Showing papers in "JAMA Internal Medicine in 1921"
TL;DR: By developing a method of operative approach to the region of the sella, perfected by Cushing and developed by him and his associates, operative procedures on the pituitary gland became relatively easy.
Abstract: INTRODUCTION AND HISTORY It has been known for a long time that tumors and other pathologic lesions in the region of the sella turcica are attended by far-reaching pathologic alterations in other parts of the body. For some time also it was a matter of dispute among clinicians as to whether the symptoms were due essentially to lesion of the pituitary gland or of the immediately adjacent base of the brain (Erdheim 1 ). Recently this controversy has arisen anew in the contradictory articles of Leschke 2 and Maranon. 3 In 1907 Paulesco 4 opened the way to a solution of the question by developing a method of operative approach to the region of the sella. By this method, perfected by Cushing and developed by him and his associates, operative procedures on the pituitary gland became relatively easy. Cushing 5 was the first to note, after experimental lesions of the pituitary in dogs, the development of
209 citations
TL;DR: During the last few years the average of results obtained in the dietetic management of diabetes has been improved greatly through the work of Allen and Joslin, and the system they have developed is in some respects more logical and less empirical than any the authors have had heretofore.
Abstract: In the dietetic management of diabetes we are engaged in the effort to correlate symptoms and signs shown by the patient with the kinds and quantities of food he consumes. The success of treatment, the average of results in all types of cases, depends on the truth of our concept of the relationship existing between symptoms or signs and the food supply. During the last few years the average of results obtained in the dietetic management of diabetes has been improved greatly through the work of Allen and Joslin, and the system they have developed is in some respects more logical and less empirical than any we have had heretofore. Yet the literature of the subject is still confused by a lack of unanimity among all writers as to the best manner of handling all cases. In a recent monograph, Falta1has again told the merits of his "cereal cure"
130 citations
TL;DR: The methods of the electrocardiograph are applied to the study of anoxemia and the degree of circulatory efficiency at the onset of unconsciousness is adequate for the moment, but is assumed, in general, to be failing rapidly.
Abstract: Anoxemia in the normal man can safely be carried to the stage of unconsciousness when produced by the process of continuous and gradual reduction of the oxygen in the air breathed. The responses of the body to the gradual oxygen reduction are compensatory to a certain limit. The crisis appears promptly when the compensating limit is reached for any particular person and set of experimental conditions until in rapid succession the following states are passed: (1) Decrease and loss of attention; (2) loss of voluntary control of muscles, and (3) complete unconsciousness but with a degree of reflex control of voluntary muscles. The heart beat and respiratory movements persist through these three cycles. The degree of circulatory efficiency at the onset of unconsciousness is adequate for the moment, but is assumed, in general, to be failing rapidly. We have applied the methods of the electrocardiograph to the study of the
82 citations
TL;DR: Cowdry critically examined the descriptions of protoplasmic granules as given by a great many investigators under a very varied terminology and finds that granules having definite characteristics and hence capable of being separated from other cytoplasmic constituents have been observed and described in the protoplasms of almost every type.
Abstract: INTRODUCTION It has been suggested (Shipley, 1 Sappington 2 ) that the study of the mitochondria in the erythrocytes in the circulating blood would be of value clinically in estimating the state of activity of the bone marrow. The term mitochondria was introduced by Benda 3 in 1899 to designate certain threadlike granules which he had noted in his studies on spermatogenesis. Many authors had previously described similar protoplasmic granules under various terms. The protoplasmic fila of Flemming 4 included some poorly fixed mitochondria, and a large percentage of the bioblasts of Altmann 5 were mitochondria. Cowdry 6 has carefully reviewed a very extensive literature on the subject and critically examined the descriptions of protoplasmic granules as given by a great many investigators under a very varied terminology. He finds that granules having definite characteristics and hence capable of being separated from other cytoplasmic constituents have been observed and described in the protoplasm of almost every type
74 citations
TL;DR: Six cases 1 of paroxysmal tachycardia are reported which illustrate the moot points and the variety of clinical conditions in which the disorder occurs.
