SIGNIFICANCE OF THE HEMOSIDEROSIS OF PERNICIOUS ANEMIA

The selective deposition of hemosiderin in the liver parenchyma during pernicious anemia does not constitute evidence that there is a hemolytic cause for the disease located in the portal region. The repeated introduction of small amounts of free hemoglobin into the general circulation, by the subcutaneous route, leads, as we have shown, to an identical siderosis. Larger amounts of hemoglobin cause a renal pigmentation equalling or exceeding the hepatic, a fact that is in keeping with what is known of the physiology of hemoglobin excretion and of the findings in human beings afteroutspoken hemolysis.     

THE SIGNIFICANCE OF THE VAN DEN BERGH REACTION

1. The significance of the various types of direct van den Berghreaction is discussed, and it is emphasized that the so-calledbiphasic reaction is not due to the presence in the serum oftwo forms of bilirubin, but to the failure of strong solutionsof azobilirubin to follow Beer's Law.
2. The terms direct andindirect bilirubin should be abandonedbecause there is no proofthat these two forms really exist.
3. The use of the term direct-indirectquotient (D.I.Q.) is recommendedsince it merely gives an expressionof the extent of the directreaction under the conditions ofthe experiment.
4. Neither the direct van den Bergh reactionnor any of its modernmodifications enable one to distinguishbetween the jaundiceof acute hepatitis and that due to obstruction.
5. For clinical purposes, the method of Malloy and Evelyn isthesimplest and best of those examined. A D.I.Q. below 40 isthendiagnostic of retention jaundice, and a D.I.Q. above 50,althoughusually indicative of regurgitation jaundice, can occurin retentionjaundice complicated by liver damage.

Grants from the Central Research Fund of the University of London,and from the Medical Research Council, enabled special necessaryapparatus and chemicals to be purchased.     

CHANGES IN THE ELECTROCARDIOGRAMS ACCOMPANYING EXPERIMENTAL CHANGES IN RABBITS' HEARTS

1. In rabbits transient and also permanent enlargements of the heart occur as the result of the intravenous injection of adrenalin, spartein and adrenalin, diphtheria toxin, and streptococci. 2. Transient and permanent enlargements of the heart to the left are associated with decrease in the size of the upwardly directed waves of the Q, R, S group in Lead II of the electrocardiograms and increase in the downwardly directed. Transient enlargement to the right is associated with changes in the opposite direction. 3. The stages in the process of enlargement have been observed and are associated with gradual changes in the size of these waves. 4. A diminution in the size of all the waves of the Q, R, S group was observed in degenerative conditions of the heart muscle. 5. Extreme degeneration of the structures of the heart was associated with slowing of the heart''s action, lengthening of conduction time (P-Q), and lengthening of the time occupied by the individual waves of the electrocardiogram. 6. Ectopic ventricular contractions were seen in rabbits injected intravenously with suspensions of living streptococci.     

THE SIGNIFICANCE OF ANAPHYLAXIS IN PNEUMOCOCCUS IMMUNITY

1. Intraperitoneal injections of killed and living broth cultures of a virulent pneumococcus produce in guinea pigs a high degree of active immunity and a serum with strong protective power. 2. Despite the protective power of such serum no agglutinins for the homologous organism and no precipitins for soluble derivatives were demonstrable. 3. Guinea pig immunity to pneumococcus infection produced by the method described is not attended by cutaneous allergy to derivatives of the pneumococcus used for immunization. 4. During the course of an artificially produced active immunity, anaphylaxis may at times be present and at times absent without any measurable effect upon the resistance of the animal to infection by intraperitoneal injection. 5. In the particular instance studied, the experiments indicate that anaphylaxis to pneumococcus protein has no important effect upon the resistance of the animal to infection. It appears to be a concomitant without any significant rôle in the immunity mechanism.     

