the rate of the sinu-auricular pacemaker from which the ventricles
TL;DR: This study of the effect of fatigue in various pathologic conditions contains observations on the gaseous metabolism of three cardiac patients while at rest and while working on an ergograph, together with analyses of the oxygen and carbon dioxid content of the venous blood in seven cases.
Abstract: The literature contains extremely few reports of observations on the metabolism of patients with heart disease. The work most frequently referred to is a monograph of Kraus.1This study of the effect of fatigue in various pathologic conditions contains observations on the gaseous metabolism of three cardiac patients while at rest and while working on an ergograph, together with analyses of the oxygen and carbon dioxid content of the venous blood in seven cases. The metabolism experiments were made with the Zuntz apparatus. One of the most striking results is the extraordinarily low value obtained in all cases for the respiratory quotient. In the two milder cases the quotients for experiments with the subjects at rest and fasting were 0.743 and 0.603, while three similar observations in the more severe case gave as respiratory quotients 0.574, 0.534 and 0.614. Exercise brought about a rise of the quotient. In
TL;DR: In view of the widespread use of emetin hydrochlorid in the treatment of amebic dysentery and of pyorrhea alveolaris, more precise knowledge of the toxicity of the commercial preparations employed is highly desirable.
Abstract: In view of the widespread use of emetin hydrochlorid in the treatment of amebic dysentery and of pyorrhea alveolaris, more precise knowledge of the toxicity of the commercial preparations employed is highly desirable. The following case reports forcibly emphasize this fact: Case 1. —I. B. (Med. No. 33209), white, male, aged 56, a native of Baltimore, was admitted to the surgical service Oct. 12, 1914, complaining of an "ulcerated rectum." Fifteen years previously he had had a chancre, followed by a secondary eruption. For the past six years there had been alternating periods of diarrhea and constipation, with blood in the stools at times. Examination. —On examination, there was found slight enlargement of the heart to the left, a soft systolic murmur at the apex and some impairment of the percussion note over the manubrium. The systolic pressure was 150 mm. Hg; diastolic, 70. The urine was negative. The
TL;DR: The earlier the premature beat the more likely it was to be followed by an abnormal ventricular complex, according to the electrocardiogram of patients showing both normal and abnormal or aberrant deflections.
Abstract: The present communication contains observations on ventricular response to auricular premature beats and to auricular flutter with especial reference to the electrocardiogram. Auricular premature beats may be attended by normal or abnormal ventricular response, normal or aberrant complexes in the electrocardiogram. Of twenty-three patients with auricular premature beats, whose electrocardiograms were taken at the Massachusetts General Hospital, twelve showed entirely normal ventricular complexes following the abnormal auricular deflections ; six showed both normal and slightly aberrant ventricular complexes ; four showed normal, slightly aberrant and markedly aberrant complexes, and one showed merely slightly aberrant ventricular complexes. In the electrocardiogram of those patients showing both normal and abnormal or aberrant deflections, the earlier the premature beat the more likely it was to be followed by an abnormal ventricular complex (Figs. 1, 2 and 3). In Figure 1 the earliest premature auricular contractions are entirely blocked ; those coming
TL;DR: An attempt was made to correlate the amount of fat present in the blood vessels of the various organs, demonstrable by histologic methods, with the severity of the symptoms noted clinically and the frequency with which the delirium occurring after fractures was ascribed to alcoholism.
Abstract: INTRODUCTORY In a previous study 1 of the tissues of fourteen persons who died following fractures complicated by fat embolism, an attempt was made to correlate the amount of fat present in the blood vessels of the various organs, demonstrable by histologic methods, with the severity of the symptoms noted clinically and the frequency with which the delirium occurring after fractures was ascribed to alcoholism was emphasized. In eight of the fourteen, delirium tremens had been diagnosed clinically, although histories of alcoholism had not been definitely established in each of the cases. The study was made on the bodies coming to necropsy from the Cook County and Presbyterian hospitals, Chicago. One of these, which will be called Case A, because of the pronounced clinical manifestations and marked anatomic changes was chosen as the standard. Preparation of the tissues for purpose of accurate estimation of the fat content was as follows:
TL;DR: The results which can be obtained are uniform, especially if the writer's suggestions about the technic are followed and his automatic pipet is used to assure accuracy of measurements.