Abstract: Of the recognized disorders of the cardiac mechanism, none possess greater interest than the paroxysmal tachycardias. This affection has been recognized as a clinical entity for more than thirty years, and the condition has been produced experimentally by various means. Two questions have recently been revived; one, concerning sites of origin, especially the possibility of a paroxysm arising at the sinoatrial node (nomotopic tachycardia) and the other, concerning the role of the extrinsic nerves of the heart. Herewith I wish to report six cases 1 of paroxysmal tachycardia which illustrate the moot points and the variety of clinical conditions in which the disorder occurs. REPORT OF CASES Case 1. —J. W., aged 19 years, student. This patient was first seen Dec. 30, 1919, when he came for examination because of unduly rapid and forceful heart action which frequently occurred following exercise. He says they have been present as long as he
70 citations
TL;DR: Abdominal pain occasionally occurs alone, however, or rather, it is occasionally the sole striking symptom of hypersensitiveness to a food.
Abstract: Severe abdominal pain is a symptom which is never taken lightly by a careful physician. It often indicates a severe illness; in fact, often indicates an emergency. However, abdominal pain which may simulate in some respects the pain caused by serious abdominal disease is occasionally the result of hypersensitiveness to a food. It has been known for a number of years that hypersensitiveness to foods may give rise to bronchial asthma and a condition which simulates hay fever; to urticaria, angioneurotic edema, purpura, eczema and other dermatoses; to dyspepsia, gastro-intestinal upsets associated with vomiting, diarrhea, gripping pains in the abdomen and mucous colitis; to an interesting syndrome of symptoms known as Henoch's purpura, and that with the latter conditions a patient may have severe abdominal pain. Abdominal pain occasionally occurs alone, however, or rather, it is occasionally the sole striking symptom of hypersensitiveness to a food. In this case, the
48 citations
TL;DR: In 1854, Welcker 1 attempted to determine the quantity of blood in the bodies of two criminals by means of a washing out method, and he established as normal the figure of 1/13 of the body weight, which has remained the standard commonly adopted up to the present time.
Abstract: INTRODUCTION Until about the middle of the nineteenth century no observations as to the total blood mass in the human body were presented by either clinicians or physiologists. In 1854, Welcker 1 attempted to determine the quantity of blood in the bodies of two criminals by means of a washing out method, and he established as normal the figure of 1/13 of the body weight, which has remained the standard commonly adopted up to the present time. Even today, after a considerable series of investigations of this problem by various workers, figures given for the total blood volume in man are approximate and not absolute. The results usually quoted vary from 1/10 to 1/21 of the body weight. This uncertainty regarding the actual amount of circulating blood is largely due to technical difficulties. Clinical methods for determining the blood volume now available, however, yield results consistent enough to furnish a figure
43 citations
TL;DR: During the past winter a series of patients with bronchial asthma was studied in detail in the hope of correlating any findings which all, or nearly all, might present.
Abstract: The causes and factors apparently responsible for bronchial asthma vary widely among different individuals. One feature common to all patients with this disease is the presenting symptom—a paroxysm of difficult breathing. In studying patients during intervals of freedom from these attacks, attempts have been made to associate other conditions with bronchial asthma. It has been considered as being due to a vasomotor neurosis, 1 to an exudative diathesis, 2 to increased tone of the vagus nerve, 3 to sensitiveness to foreign proteins, 4 to a disordered metabolism, 5 bacterial infection of the respiratory tract, 6 and to certain abnormalities in the nose. 7 During the past winter a series of patients with bronchial asthma was studied in detail in the hope of correlating any findings which all, or nearly all, might present. From these individuals careful histories were obtained and physical examinations were made, with special reference to lesions of the nose and throat; signs of vagotonia;
42 citations
TL;DR: What conditions of oxygen want could be relieved by the therapeutic inhalation of oxygen were determined and the effect of oxygen administration was thus quantitatively measured by comparison of values before and after treatment.
