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Showing papers in "JAMA Internal Medicine in 1949"


Journal ArticleDOI
TL;DR: Proof that thrombosis is not equivalent to simple clot formation but consists primarily in a process of selective precipitation of protoplasmic elements from the flowing blood at sites of vascular injury to form a homogeneous, grayish white deposit (the "white thrombus").
Abstract: DEVELOPMENT OF MODERN CONCEPTS OF THROMBUS FORMATION IN THE first half of the nineteenth century, thrombosis of blood vessels was held to result either from excessive coagulability of the blood or from exudative inflammation of the vascular wall. Virchow's views1influenced subsequent thought on the subject of intravascular clotting by their stress on the importance of slowing or stagnation of blood flow as well as on altered "molecular attraction" between the blood and the vascular wall. By means of experiments in living animals, Mantegazza2(1869, 1871) and Zahn3(1875) assembled proof that thrombosis is not equivalent to simple clot formation but consists primarily in a process of selective precipitation of protoplasmic elements from the flowing blood at sites of vascular injury to form a homogeneous, grayish white deposit (the "white thrombus"). With complete occlusion of the lumen by the white thrombus, the blood which is trapped in

108 citations


Journal ArticleDOI
TL;DR: It has gradually become apparent that if one classifies according to their major functional effects the various physiologically active steroids each falls into one of three main groups: adrenal steroids possessing activities of sex hormones Androgenic Estrogenic Progesterone Adrenal steroids which affect protein, carbohydrate and uric acid metabolism and which also produce important hematologic changes.
Abstract: DURING the past fifteen years a large number of steroid compounds have been isolated from adrenal cortices of animals. Whether the adrenal cortex during life actually secretes each of these steroids remains an unsolved problem. In more recent years it has gradually become apparent that if one classifies according to their major functional effects the various physiologically active steroids which have been derived from the adrenal gland each falls into one of three main groups: Adrenal steroids possessing activities of sex hormones Androgenic Estrogenic Progesterone Adrenal steroids which affect protein, carbohydrate and uric acid metabolism and which also produce important hematologic changes. Adrenal steroids which act mainly on sodium, potassium and chloride metabolism and, thus, on water metabolism as well. Even when classified according to their major functional activities, certain of the steroids exhibit important physiologic effects in one or both of the other two fields. The androgenic adrenal

99 citations


Journal ArticleDOI
TL;DR: It is shown that venipuncture for the injection of opium or its derivatives was a possible factor in only 12 instances of cases of endocarditis reported in English in the past thirty years.
Abstract: THE possibility that intravenous injection of opium in addicts might serve as a means of entry for organisms that could cause endocarditis was suggested by Lutembacher 1 more than thirty years ago, when he wrote of " une injection intraveineuse malpropre ." A review of almost all the cases of endocarditis reported in English in the past thirty years, however, shows that venipuncture for the injection of opium or its derivatives was a possible factor in only 12 instances (table 1). An interesting group of 11 such cases, involving patients observed in a short period, forms the basis of this paper (table 2). METHOD OF ADMINISTRATION OF DRUG BY ADDICTS The method of administration of opium employed by addicts lends itself to the introduction of organisms into the blood stream. The equipment of an addict consists of an ordinary medicine dropper and a hypodermic needle, with a bit of cigaret paper

93 citations


Journal ArticleDOI
TL;DR: In spite of an abundance of reports on single cases of defect of the ventricular septum, no series was collected until 1920, when Muller 2 reported 9 cases and gave a brief review of case reports collected from the literature; the paper was presented in a somewhat sketchy and unsystematic manner.
Abstract: UNCOMPLICATED defects in the interventricular septum are among the earliest of the congenital cardiac malformations to be recognized clinically. Henri Roger presented a remarkably accurate clinical description of this syndrome in 1879, 1 and the name maladie de Roger is frequently used in connection with defects of the ventricular septum. Roger's presentation was in the form of a clinical lecture without the benefit of illustration by an autopsy. In spite of an abundance of reports on single cases of defect of the ventricular septum, no series was collected until 1920, when Muller 2 reported 9 cases and gave a brief review of case reports collected from the literature; the paper was presented in a somewhat sketchy and unsystematic manner. The basic information about the pathologic features and the clinical picture of defect of the ventricular septum was contained in Maude Abbott's monograph 3 and was based on her well known