THE SIGNIFICANCE OF THE DIASTOLIC WAVES OF THE VENOUS PULSE IN AURICULAR FIBRILLATION

With the clinical recognition, that different degrees of fibrillation occur and that these in turn are closely related to a coordinated type of auricular tachyrhythmia (flutter); further, that one type may lapse into another or into a perfectly normal rhythm, the conviction has grown that finer and coarser types of auricular movement may be recognized by the amplitude of the diastolic waves of the electrocardiogram and venous pulse. The present investigation into the cause of these waves has shown that this is not possible. There is no theoretical or experimental reason for the assumption that any fixed relation exists between the amplitude of the electrical variations of the electrocardiogram, which are the resultant of variations accompanying the irregularly spreading excitation wave, and the degree of mass contraction following. The large recurrent waves of the venous pulse, which may with more reason be regarded as related to the size of the auricular mechanical contractions on theoretical grounds, are also shown to be without differential value. The reasons for this may be briefly summarized. In the first place, the presence of diastolic waves is contingent upon a slow heart rate and long ventricular diastoles. With rapid heart rate their occurrence is prevented by the closely placed systolic variations. It is therefore conceivable that both coarse and fine fibrillation as well as flutter will be without diastolic waves as long as the heart is rapid. Even in the cases with long beats present their significance must remain doubtful. It is true that in the experiments the waves accompanying coarse fibrillation are as a rule somewhat larger than those occurring during fine fibrillation; waves of considerable size may, however, be present in fine fibrillation. Hence, as long as no calibrated method of recording is possible, it is difficult to draw any inference. It is possible from the same patient to record with the same apparatus diastolic waves of varying amplitude by merely changing the pressure of the receiving tambour. The chief reason that the amplitude of these waves cannot be regarded as of differential value is found in their origin. Fine fibrillating movements of the auricle do not in themselves produce waves in the jugular. They produce neither pressure variations in the auricle, nor exert any traction upon the veins. The only factor capable of producing jugular waves during fine fibrillation seems to be the traction exerted by the position changes of the ventricle on the auricle and large veins. This may, in a measure, explain why the diastolic waves recorded from the apex and second left interspace of patients often closely correspond with those simultaneously recorded from the jugular. The term "fibrillary waves" commonly applied to the smaller of these variations is evidently poorly chosen when their etiology is considered. The coarser contractions of the auricle during coarse fibrillation also produce no pressure changes within the auricle. They are vigorous enough at times, however, to exert a traction upon the venous walls. Hence, the waves during coarse fibrillation may be regarded as partly of ventricular and partly of auricular origin, or, as is frequently the case, as due to an interference of the two tractions. It is owing to their dual origin that they are more numerous and distinct when recorded from the same animal without changing the position or pressure of the receiving apparatus.     

THE SIGNIFICANCE OF THE EPITHELIAL CELLS AND SAPROPHYTES IN SPUTUM

1. Microscopical examination of sputum that has been washed with isotonic salt solution indicates its source. Sputum from above the vocal cords contains polygonal flat epithelial cells and numerous species of non-pathogenic microorganisms. Sputum from below the cords is clear of saprophytes, although it sometimes contains bronchoalveolar cuboidal cells. 2. The source of the sputum can be determined by the erythrocytes and the bacilli that are contained in it, and the site of the lesion can also be ascertained. 3. In every instance I found erythrocytes in the pulmonary sputum after severe pulmonary hemorrhage. 4. Six of the cases of laryngeal affection referred to in the presentpaper had had no subjective symptoms, but microscopical examination showed tubercle bacilli in the laryngeal sputum. All the six cases were examined by Dr. Tanaka and were found to have tuberculous lesions in the larynx. In the laryngeal sputum of most cases of laryngeal tuberculosis with symptoms, tubercle bacilli have been frequently demonstrated, while in some cases contaminated laryngeal sputum was obtained only after a long series of examinations. 5. Microscopical examination of the sputum plays a significant part in the diagnosis of tuberculosis.     

鼻中隔的断层解剖及其临床应用

目的 :通过研究鼻中隔各部厚度的变化及其与周围结构的关系 ,为临床涉及鼻中隔的疾病的诊断和治疗提供解剖学依据。方法 :采用 18具成人头部连续冠状和横断层标本 ,观测鼻中隔及其邻近结构。结果 :鼻中隔各部厚度不一 ,鼻中隔前 1/3的中段最厚 ,达 10 8± 1 2mm ;后部较薄处仅为 1 5± 0 3mm。增厚的部分以粘膜为主 ,达 8 6± 0 7mm。结论 :在行鼻中隔偏斜纠正术、判断鼻腔出血的部位及寻找鼻腔通气障碍的原因时 ,均应考虑鼻中膈增厚的因素     

术中内镜检查对上消化道大出血的诊断意义

该文报告对上消化道大出血病人术中施行内镜检查28例，其中经口腔插镜10例，经胃肠切口置镜18例。发现出血病灶26例（92.9％）。经手术治愈25例，死亡3例。其中2例镜检时分不清真正出血原因，水后再度出血死亡，1例镜检时出现心跳骤停，水后昏迷死亡。文中就水中镜检的指征、方法、镜检与手术探查的关系及临床应用应注意的问题进行了讨论。     

THE SIGNIFICANCE OF CHANGES IN ANTIGENIC VOLUME AS THE RESULT OF SPECIFIC AGGLUTINATION

Findings are described which amplify those of a preceding paper in showing that bacteria increased in volume when treated with specific agglutinin. When the increase in volume approximated 20 per cent all the bacteria were agglutinated. We have attempted to correlate the volumetric increase with the quantity of protein adsorbed by the organisms during agglutination and have studied not only bacteria but collodion particles first sensitized to antigen and then agglutinated with a precipitin specific for the antigen. The increase in volume of the collodion particles was small and the quantity of protein adsorbed relatively large. When two species of bacteria were agglutinated with their respective antisera the reverse was true; the apparent volume increase was much greater than the quantity of protein deposited during the reaction. There is, then, no direct correlation between protein deposition and apparent increase in volume. Nevertheless, the results of experiments here reported have suggested an explanation for the fact of increase in volume.     