Abstract: TABLE OF CONTENTS Harmful effects produced by an insufficient oxygen supply. Evidence that an insufficient oxygen supply exists in clinical disease. Desirability of raising oxygen content of blood to normal level. Methods of administration in recent war. Method developed in this investigation. Illustrative cases of cardiac disease, bronchitis, edema of the lungs. (Pneumonia, edema of the lungs, empyema and respiratory paralysis considered in Papers II and III.) Increase in oxygen content of blood following oxygen inhalation. Clinical improvement that occurs in acute anoxemia, following oxygen inhalation. INTRODUCTION The purpose of this investigation was primarily to determine what conditions of oxygen want could be relieved by the therapeutic inhalation of oxygen. The degree of anoxemia was determined by the oxygen saturation of the arterial and venous blood. The effect of oxygen administration was thus quantitatively measured by comparison of values before and after treatment. The correlation of the oxygen
40 citations
TL;DR: The preponderance of evidence favors the view originally advanced by Vincent and Harrison, that the hemal nodes are more closely related to the spleen, structurally and otherwise, than to the lymph nodes proper.
Abstract: In man and in certain of the lower vertebrates, nodal collections of lymphoid cells occur, and are divisible into two groups, namely, those which are provided with lymph sinuses, or ordinary lymph nodes, this group comprising by far the larger number; and those which are provided with blood sinuses, the latter being variously known as hemolymph nodes, splenolymph nodes, or more simply and better, perhaps, as hemal nodes. The exact anatomic position of the hemal nodes has not been determined. The preponderance of evidence, however, favors the view originally advanced by Vincent and Harrison,1that they are more closely related to the spleen, structurally and otherwise, than to the lymph nodes proper. In fact, Meyer,2in a series of injection experiments in sheep, has shown that the hemal nodes are in no way connected with the lymphatic system. Embryologically, the hemal nodes, like the spleen, are vascular bodies or masses
38 citations
TL;DR: A new method of evaluating the electrical axis of the heart is presented, and a brief discussion of some aspects of the study of the subject is discussed.
Abstract: The subject of the electrical axis of the heart has been receiving more and more attention in recent years. In the first edition of Lewis' work "The Mechanism of the Heart Beat"1it is not mentioned. Considerable attention, however, is given the subject in the second edition.2It is not too much to say that a thorough understanding of the relations of the axis is a necessary foundation of knowledge of apparently simple features of the electrocardiogram. This paper has for its purpose the presentation of a new method of evaluating the electrical axis, and a brief discussion of some aspects of the study of the subject. DEFINITION By the term "electrical axis" is meant the line along which the resultant of the electrical forces acting in the heart at any instant is expressed. Or, from another point of view, it corresponds, as Lewis puts it,2to "the average direction
TL;DR: Bigeminal pulsation in atrioventricular rhythm is extremely rare and has not been reported in the literature, so far as I is aware.
Abstract: Bigeminal pulsation in atrioventricular rhythm is extremely rare. In 1915, the electrocardiograms of an unique case seen at the Massachusetts General Hospital were published.1During the past year, a second case showing the same condition has been examined, also at the Massachusetts General Hospital. No other cases have been reported in the literature, so far as I am aware.2 Atrioventricular rhythm, once called "nodal rhythm," is that cardiac rhythm arising from the atrioventricular node (of Tawara) which lies in the connective tissue below the endocardium of the right auricle just above the septal edge of the tricuspid valve ring. Impulses arising in this node travel in both directions, upward to produce an upside-down contraction of the auricles, and downward to produce ventricular systole. If thea-vnode stimulates the ventricles alone while the sino-auricular node (the normal "pacemaker" of the heart) stimulates the auricles, auriculo-ventricular dissociation occurs either of the
TL;DR: During the past ten years reports on the treatment of hay-fever have been too numerous to justify reference to all of them in this paper, but the work of Noon, Freeman, Koessler, Cooke, Scheppegrell, Goodale, Selfridge and possibly of others justify the mention of their names.
Abstract: Although John Bostock, 1 in 1819, first described the symptom complex of hay-fever, it was not until 1873 that Blackley 2 determined the real cause of the symptoms, namely, the pollen of plants. Curtis, 3 in 1900, was the first to attempt to produce active immunity or to treat the condition; he used extracts of the whole plant. Since Dunbar, 4 in 1905, was the first to employ extracts of the plant pollen, the modern treatment of hay-fever was really begun by him. During the past ten years reports on the treatment of hay-fever have been too numerous to justify reference to all of them in this paper, but the work of Noon, Freeman, Koessler, Cooke, Scheppegrell, Goodale, Selfridge and possibly of others justify the mention of their names since it is these who have done most toward establishing the treatment of seasonal hay-fever. Notwithstanding the number of papers on the subject, there is
TL;DR: The present communication is a continuation of physiologic investigation of the alimentary canal in normal man, and deals with methods for the study of the enzymatic activities of the duodenal contents.