85 citations


Journal ArticleDOI
TL;DR: This report is concerned with the clinical importance of Bacteroides in a group of cases in which this organism was recovered and a number of provocative studies purporting to demonstrate this organism's role in human disease.
Abstract: CERTAIN anaerobic, nonsporing, gram-negative bacilli are classified in the genus Bacteroides. 1 (Excluded from this designation are the genera Dialister and Fusiformis, the former being characterized by small size and the latter by pointed ends.) These organisms are saprophytic inhabitants of the intestine, the urinary tract, the pharynx and the female genital tract. 2 Comparatively few studies of infections induced by Bacteroides have been reported in this country. The impression prevails, therefore, that it is a rare, even exotic, cause of human disease. This report is concerned with the clinical importance of Bacteroides in a group of cases in which this organism was recovered. Dack's comprehensive survey 3 may be consulted for a review of the morphology, taxonomy, biochemical reactions and antigenic characteristics of Bacteroides. "Bergey's Manual of Determinative Bacteriology" 1 presents a detailed, but provisional, classification of this group of bacteria. A number of provocative studies purporting to demonstrate

55 citations


Journal ArticleDOI
TL;DR: The results of the analysis on the long term prognosis of recent myocardial infarction patients seen in the hospital during the period from 1940 to 1945 are presented.
Abstract: R ECENTLY we have analyzed the factors concerned with the immediate prognosis in recent myocardial infarction. 1 In this report we wish to present the results of our analysis on the long term prognosis. Of the 572 cases previously reported, 507 were selected for this study. These patients were the ones seen in the hospital during the period from 1940 to 1945, inclusive. They represent 0.48 per cent of the total admissions for these years. The selection of these cases was based on the electrocardiographic findings, correlated with the clinical data and, when available, with the necropsy observations. Considerable reliance was placed on unmistakable signs of recent myocardial infarction in the electrocardiogram. The follow-up observations on these patients were made through private physicians, the hospital outpatient department or direct correspondence with the patients known to be alive. Seventeen of the 507 patients could not be followed. A number of the

53 citations


Journal ArticleDOI
TL;DR: The present studies were undertaken to determine whether the blood volume is altered, to observe the time at which the changes develop and to correlate the magnitude of the alterations with the clinical picture and other pertinent laboratory data.
Abstract: PERIPHERAL circulatory failure is an important complication of Rocky Mountain spotted fever. Previous studies have shown that the collapse occurs usually in the second week of rash and that the disturbance can be alleviated by the administration of preformed protein. 1 The mechanism responsible for the circulatory changes is obscure, but the peripheral collapse is accompanied with a drop in serum proteins and with the development of visible generalized edema. 2 The resemblance of the clinical picture to "shock" suggests that a drop in the circulating blood volume occurs. The present studies were undertaken to determine whether the blood volume is altered, to observe the time at which the changes develop and to correlate the magnitude of the alterations with the clinical picture and other pertinent laboratory data. Determinations of the plasma volume and the thiocyanate space were done serially in a group of patients with rickettsial spotted fever,