Abstract: In spite of numerous results found in literature, the albumin and globulin content of serum in health and disease has been reinvestigated by use of Robertson's1method, because of the simplicity and freedom from possible error of the new technic as compared with that of former methods. The small amount of serum used is another advantage and has made possible the use of two controls on each serum examined by the writer. The results which can be obtained are uniform, especially if the writer's suggestions about the technic, which will soon be published, are followed and his automatic pipet2is used to assure accuracy of measurements. During the last seven months a number of normal serums have been examined. The average results differ slightly from those obtained by Robertson's method previously reported.3The total protein is lower than in the previous series, due to the fact
TL;DR: Papaverin is one of the principal primary opium alkaloids in point of both quantity and pharmacologic interest, and is the sulphate and more especially the hydrochlorid that are chiefly used in physiologic work.
Abstract: Papaverin is one of the principal primary opium alkaloids in point of both quantity and pharmacologic interest. Its amount in opium varies from 0.11to 0.22per cent. The alkaloid was discovered by Merck in 1848. It crystallizes in white prisms, with a melting point of 147 C. The crystals are insoluble in water and alkalis, difficultly soluble in ether and benzol, but easily soluble in warm alcohol, chloroform and acetone. It is tasteless, is neutral in reaction with litmus and is polariscopically inactive. The alkaloid easily combines with acids, forming salts, and it is the sulphate and more especially the hydrochlorid that are chiefly used in physiologic work. These salts can be obtained on the market in a very pure chemical state, and are soluble in water and in normal saline. Like all the other opium alkaloids, papaverin is characterized by color reactions by which
TL;DR: It is remarkable to find in the works of Galen, whose name still clings to the neighboring veins, that he used the term "acervulus" in describing the psammona or sand bodies found in the gland, and in his works recur such illuminating statements as the following.
Abstract: Introductory The ancients believed that the pineal body or cornarium, as it was called, regulated the flow of vital spirits from the brain to the spinal cord, acting in this capacity in a manner similar to the pylorus of the stomach. It was assumed that it was a part of the brain, capable of movement, and stood as a guard between the third and fourth ventricles. But it is remarkable to find in the works of Galen, 10 whose name still clings to the neighboring veins, that he used the term "acervulus" in describing the psammona or sand bodies found in the gland, and in his works recur such illuminating statements as the following: "The pineal was devised for the same purpose as the other glands of the body." In the first place, "it is in substance glandular," and, observing that the blood supply came from the same
TL;DR: It is now possible to calculate the normal baseline much more exactly than a year ago and it is therefore necessary to reconsider the whole question at this early date.
Abstract: Since the writing of Paper 41of this series an unusual amount of work has been published on the subject of the normal metabolism. It is now possible to calculate the normal baseline much more exactly than a year ago and it is therefore necessary to reconsider the whole question at this early date. The figures representing the average normal metabolism have been changed frequently since the study of the respiratory exchanges began and it may be said that the chief advance has depended on the fact that it has been possible to make the variation in the normal smaller and smaller each year. With the oldest type of large respiration chamber the range of heat production fluctuated enormously with the uncontrolled influences of muscular activity and the specific dynamic action of food. With the improved technic of Johansson and with the small apparatus of the
TL;DR: It was shown by one of us that repeated injections of foreign protein in sensitized animals may lead to damage of the kidney, as well as to the other organs, and it seemed important to determine whether the edema, which is often general in serum disease, is associated with this illness.
Abstract: Since the classical work of von Pirquet and Schick on serum disease, it has been repeatedly observed that with the edema which appears in the course of this illness, albumin and occasionally casts may occur in the urine, and a few observers have noted suppression of urine with subsequent albuminuria and cylindruria during severe immediate or accelerated reactions following a second dose of serum. Though these symptoms are said to be transient, no accurate studies have so far been made to determine whether actual changes take place at this time in the functional activity of the kidneys, and since it has been shown by one of us 1 that repeated injections of foreign protein in sensitized animals may lead to damage of the kidney, as well as to the other organs, it seemed important to determine whether the edema, which is often general in serum disease, is associated with
TL;DR: Urine and blood examinations in a typical case of progressive muscular dystrophy, which was being studied clinically by Drs.