Abstract: In a former paper 1 reference was made to the need of data concerning details of the physiology of the human gastrointestinal tract in order that experimental observations on the functional pathology of the latter might be more intelligently interpreted The present communication is a continuation of physiologic investigation of the alimentary canal in normal man, and deals with methods for the study of the enzymatic activities of the duodenal contents A resume of most of the methods which have been used for such studies in the past is given in the appendix of the book of Euler 2 The methods, or their modifications, which have been used most frequently in investigation in clinical medicine are as follows: Proteolytic enzymes —Methods of Gross 3 and Mett 4 The method of Gross is a modification of one devised by Volhard 5 It is based on the principle that from faintly alkaline solutions (01 per cent, sodium
TL;DR: A critical review of the literature on eventration of the diaphragm principally from the standpoint of the diagnosis, attempting also to establish or disprove the authenticity of the reported results.
Abstract: I. INTRODUCTION So-called "eventration" of the diaphragm is understood to mean a high position of one-half of the phrenic leaf, conditioned, not simply on displacement, but on aplasia (congenital) or atrophy (acquired) of the muscle fibers of that half of the diaphragm. Obviously, the term is a misnomer, but it appears that the various terms which have been offered as substitutes, while in themselves more exact, have served by their multiplicity merely to add to the confusion in terminology. One is tempted to choose from among these terms one more suitable, but inasmuch as the condition is definitely defined, it may as well go by the name of "eventration" as by any other. I propose in this paper (1) to make a critical review of the literature on eventration of the diaphragm principally from the standpoint of the diagnosis, attempting also to establish or disprove the authenticity of the reported
TL;DR: This rare affection of the skin and mucous membranes of the nose and mouth, which may involve also the cheeks, ears, tongue, lips, fingers and other parts of the body, is associated with recurring epistaxis of the familial type.
Abstract: This rare affection of the skin and mucous membranes of the nose and mouth, which may involve also the cheeks, ears, tongue, lips, fingers and other parts of the body, is associated with recurring epistaxis of the familial type. In one of my cases, hemorrhage in the brain occurred, causing temporary hemiplegia and other symptoms of apoplexy. I have been able to find only thirty case reports. Steiner 1 found twenty-eight, including three of his own. Osler, in one of the best contributions to the subject, 2 reported three cases; and at that time (1901) he could find only one reference to a similar case, reported by Rendu. 3 Six years later, Osler 4 reported an additional case. However, he overlooked the cases reported by Chiari 5 and by J. W. Legg. 6 Only eight cases were found by A. Brown Kelly, 7 and he reported two cases of his own. None of the numerous works on
TL;DR: It has been known from the earliest times that a crusta phlogistica in human blood is a pathologic phenomenon, and the newer medicine generally has disregarded this symptom.
Abstract: If venous blood from a normal man or woman is left to clot it will, as a rule, form a homogenous red mass at the end of the coagulation. In certain pathologic and physiologic states, the coagulum is differentiated into a lower red and an upper, more or less broad, yellowish layer (crusta phlogistica, buffy coat, size), which consists of coagulated plasma. While this phenomenon is normal in the blood of several animals, it has been known from the earliest times that a crusta phlogistica in human blood is a pathologic phenomenon. The newer medicine, however, generally has disregarded this symptom, possibly because it may be found in so many different states, which did not seem to form a unity. This opinion, for instance, is thus expressed by Panum 1 (1851): "Utrum crusta in sanguine appareat, necne, ex rationibus compluribus vere physicis pendet, et vix unquam licet inde certam sanguinis compositionem
TL;DR: It is believed that this study throws some light on the etiology, course and prognosis of these toxic phenomena, especially through the recognition of special factors underlying the constitutional disturbances in the graver type of reactions.