52 citations


Journal ArticleDOI
TL;DR: There are several forms of serious complications in this disease (hepatitis, thrombocytopenia, myocarditis, spontaneous rupture of the spleen and involvement of the central and peripheral nervous system), with instances of fatal outcome from the latter three.
Abstract: INFECTIOUS mononucleosis, until recently, has been regarded as a mild disease with few complications and with a uniformly favorable outcome. Glanzmann,1in 1930, stated in his monograph that the prognosis in infectious mononucleosis, as in German measles, is absolutely favorable. In the opinion of Contratto2(1944) infectious mononucleosis is attended with no more complications than an ordinary infection of the respiratory tract. However, there are several forms of serious complications in this disease (hepatitis, thrombocytopenia, myocarditis, spontaneous rupture of the spleen and involvement of the central and peripheral nervous system), with instances of fatal outcome from the latter three. Multiple serious complications may occur in the same patient. Electrocardiographic changes have been reported by several authors,3with death in Jersild's3acase, Microscopic evidence of focal myocarditis and of involvement of the central nervous system was found in a recently discharged convalescent patient who had died in an airplane crash on

51 citations


Journal ArticleDOI
TL;DR: Archeologic findings indicate that Carrion's disease was known in Peru in the pre-Incaic era, and Surprisingly accurate representations of the cutaneous nodules, or verrugas, are found in the Peruvian ceramic pots called huacos, especially in the Chimu civilization.
Abstract: CARRION'S disease is caused by Bartonella bacilliformis, a polymorphous organism classified as a bacterium in 1927 by Noguchi, 1 transmitted by sandflies of the genus Phlebotomus. The disease is limited geographically to certain areas of the Andean regions in Peru, Colombia and Ecuador. The disease is extremely polymorphic in symptoms. The confusion existing in the literature arose in part from reports prior to the discovery of B. bacilliformis, when intercurrent infections were not recognized and many symptoms were erroneously assigned to Carrion's disease. The present report is based on a study made on several hundred cases in Lima, Peru, during the period 1938 to 1943. HISTORY AND NOMENCLATURE Archeologic findings indicate that the disease was known in Peru in the pre-Incaic era. Surprisingly accurate representations of the cutaneous nodules, or verrugas, are found in the Peruvian ceramic pots called huacos , especially in the Chimu civilization. 2 The first medical publication

49 citations


Journal ArticleDOI
TL;DR: The degree of protein depletion required to impair production of antibodies in animals was rather drastic in many of the experiments cited, and the relative importance of their observations as they relate to human antibody response has been challenged.
Abstract: IMMUNITY is dependent in part on antibody production. There is ample evidence that antibodies are globulins modified in response to the presence of an antigen.1Antibody globulins, like other plasma proteins and body proteins as well, are derived from dietary protein and thus depend for their formation on protein intake adequate in quality and quantity.2Furthermore, the fundamental studies of Cannon and his co-workers3and of others4have shown that antibody production is lessened when hypoproteinemia is produced in experimental animals. Wissler and others5demonstrated that protein repletion is associated with improved antibody response. The degree of protein depletion required to impair production of antibodies in animals was rather drastic in many of the experiments cited, and the relative importance of their observations as they relate to human antibody response has been challenged.6 Because of the clinical implications of these experimental studies, we have (1) investigated production of antibodies in

48 citations


Journal ArticleDOI
TL;DR: A rare case of this type, with detailed clinical and postmortem studies, is reported at some length, as it appears to be an authenticated instance of thrombosis of the coronary artery with consequent myocardial infarction, produced by a contusion of the anterior wall of the chest.
Abstract: IN THE rapidly expanding literature on nonpenetrating injury to the human heart, there is scant reference to direct damage to the coronary arteries by such blunt injury. A rare case of this type, with detailed clinical and postmortem studies, is reported at some length, as it appears to be an authenticated instance of thrombosis of the coronary artery with consequent myocardial infarction, produced by a contusion of the anterior wall of the chest. REPORT OF A CASE C. B., a woman, was first admitted to the Mount Sinai Hospital in November 1945, when she was 49 years of age. Renal disease of unspecified type developed at the age of 31, during her second pregnancy. At the age of 37, a laparotomy was performed with the removal of a pelvic tumor; postoperative radiation treatment was given. Early in 1945, hypertension was first brought to her attention. The systolic reading was then