ON THE SIGNIFICANCE OF THE SUBMILIARY MYOCARDIAL NODULES OF ASCHOFF IN RHEUMATIC FEVER

1. In rheumatic myocarditis, foci, termed submiliary nodules of Aschoff, are present which are characteristic of the rheumatic infection. 2. They are most frequently found in the walls of the left ventricle, the auricles usually escaping. 3. The nodules were found in three cases of chorea without joint manifestations, proving the close relation of this condition to rheumatism. 4. They were absent in fourteen cases of subacute bacterial endocarditis due to Streptococcus mitis. 5. They were not found in infections of the endocardium with the gonococcus, staphylococcus, streptococcus, or pneumococcus. 6. Even in the absence of a rheumatic history we believe, in accordance with Fraenkel, that the presence of Aschoff bodies signifies a previous rheumatic infection. 7. Aschoff bodies are not always found in rheumatic carditis, where the infection antedates death by a long period, but the healed remains, represented by sclerotic patches ("Schwielen"), are present. 8. We suggest that the cases of arthritis characterized by the presence of the submiliary nodules of Aschoff in the myocardium be placed in one group and called for the time being "rheumatism"; and the cases with articular manifestations, yielding positive bacteriological findings and no Aschoff bodies, should be classified according to the infecting microörganisms concerned, and not as rheumatism.     

内镜下十二指肠粘液池的变化及临床意义的探讨

十二指肠粘液池是内镜下常见的征象。为探讨十二指肠粘液池的临床意义,对250例病人的胃镜资料进行分析,发现其中184例的十二指肠球部有粘液池,检出率占73.6％,并根据十二指肠粘液池的内镜下特点可分为0°～Ⅲ°,本组0°:26.4％、Ⅰ°:37.2％、Ⅱ°:25.2％、Ⅲ°:11.2％。同时具有十二指肠粘液池和胃镜可见胆汁反流者61例,占33.15％,主要是Ⅱ°和Ⅲ°十二指肠粘液池者,尤以Ⅲ°均见胆汁反流。结合十二指肠粘液池的外观和性状,认为十二指肠粘液池与胆汁反流密切相关,是诊断胆汁反流的一项重要内镜指标之一。也讨论了十二指肠粘液池与消化性溃疡、慢性胃炎和幽门螺杆菌感染之间的关系。     

THE SIGNIFICANCE OF HUMAN DOUBLE ZONE BETA HEMOLYTIC STREPTOCOCCI IN THE UDDER OF THE COW

Human strains of double zone beta hemolytic streptococci produced mastitis in 11 quarters of 4 young cows. Following the acute phase of the infection, the streptococci were eliminated from 6 quarters at various intervals. However, sufficient positive infections were maintained throughout the period of observation to show that the human strains can produce the same degree of infection as bovine double zone beta hemolytic streptococci.     

氙光低周波加封闭治疗腰腿痛的临床观察

我们对门诊就诊５２例腰腿痛病人，男３０人，女２２人，随机分为三组进行了对比观察。患者分组１（超短波组）、组２（Ｘｅｎｏｎ氙光低周波治疗组）和组３（氙光低周波加椎旁或硬膜外腔封闭组）。对于上述各组以ＶｉｓｕａｌＡｎａｌｏｇＳｃａｌｅ（ＶＡＳ）测痛法以疼痛为主要指标、快适度以舒适轻松程度为主要指标，就治疗前后自觉症状的改变进行了评价及统计学处理。结果表明：组３优于组２，组２优于组１，都具有显著性差异。本组结果提示日本医广公司生产的５５０／型氙光低周波治疗仪加激素类药物行椎旁或硬膜外腔封闭具有良好的协同作用，治疗效果显著。使ＶＡＳ痛苦度明显降低，同时治疗后还具有良好的舒适感，是治疗腰腿痛的好方法。     

THE INFLUENCE OF A LOW ELECTROMOTIVE FORCE ON THE ELECTROPHORESIS OF LYMPHOCYTES OF DIFFERENT AGES

1. Small lymphocytes in serum at 37°C. migrate toward the anode under experimental conditions described. 2. The electromotive force of 0.8 volt per cm. under the same conditions produced a straight line velocity which approximated that reported by McCutcheon for spontaneous velocity after his preparation had been studied over 5 hours. 3. Keeping the lymphocytes on ice up to 30 hours did not produce an appreciable difference in velocity of straight line migration from that speed determined if the cells were studied immediately. 4. The possible relationships between the type and order of magnitude of the electromotive force passing between injured and normal tissues and the electromotive force used experimentally are briefly discussed.