Abstract: The fact that physicians have frequently failed to appreciate the significance of dermatitis following the arsenical treatment of syphilis, or to differentiate the rashes of minor significance from those indicating grave constitutional disturbances, has prompted us to report the results of our study of a series of such cases of dermatitis and of allied reactions. Our experience has led us to believe that it is possible to divide all untoward reactions of this type into two classes from the viewpoint of their significance with regard to the continuation of arsenic therapy. We also believe that this study throws some light on the etiology, course and prognosis of these toxic phenomena, especially through the recognition of special factors underlying the constitutional disturbances in the graver type of reactions. We have, therefore, reviewed in some detail twenty-three cases of reactions of this group which have occurred within the last six years in
TL;DR: Patients with pyelonephritis are not considered cured until specimens catheterized from each kidney are found to be free from both bacteria and pus, and investigators have centered their attention on this organism.
Abstract: In most nonspecific urinary infections, either in the bladder or in the kidney, a gram-negative motile bacillus, believed to be the colon bacillus, is generally the predominating organism in the urine. Naturally, investigation and treatment have been directed against this organism, and patients with pyelonephritis are not considered cured until specimens catheterized from each kidney are found to be free from both bacteria and pus. Recently, investigators have centered their attention on this organism. During the chill incident to the removal of residual urine in prostatic cases, colon bacilli have been recovered from the blood in as high as 40 per cent. of cases. 1 Helmholz and Beeler have attempted to produce pyelonephritis experimentally in rabbits by the intravenous injection of colon bacilli obtained from human cases, but only eight of sixty-six animals injected had lesions in the kidney; twenty-one had lesions in other organs. 2 However, during the course of the
TL;DR: During the past year the authors have had several acute infectious cases, running a febrile course, usually mild and all ending in recovery, but in which the blood picture gave rise to considerable apprehension, at the time, as to the ultimate outcome.
Abstract: During the past year we have had several acute infectious cases, running a febrile course, usually mild and all ending in recovery, but in which the blood picture gave rise to considerable apprehension, at the time, as to the ultimate outcome. The appearance in the blood of cells indistinguishable from those found in acute leukemia, together with enlargement of the lymph nodes and sometimes enlargement of the spleen, with a moderate fever, and absence of definite signs pointing to other disease entity, is a clinical picture that might easily give rise to a grave prognosis. An excessive proportion of lymphocytes, a reversal of the polymorphonuclear lymphocyte relation, is not infrequently seen in the normal blood of children, and occasionally in adults under pathologic conditions other than lymphatic leukemia. A lymphocytosis is also noted in some cases following the administration of certain therapeutic agents. In early childhood is found the most
TL;DR: Because of the frequent involvement of the central nervous system in syphilis, and because of the relatively simple chemical character of cerebrospinal fluid, it would appear probable that syphilis can be cured through the development of immunology.
Abstract: Chemistry plays an ever-increasing role in the practice of medicine; in the field of metabolism it is the alpha and omega. Medical chemistry deals largely with studies of body fluids and gases. The urine, because of its accessibility, was the first to be subjected to investigation, while the cerebrospinal fluid, because of its inaccessibility, has received relatively little attention to date. Although chemical changes undoubtedly do accompany infectious and protozoal diseases, the paucity of information concerning the nature of chemical changes in infections, and the complex nature of the proteins themselves, have barred, to a large extent, direct chemical approach to the study of infection. As a result, progress has come along other and indirect lines, namely, through the development of immunology. Because of the frequent involvement of the central nervous system in syphilis, and because of the relatively simple chemical character of cerebrospinal fluid, it would appear probable that
TL;DR: Although acute muscular rheumatism is generally conceded to be an infectious process, the myalgias and milder forms of myositis are not so definitely accepted as such.