Journal ArticleDOI
TL;DR: I N 1911, I saw a psychopathic woman, past the menopause, who, with her protuberant abdomen, was sure that she was pregnant by the Holy Spirit, and learned then that a bloated abdomen can be produced purely by nervous means.
Abstract: I N 1911, I saw a psychopathic woman, past the menopause, who, with her protuberant abdomen, was sure that she was pregnant by the Holy Spirit. She insisted on going to a lying-in hospital and was outraged when told that she was not going to have a baby. I learned then that a bloated abdomen can be produced purely by nervous means. Later I saw an occasional nervous, unhappy woman who during the day would become more and more bloated, until by evening she would appear about eight months pregnant. The abdomen usually became flat during the night. Soon I began to realize that in these cases the cause could not be gas. Why? Because (1) a roentgenogram of the enlarged abdomen showed that there was no excess of gas in the stomach or bowel, and (2) as the swelling went down, sometimes suddenly, there was no passage of flatus.

Journal ArticleDOI
TL;DR: In this syndrome renal dysfunction was characterized by severe, intractable chronic hyperchloremic acidosis of months or years' duration, together with pronounced chronic polyuria, polydipsia, asthenia and either osteoporosis (adults) or "renal rickets" (children).
Abstract: IN RECENT years the term "nephrocalcinosis" has been used to designate cases of bilateral generalized calcification within the renal parenchyma. In many instances little importance has been attached to the particular anatomic position of the multiple renal calcifications. However, several observers 1 called attention to a few rare cases of idiopathic nephrocalcinosis in which numerous submiliary, symmetric bilateral calcifications were confined to the renal pyramids. Special significance was attributed to the localization of the renal calcifications in these cases, since they were associated with a unique form of chronic renal failure. In this syndrome renal dysfunction was characterized by severe, intractable chronic hyperchloremic acidosis of months or years' duration, together with pronounced chronic polyuria, polydipsia, asthenia and either osteoporosis (adults) or "renal rickets" (children). Several therapeutic measures directed against this metabolic disorder resulted in prolonged symptomatic improvement. Lack of treatment predisposed to further deposition of calcium in the basement

Journal ArticleDOI
TL;DR: Under special conditions it is possible for prolonged transfusion therapy to be associated with a prominent iron overload of various tissues and in certain organs this metallic excess is associated with parenchymatous damage.
Abstract: TWO TYPES of excessive iron deposits in the body are usually distinguished. The widespread iron deposition associated with prolonged hemolysis or following the repeated experimental injection of hemoglobin solution intravenously has been designated as hemosiderosis. The term hemochromatosis has been reserved for a special entity in which the most common features have been widespread iron deposition (hemosiderin pigment); hemofuscin deposits; increased copper content of tissues; cirrhosis and hypogonadism; pancreatic damages ("pancreatic cirrhosis") and diabetes mellitus, and skin pigmentation. These features of hemochromatosis have varied in their intensity and also in the frequency of their combination. With the advent of blood banks and the greater confidence in blood transfusion therapy, larger volumes of blood are being administered. Under special conditions it is possible for prolonged transfusion therapy to be associated with a prominent iron overload of various tissues. In certain organs this metallic excess is associated with parenchymatous damage. The

Journal ArticleDOI
TL;DR: Observations on the effect of three different compounds with vitamin K activity on the hypoprothrombinemia of human beings after dicumarol ® therapy are described.
Abstract: THE HYPOPROTHROMBINEMIA induced with dicumarol ® (3, 3,3′-methylene-bis-[4-hydroxycoumarin] ) is much more difficult to control than that which is the result of obstructive jaundice and other states characterized by deficient intake or absorption of vitamin K. Substances which have vitamin K activity in amount sufficient to reverse the hypoprothrombinemia of the latter states are wholly inadequate against the effect of dicumarol. ® This report describes observations on the effect of three different compounds with vitamin K activity on the hypoprothrombinemia of human beings after dicumarol ® therapy. Determination of the rapidity and degree to which the hypoprothrombinemia induced with this agent can be reversed is a logical and safe method of investigating the efficacy of these agents in man and is the basis on which these studies have been made. There is general agreement that when bleeding occurs as the result of dicumarol ® poisoning the main cause is prothrombin deficiency.