Abstract: We recently made urine and blood examinations in a typical case of progressive muscular dystrophy which was being studied clinically by Drs. Goldthwait and Spear of Boston. The clinical findings are to be made the subject of a separate report, but the chemical findings seem well worth recording, even though they represent the data from but one case, since, if confirmed in other cases, they constitute a distinct contribution to our knowledge of carbohydrate metabolism. They are, therefore, published in the hope that similar examinations will be made by any other investigators who may observe a case of this uncommon disease. THE OBSERVATIONS The patient was a man 33 years of age who showed no abnormalities except progressive muscular weakness. He was put on a constant diet; the urine was saved and examined quantitatively for calcium, magnesium, nitrogen, creatinin, creatin, uric acid, and ammonia ; and the blood for
TL;DR: In paper 5 1 of this series a method was described by means of which it was possible to determine the surface area of living subjects, on the basis of the measurements of five persons of widely varying body shapes, a formula was devised which gave an average error of only 1.7 per cent.
Abstract: In paper 5 1 of this series a method was described by means of which it was possible to determine the surface area of living subjects. On the basis of the measurements of five persons of widely varying body shapes, a formula was devised by Mr. Delafield Du Bois which gave an average error of only 1.7 per cent. when applied to the persons measured. The number of subjects was rather small and it has seemed best to continue the work and apply the formula to persons of unusual shapes. Since the publication of the previous paper, in which the literature was reviewed, a number of references have come to light largely through the attention of Dr. Francis G. Benedict of the Nutrition Laboratory of Boston. The work of Sicheff 2 is of considerable importance. Working in Gundobin's clinic he applied the methods used by Meeh to twenty-four children
TL;DR: The appearance of a disease in a locality in which it had seldom or never been recognized is of somewhat more than local interest, not only from the viewpoint of geographic distribution, but also from that of causation and of variation in type or manifestation.
Abstract: The appearance of a disease in a locality in which it had seldom or never been recognized is of somewhat more than local interest, not only from the viewpoint of geographic distribution, but also from that of causation and of variation in type or manifestation. Particularly is this true of a disease which exhibits so marked a range of appearance and so much confusion in diagnosis as does the condition generally known in this country as blastomycosis. This infection, caused by an organism or group of organisms the different strains of which are evidently related to certain of the higher molds on the one hand, and to the torulae on the other, is one of the most important of the group of mycoses. The localized skin disease produced by this type of parasite is widely distributed geographically and is not infrequently encountered. It is fairly easy of recognition and
TL;DR: The majority of those who have undertaken studies were unable to demonstrate that urea acted as a poison, and attempts have been made to explain the occasional toxic effects observed on one or more of the following assumptions.
Abstract: In order to throw light on the nature of uremia, many investigators have studied the physiologic effects produced when urea is administered to or injected into animals. The majority of those who have undertaken such studies were unable to demonstrate that urea acted as a poison. Only a few have succeeded in producing definite toxic effects. For example, Herter and Wakeman, 1 as well as Marshall and Davis, 2 found that approximately 1 per cent. of the body weight must be injected into animals in order to produce a fatal result. Ascoli, 3 in reviewing the earlier literature, has sought to explain the occasional toxic effects observed on one or more of the following assumptions: (1) the urea used was not pure, (2) it was injected intravenously in too concentrated a solution, or (3) where used in dilute solution the effects were attributable to the excessive amounts of liquid
TL;DR: The experiments here to be described concern two patients with moderate diabetes treated by the oatmeal method in the metabolism ward of the Russell Sage Institute of Pathology and four Rockefeller Hospital patients with more severe diabetes transferred to Bellevue Hospital for study in the respiration calorimeter during various stages of the fasting treatment.