Abstract: Although acute muscular rheumatism is generally conceded to be an infectious process, the myalgias and milder forms of myositis are not so definitely accepted as such. Myalgic pains are considered by Taylor 1 to be the result of faulty metabolism, by Gordon 2 of excessive katabolism from over-exertion of muscle cells, and by Profanter 3 as the peripheral expression of pain caused by defective function or injury of visceral organs. Except among English writers, such as Poynton, 4 Llewellyn and Jones, 5 Munroe and Almond, 6 and Stockman and Renton, 7 little credence is given to the idea of localized invasion of the muscles by bacteria other than in marked acute generalized myositis, and the condition described as dermatomyositis. The demonstration by one of us (Rosenow 8 ) eight years ago that streptococci from patients with rheumatic fever with muscular involvement, and streptococci from patients with acute nonrheumatic myositis, 9 tended to localize and produce nonsuppurative lesions in muscles of
TL;DR: This is a far larger series than has been reported from the standpoint of a microscopic study hitherto, and lends itself to quantitative analysis with the prospect of yielding much more accurate results, within the limitations of the data considered, than the smaller numbers forming the basis of previous studies.
Abstract: An unusual opportunity to study the less common pathologic changes in the tonsil has been afforded in the department of pathology of the University of Michigan through the practice of making routine histologic examinations of all tonsils received from the University Hospitals. This material now represents approximately 9,000 cases. This is a far larger series than has been reported from the standpoint of a microscopic study hitherto, and lends itself to quantitative analysis with the prospect of yielding much more accurate results, within the limitations of the data considered, than the smaller numbers forming the basis of previous studies. While tuberculosis occurs in but a small percentage of the tonsils examined, as compared to the various chronic inflammatory manifestations, hyperplasias and metaplasias, which are present in varying degrees in all tonsils, regardless of the clinical history, its occurence is of sufficient frequence to constitute one of the chief reasons for
TL;DR: This paper is based on the study of five cases of primary carcinoma of the lungs and bronchi, and the object will be to give a brief resume of the pathology of carcinoma.
Abstract: CONTENTS Introduction. General Considerations: Historical. Incidence. Clinical Characteristics. Metastases. Anatomy and Embryology. Classification: According to Gross Anatomy. According to Histological Anatomy. According to Histogenesis. Relation of Irritation to Neoplastic Growth. Case Reports. Discussion: Incidence. Clinical Characteristics. Metastases. Gross and Histologic Features. Histogenesis. Relation of Irritation to Neoplastic Growth. Conclusions. INTRODUCTION The relative rarity of primary carcinoma of the lungs and bronchi, the difficulty of making a clinical diagnosis and the comparative inaccessibility in regard to surgical procedures, have tended to limit the practical interest in these tumors. In spite of these limitations, there is a very extensive literature on the subject which suggests, at least, a wide scientific interest in this group of neoplasms. This paper is based on the study of five cases of primary carcinoma of the lungs. The object will be to give a brief resume of the pathology of carcinoma
TL;DR: It is highly probable that one of the mechanisms found to occur in gradual cardiac death, that is, ventricular fibrillation, is responsible for many sudden deaths of otherwise unknown cause, as suggested by McWilliam.
Abstract: Because of the frequency with which death of the individual is dependent on cardiac failure, the mode of death of the heart is a matter of considerable interest. Moreover, it is highly probable 1 that one of the mechanisms found to occur in gradual cardiac death, that is, ventricular fibrillation, is responsible for many sudden deaths of otherwise unknown cause, as suggested by McWilliam. 2 At the present time, the electrocardiogram offers our best means of attacking this problem. Despite the interest in the subject and its importance, there are but few clinical records of terminal mechanisms and fewer of ventricular fibrillation. The paucity of clinical electrocardiographic records of lethal exitus needs no explanation. That ventricular fibrillation is not better known clinically results from the fact that this mechanism is necessarily fatal, if it persists beyond a very few minutes. Experimentally, the condition is rather well known 3 since it can be produced
TL;DR: This paper represents a continuance of the studies in oxygen therapy in ten cases of lobar pneumonia and two cases of bronchopneumonia and the correlation of the clinical condition of the patient with the oxygen saturation of the arterial and venous blood before and after treatment is maintained.