Journal ArticleDOI
TL;DR: Rapid as well as prolonged procedures for desensitization of the patients have consequently been worked out and it is shown that if successful, the rapid desensItization eliminates the difficulties in insulin therapy.
Abstract: ALLERGIC reactions from insulin can be viewed from different aspects. They causedifficulties in insulin therapy, sometimes even making a discontinuation of treatment with insulin compulsory. Of no less interest from a theoretic point of view is the question of the presence or absence of antigenic properties in insulin. As a hormone common to all vertebrate animals, insulin could be assumed to have a definite molecular structure irrespective of the species from which it derives and should not be antigenic. Nevertheless, authors who review the literature on this topic (Yasuna 1 and Watson 2 ) tacitly accept the concept that insulin is an antigen, capable of inducing sensitization. Desensitization has consequently been considered as the last resort in cases of severe allergic reactions. Rapid (Corcoran, 3 Ulrich and others 4 and Bayer 5 ) as well as prolonged (Weitz 6 ) procedures for desensitization of the patients have consequently been worked out. If successful, the rapid desensitization eliminates the difficulties

Journal ArticleDOI
TL;DR: The authors described 2 patients with pulmonary disease and observed that some normal subjects could lose consciousness by performing the Valsalva experiment of forced expiration against a closed glottis; in addition, diminished venous return and cardiac output were recorded by the ballistocardiographic method.
Abstract: IN 1876, Charcot1described the syndrome of laryngeal vertigo,2characterized by the loss of consciousness after severe coughing. Since then, occasional cases have been described, and in some instances the unusual vigor of coughing, associated with a respiratory infection, such as pertussis, may have been important. Whitty3reviewed nearly 100 of these cases in 1943, adding 4 more, and stated that he felt that epilepsy was an important factor despite rather meager evidence. He quoted De Havilland Hall, who in 1894 called attention to the large number of middle-aged plethoric males with laryngitis or bronchitis in a series of these cases. Wilkins and Friedland4observed that some normal subjects could lose consciousness by performing the Valsalva experiment of forced expiration against a closed glottis; in addition, diminished venous return and cardiac output were recorded by the ballistocardiographic method. The authors described 2 patients with pulmonary disease

Journal ArticleDOI
TL;DR: Data is presented on a series of 855 cases of chronic ulcerative colitis, with specific reference to the development of pseudopolyposis and carcinoma, to suggest that the malignant process occurs in the pseudopolyps and in association with, or as the result of, the existing chronic intestinal infection.
Abstract: THE PURPOSE of this communication is to present data on a series of 855 cases of chronic ulcerative colitis, with specific reference to the development of pseudopolyposis and carcinoma. A review of the literature appears to indicate a growing conviction that carcinoma may develop in patients with chronic ulcerative colitis and pseudopolyposis of long standing. The inference is that the malignant process occurs in the pseudopolyps and in association with, or as the result of, the existing chronic intestinal infection. The reported incidence of such malignant growths varies with different authors. Streicher (1938) 1 reported 1.2 per cent of 217 cases. Matzner and Schaefer (1939) 2 found the incidence of carcinoma among 185 patients with chronic ulcerative colitis to be 1.6 per cent, as compared with 0.5 per cent of the general hospital admissions. Brust and Bargen, 3 in 1934, reported an incidence of 2.5 per cent of 800 cases.