Abstract: The experiments here to be described concern two patients with moderate diabetes treated by the oatmeal method in the metabolism ward of the Russell Sage Institute of Pathology and four Rockefeller Hospital patients with more severe diabetes transferred to Bellevue Hospital for study in the respiration calorimeter during various stages of the fasting treatment. Only very brief mention is possible of the literature1concerning the subjects touched upon in the experiments, namely, (1) the oatmeal and fasting treatment, (2) the dextrosenitrogen ratio, (3) the respiratory quotient under certain conditions, and (4) the total metabolism in diabetes. 1. According to literature previously reviewed,2the von Noorden school no longer holds that oatmeal stands entirely alone in respect to the capability of utilization by diabetic patients, but nevertheless maintains that for some unknown reason it is superior to other forms of carbohydrate. On the other hand, Blum3and
TL;DR: The condition commonly called `` eventration .
Abstract: Among the lesions of the diaphragm, none has passed into the literature under more synonyms than the condition commonly called `` eventration .'' Since 1849, when Cruveilhier introduced his conception of the disease under this term, the names: "dilatation," ``relaxation'' (Wieting), "insufficiency" (Franck), "high position," "elevation" (Griffin), have been used to designate a pathological state of the diaphragm, characterized by a general expansion of one half of the organ, allowing the abdominal viscera to be displaced upward into the thoracic cavity. The diaphragm is greatly thinned as well as distended, but its three layers remain intact, and there is no solution of its continuity. In this essential respect, the condition is different from hernia of the diaphragm, which, whether true or false, depending on the presence or absence of a hernial sac, consists of a localized opening in the sheet of the diaphragm, through which the abdominal viscera pass
TL;DR: Boys in the period of prepubescence are considered as individuals of adult form but of small size, growing rapidly, and as yet scarcely influenced by the internal secretions of the sex glands.
Abstract: In the period of development of boys, the years immediately preceding puberty are of especial interest. By this time the figure has lost most of its childish characteristics and the mind has reached a point of great intelligence. Although the individual has scarcely passed the half-way mark in the years of growth, and has only attained half his future weight, yet he resembles the adult much more than he resembles the infant. At this stage the sex glands have not yet begun the rapid development of puberty with its profound effect on the whole organism. Curiously enough there is a sudden increase in the rate of growth which takes place at this time. In fact, we may consider boys in the period of prepubescence as individuals of adult form but of small size, growing rapidly, and as yet scarcely influenced by the internal secretions of the sex glands.
TL;DR: The findings in four cases of obesity and one of acromegaly are discussed, and observations on eight new cases are reported to report observations on the gaseous metabolism.
Abstract: A year ago I reported some observations of the gaseous metabolism in four cases of obesity and one of acromegaly. 1 At present I wish to discuss the findings in these cases somewhat further, and at the same time to report observations on eight new cases. 2 The object in view has been to determine whether any gross disturbances in the metabolism as shown by the basal gas exchange occur in obesity. The method has been described in the previous paper and consists, briefly, in the determination of the gas exchange in the nuchtern subject, lying prone, in a moderately warm room, and the calculation of the heat production by indirect calorimetry from the oxygen absorption and the calorific value of oxygen for the respiratory quotient obtained. 3 In judging of the normality of any given metabolism the body surface is unquestionably a better criterion than the
TL;DR: The mechanism of formation, the pathology, the course, the symptomatology of ventricular hemorrhages have been somewhat differently considered by various authors who have had the opportunity to observe such findings, but all writers concur in the belief that this form of cerebral hemorrhage is cerebral.
Abstract: Hemorrhage in the brain may be extraventricular or intraventricular. In the latter case the blood may originate in the ventricle itself and produce a primary ventricular hemorrhage. In the first, the original seat of the hemorrhage is the tissue surrounding the ventricle and the ventricle itself is only secondarily involved. Secondary effusion of blood into cerebral ventricles is not an infrequent phenomenon, while a primary hemorrhage within the ventricular cavity is rather a rare occurrence, judging from the meager literature on the subject. Not many records are to be found on primary intraventricular hemorrhage. Nevertheless, sufficient data have been accumulated to deserve a special description. The mechanism of formation, the pathology, the course, the symptomatology of ventricular hemorrhages have been somewhat differently considered by various authors who have had the opportunity to observe such findings. All writers, however, concur in the belief that this form of cerebral