Abstract: In the previous paper, a report was made of the effect of oxygen on two normal individuals and seven cases of cardiac insufficiency. This paper represents a continuance of the studies in oxygen therapy in ten cases of lobar pneumonia and two cases of bronchopneumonia. The theoretical indications for giving oxygen, the methods employed, and the recent pertinent literature have been outlined in the beginning of the first paper. The plan of investigation has been maintained, namely, the correlation of the clinical condition of the patient with the oxygen saturation of the arterial and venous blood before and after treatment. REPORT OF CASES The individual cases follow: Case 10 1 (Table 3).—M. W., white, male, driver, 36 years. Diagnosis .—Lobar pneumonia; chronic pulmonary tuberculosis; edema of the lungs. History .—Mother and sister died of tuberculosis. Patient has suffered from a chronic productive cough for five years. Three days before entry, tiredness, headache, and
TL;DR: It seems to us that the conception of the small thymic cell as a lymphocyte is more in harmony with common knowledge of the pathology of the gland, especially its tumors and, if Maximow's conception is correct, it is likely to give to the organ the appearance of a lymphoid structure.
Abstract: The histogenesis of the thymus is still a subject of debate. Most investigators are agreed that the reticulum and Hassall's corpuscles are epithelial in origin. The derivation of the chief elements of the organ, however, namely, the small cells, has not been determined. For example, Maximow 1 believes that early in the process of development the thymus becomes invaded by mesenchymal elements which differentiate into lymphocytes and that these accumulate in such numbers as to give to the organ the appearance of a lymphoid structure. Maximow's belief in the lymphocytic nature of the small cells is shared by Hammar 2 and Schaffer, 3 but is opposed by Stohr 4 and Pappenheimer, 5 who regard them as epithelial. It seems to us that the conception of the small thymic cell as a lymphocyte is more in harmony with common knowledge of the pathology of the gland, especially its tumors and, if Maximow's conception is correct, it
TL;DR: The objects of this research were to determine what relationship existed between the toxicity of various normal urinary constituents and the manifestations of what is clinically known as uremia.
Abstract: The objects of this research were to determine what relationship existed between the toxicity of various normal urinary constituents and the manifestations of what is clinically known as uremia—meaning by the term "uremia" the symptoms observed as a result of marked obstruction to the outflow of urine, on the one hand, and, on the other hand, the symptoms which appear in many cases of chronic Bright's disease, characterized by convulsions, various paralyses and coma. In pursuance of these objects, it was thought advisable to begin with the simplest organic urinary constituent—urea—to determine its toxicity on dogs—when injected in large doses in relatively short periods of time—to note the symptoms produced, to follow the changes in the blood and urine content of urea, and to determine, at the necropsy, the pathologic changes that might have taken place—both gross and microscopic—as well as the urea content of various body fluids. Then, the
TL;DR: Since the time when Bunge and Schmiedeberg showed that the perfused dog kidney could effect the synthesis of hippuric acid from benzoic acid and glycine, it has been assumed by investigators that the synthetic ability of the kidney for the formation of hippuranic acid could be used as an index of renal function.
Abstract: Since the time when Bunge and Schmiedeberg1showed that the perfused dog kidney could effect the synthesis of hippuric acid from benzoic acid and glycine, it has been assumed by investigators, from time to time, that the synthetic ability of the kidney for the formation of hippuric acid could be used as an index of renal function. Rowntree and Geraghty,2in their paper on the use of phenolsulphonephthalein as a means of testing renal function, enumerate among other renal tests that of the synthesis of hippuric acid. More recently, Violle3reported that in nephritis the formation of hippuric acid is much less than in normal individuals after giving 0.5 gm. doses of sodium benzoate and collecting the twenty-four hour specimens. He found that in some cases the amount of extra hippuric acid corresponding to the amount of ingested benzoate was not excreted under forty-eight hours. The work of Kingsbury and
TL;DR: The question of total metabolism and of utilization of protein in liver disease is discussed and the specific dynamic action of protein is given by Rubner 1 to the increase in total heat production.
Abstract: Much study of the liver has shown that it has so large a factor of safety that even when quite severely injured by disease it is still capable of performing its metabolic functions adequately. These studies have nearly all been made from the point of view of excretion, however, and but little work has been done on the speed of absorption and the utilization of foods in liver disease. With the disturbances of circulation found in cirrhosis, and the marked loss of liver tissue, it seems reasonable that, at least, the speed of utilization of foodstuffs might be delayed. This can best be studied by the respiratory metabolism, and in this paper, therefore, the question of total metabolism and of utilization of protein in liver disease is discussed. The specific dynamic action of protein is a term first given by Rubner 1 to the increase in total heat production which follows