Journal ArticleDOI
TL;DR: The case to be presented is of unusual interest because it has been possible to present a typical and characteristic lesion of bone in multiple myeloma that is a discrete osteolytic involvement.
Abstract: THERE that the typical and characteristic lesion of bone in multiple myeloma is a discrete osteolytic involvement. The roentgenographic appearance is usually that of a punched-out area with sharp margination and without evidence of surrounding productive reaction. In a description of multiple myeloma Boyd 1 stated, "It is a pure rarefying lesion with no formation of new bone." To quote Geschichter 2 : "The widespread occurrence of small, sharply demarcated defects in the marrow cavity, unaccompanied by bending deformity or the formation of new bone, are the cardinal features in the diagnosis of multiple myeloma." Snapper 3 affirmed that in multiple myeloma "no new formation of bone takes place." Shanks, Kerley and Twining 4 declared categorically concerning the osseous lesions of multiple myeloma that "they are entirely osteolytic, and never give rise to new bone formation." The case to be presented is of unusual interest because it has been possible to

Journal ArticleDOI
TL;DR: Clinical observation long ago revealed that pulmonary infarction following an embolus occurred usually in patients who had concomitant pulmonary disease, and most authors reported that obstruction of branches of the pulmonary artery is not sufficient to cause infarctions.
Abstract: PULMONARY infarction has never been produced consistently in experimental animals, although numerous investigators have attempted it. 1 Virchow, in 1856, 1k observed that obstruction of branches of the pulmonary artery was not in itself sufficient to result in infarction. Karsner in 1912, 1f using turnip seed emboli in dogs, concluded that some factor other than an embolus was necessary to cause infarctions. Most authors reported that obstruction of branches of the pulmonary artery is not sufficient to cause infarction, if infarction is defined as necrosis of pulmonary tissue. An exception is the work of Steinberg and Mundy, 1i who produced occasional infarcts with employment of lead shot alone as emboli to occlude branches of the pulmonary artery. They, therefore, concluded that no factor except embolism is necessary to produce infarction. Clinical observation long ago revealed that pulmonary infarction following an embolus occurred usually in patients who had concomitant pulmonary

Journal ArticleDOI
TL;DR: An epidemic acute febrile illness characterized by headache, pyrexia and paroxysmal pain in the region of the diaphragm occurred in Massachusetts in 1947, and the same syndrome has since been variously designated as "Bornholm disease," "epidemic muscular rheumatism," "acute benign dry pleurisy" and "devil's grip".
Abstract: DURING the late summer and early fall of 1947, an epidemic acute febrile illness characterized by headache, pyrexia and paroxysmal pain in the region of the diaphragm occurred in Massachusetts. Clinically it closely resembled a malady first described in Iceland by Finsen1in 1856, who called it "pleurodynia." The same syndrome has since been variously designated as "Bornholm disease," "epidemic muscular rheumatism," "acute benign dry pleurisy," "epidemic pleuritic pain," "Bamle disease" and "devil's grip." The last name was based on the description of the pain in the chest experienced by one of Dabney's2patients in the first outbreak reported from the United States. The literature on the disease was reviewed by Sylvest3in 1934 and has been brought up to date by Scadding.4 The etiology remains obscure. Small5found inclusion bodies in the erythrocytes in 2 cases, which induced him and Torrey6to believe that the disease was caused by a

Journal ArticleDOI
TL;DR: A dramatic observation in cases of refractory anemia treated with multiple blood transfusions has been the development of hemosiderosis of the liver, spleen and other organs.
Abstract: THE DISCOVERY of iron and liver therapy has brought into prominence a type of primary anemia which fails to respond to any known treatment. This type has therefore been referred to as primary refractory anemia by Bomford and Rhoads, 1 who have further subdivided it into four types according to the histopathologic appearance of the bone marrow. These, with their clinically comparable conditions, are pseudoplastic anemia (partly mature, cellular marrow), aplastic anemia, or panmyelophthisis (hypocellular marrow), chronic granulocytopenia (immature cellular marrow) and myelosclerosis (fibrosis, sclerosis, and giant cell hyperplasia of the marrow). With the lack of specific therapy, the main source of treatment is repeated blood transfusions. A dramatic observation in cases of refractory anemia treated with multiple blood transfusions has been the development of hemosiderosis of the liver, spleen and other organs. An analysis of autopsy observations in 20 cases of refractory anemia from Bomford and Rhoad's series revealed

Journal ArticleDOI
TL;DR: Though zoster is not an accurate term, the disease denoted is evident; therefore, this nomenclature is utilized in the present report.
Abstract: HERPES zoster is a nervous disorder which is usually associated with dermatologic manifestations. It was the latter which gave the disease its name, since its external manifestations were known to the ancients. Herpes is a generic term which has been applied to numerous dissimilar acute inflammatory reactions of the skin and, as such, is misleading. We shall omit it during the rest of the present paper and shall refer to the disease entity under discussion as zoster. This latter term comes from the Greek [unk] and refers to the fact that the disease when leading to dermatologic manifestations on the trunk spreads around it like a girdle. Though zoster is not an accurate term, the disease denoted is evident; therefore, this nomenclature is utilized in the present report. That zoster is a nervous disorder was established by pathologic examination in 1862. 1 Its neuropathology was established on a firm foundation in

Journal ArticleDOI
TL;DR: The frequently heard opinion that theophylline is a useful adjunct in the treatment of heart disease has made it seem worth while to report studies which have made on the immediate circulatory action and the diuretic effect of theophyLLine isopropanolamine.
Abstract: THERE is a surprising lack of factual information on which the employment of the xanthine diuretics for patients with cardiac disease may be based.1This is no doubt due to the widespread and almost exclusive use of mercurial diuretics in congestive failure of the circulation. The frequently heard opinion that theophylline is a useful adjunct in the treatment of heart disease has made it seem worth while to report studies which we have made on the immediate circulatory action and the diuretic effect of theophylline isopropanolamine,2a soluble salt of theophylline, and an organic base. METHODS To evaluate the immediate circulatory effects of theophylline isopropanolamine, the cardiac output was measured in 15 patients with heart disease before and after administration. The direct Fick procedure was used, with catheterization of the right side of the heart.3In addition to the cardiac output, the procedures used made available

Journal ArticleDOI
TL;DR: The belief that the vasa vasorum did not play a role in the production of medionecrosis of the aorta was stated and the idea of some form of hyperadrenalism as the possible etiologic factor was favored.
Abstract: REPEATED attempts have been made to ascertain the underlying etiologic factors in idiopathic cystic necrosis of the aorta since it was first described by Gsell1and by Erdheim.2Workers have pursued several courses, among which have been the morphologic and the experimental. Among the former, the work of Erdheim is still fundamental and outstanding. He noted specifically the absence of vasa vasorum at the site of rupture in those instances in which the aorta showed the typical picture of medial necrosis. In other cases, he observed some degree of hyalinization. Despite his observations and the later work of Wiese,3he stated the belief that the vasa vasorum did not play a role in the production of medionecrosis of the aorta. He favored the idea of some form of hyperadrenalism as the possible etiologic factor. Later workers4noted alterations of the vasa vasorum. Attempts to reproduce the

Journal ArticleDOI
TL;DR: An investigation of the incidence of phosphorus as a toxic agent and a review of the literature on the subject bring to the foreground its serious nature and menace to the public health.
Abstract: THE RECENT observation of 2 fatal cases of acute phosphorus poisoning prompted an investigation of the incidence of phosphorus as a toxic agent and a review of the literature on the subject. Although at first glance its importance may seem slight, a further study of this condition brings to the foreground its serious nature and menace to the public health. INCIDENCE In the ten year period between 1934 and 1943, 14 patients with proved acute phosphorus poisoning were admitted to the Boston City Hospital, 7 of whom died, a mortality rate of 50 per cent. During this same period there were 1,443 admissions due to acute poisoning from other ingestants not including alcohol, with 90 deaths, a mortality rate of 6.2 per cent. Table 1 shows the incidence and mortality of the commonest toxic ingestants listed in order of their frequency. It will be noted that, although accounting for

Journal ArticleDOI
TL;DR: It may perhaps be expedient, as the starting point for new investigations, to set down some epidemiologic facts regarding this temporary rise in the frequency of the disease and about the complaint itself.
Abstract: DURING the years 1941 to 1945 there occurred a most striking epidemic of thyrotoxicosis in Denmark. The epidemic was described and discussed by Meulengracht 1 while it was at its climax, and it has since received a detailed analysis by Kurt Iversen, 2 who has published a monograph on it. The cause of the epidemic is unexplained. As Means has so aptly expressed it to me, it remains for the time being as "just a brutal fact" which calls for an explanation. It may perhaps be expedient, as the starting point for new investigations, to set down some epidemiologic facts regarding this temporary rise in the frequency of the disease and about the complaint itself. EARLIER OBSERVATIONS ON THE EPIDEMIC OCCURRENCE OF THYROTOXICOSIS In Iversen's recently published monograph there is an extensive review of the literature relating to temporary rises in the frequency of thyrotoxicosis. It appears from this that

Journal ArticleDOI
TL;DR: The authors' investigations on the use of the artificial kidney during the past year have demonstrated many inherent dangers which previous investigators have failed to note and treated successfully patients in acute renal failure by the simpler and safer procedures to be discussed later.
Abstract: THE OCCURRENCE of acute oliguria or anuria as a complication of incompatible blood transfusions, after prolonged arterial hypotension or following intoxication with sulfanilamide derivatives, mercuric chloride and other compounds and the recognition that the resultant renal insufficiency may be temporary has stimulated interest in the use of an artificial kidney or peritoneal lavage in the treatment of such a condition. The reports in the current scientific literature, as well as in the lay press, describing the use of these measures give an erroneous impression of their wide field of usefulness as well as of the success attributed to their application. Our investigations on the use of the artificial kidney during the past year have demonstrated many inherent dangers which previous investigators have failed to note. We have also treated successfully patients in acute renal failure by the simpler and safer procedures to be discussed later. REVIEW OF THE LITERATURE

Journal ArticleDOI
TL;DR: Observations are presented to bring out the following points: that the virulence of the organism during the two years previous to this report has been great, especially when it has been transmitted by the infusion of plasma or blood.
Abstract: THE PROBLEM of hepatitis has become a very real one since the onset of World War II. Just as in and after World War I, the incidence of hepatitis and perhaps the virulence of the icterogenic substance, which has definitely been shown to be a virus, have become greater. Our observations are presented to bring out the following points: That the virulence of the organism during the two years previous to this report has been great, especially when it has been transmitted by the infusion of plasma or blood. That there is a correlation between the results of liver function tests and the clinical course of the disease. That the physician should be alert concerning the possibility of homologous serum jaundice and of syringe-transmitted hepatitis. That chronic hepatitis and portal cirrhosis do exist as sequelae of acute hepatitis. From July 1946 through December 1948, 100 patients with hepatitis

Journal ArticleDOI
TL;DR: People of Jewish extraction are particularly though not exclusively affected, and most patients come from Russia, Poland, or Italy and are of the laboring class.
Abstract: MULTIPLE with characteristic cutaneous lesions and, occasionally, widespread internal involvement. It was first described by Kaposi in 1872, and, although the disease is relatively rare, the literature on the subject has been copious. Kren 1 wrote a 113 page monograph with 10 pages of references, and twenty-four synonyms have been listed for the disease. In 1932, Dorfell 2 searched the literature and found reports of 356 bona fide cases, of which only 21 had occurred in females. Choisser and Ramsey, 3 in 1939, stated that 600 cases had been reported since 1872. Persons of Jewish extraction are particularly though not exclusively affected, and most patients come from Russia, Poland, or Italy and are of the laboring class. Lowenthal, 4 in 1938, recorded a case in a fullblooded Negro and stated that only 3 similar cases had been reported previously; Persky and Lisa 5 reported another in 1944. The disease generally