bluuebunny/crossref_metadata_2025 huggingface dataset:
NORMAL VALUES FOR THE RED CELLS IN AUSTRALIA
Authors: LANCASTER H. O. , BANKS NINA P.
Published: September 2017

The means and standard deviations of the red blood cell indices of healthy Australian adults have been found to be as follows : Mean corpuscular volume (cubic micra) : 89·1±2·9 for males, 87·9±6·4 for females. Mean corpuscular hmoglobin (micromicrogrammes per cell) : 33·2±1·1 for males, 32·4±2·0 for females. Mean corpuscular hmoglobin concentration (grammes of hmoglobin per roo millilitres of packed cells) : 37·4±1·4 for males, 37·1±1·9 for females.

The estimated mean red cell counts per cubic millimetre corresponding to the hmoglobin values of the main survey of Walsh et alii (1953) are 4·73 million for males and 4·29 million for females, using the above figures for mean corpuscular hmoglobin.
HÆMOGLOBIN AS A SOURCE OF IRON IN NUTRITION
Authors: KALDOR I.
Published: September 2017

Hydrochloric acid and pepsin can liberate little of the iron contained in native hæmoglobin ; but if hæmoglobin is denatured by heat, prior to the application of these agents, the yield of iron is increased several fold.
HÆMOGLOBIN AS A SOURCE OF IRON IN NUTRITION
Authors: BRADING ILSE , KALDOR I. , GEORGE E. P.
Published: September 2017

The absorption of iron from haemoglobin introduced into the gastro‐intestinal tract was investigated in rats. It was found that a greater amount of iron was absorbed from heat‐denatured hæmoglobin than from hæmoglobin administered in its native state. Approximately half as much was absorbed from hæmoglobin administered into the jejunum as from hæmoglobin administered into the stomach.
DE MOTU CORDIS : CELLULAR PHYSICS AND CHEMISTRY
Authors: MACFARLANE W. V.
Published: September 2017

William Harvey regarded himself as an anatomist although he provided the first physiological analysis of the circulation. In this he used the physical concepts which Galileo taught while Harvey was at Padova, as well as the experimental method and inductive‐deductive sequence of logic which the New Philosophy recommended as an approach to understanding. His hypothesis was supported shortly after his death by Malpighi's discovery of the capillaries in 1661. The circulation of the blood was expounded in medical schools in physical terms. It was not until late in the eighteenth century that quantitative chemistry began, and at that time the first suggestion that the heart might require energy for its pumping action was made by Felice Fontana of Bologna. During the nineteenth century physical analysis of heart action in terms of pressures, velocities, sound and electrical activity went forward. The metabolic background was, however, slow to develop, and only in the nineteen‐thirties was it clear that oxygen and lactate were the energy sources of heart action.

In the last ten years some attempt at synthesis of the physical and the chemical background of heart action has been made. Single cells studied chemically and physically yield a picture of the heart as a whole. Using intracellular electrodes and metabolic blocking agents it is found that the duration of the refractory period is lessened in the absence of oxygen or in the presence of agents decoupling oxidative phosphorylation. The rest pause before any particular action potential of the cell determines the length of that action potential and therefore of the refractory period. High energy phosphate is probably necessary for the maintenance of refractoriness.

Agents (dinitrophenol, digitalis glycosides, sodium azide or hypoxia) which reduce the duration of the action potential also slow the heart, when innervation of the heart has been interrupted. It is possible that the initiation of heart beat is an active process of ion transfer employing the same energy sources as those producing the refractory period.

The physical manifestations of heart action studied by Harvey thus meet the chemical sources of energy at the cellular level where analysis of the motion of the heart must ultimately take place.
A CASE OF AMAUROTIC FAMILY IDIOCY WITH LIPID STORAGE DISEASE OF BONE
Authors: GLASGOW GAVIN L.
Published: September 2017

A case of amaurotic family idiocy is described in which lipid storage disease of bone marrow closely resembling Gaucher's disease developed. The bone changes became evident at the age of twenty‐one years, thirteen years after the neurological condition had been recognized.

The literature relevant to the case is reviewed and its significance discussed.
THE NATURE OF LEUCHÆMIA
Authors: Louis C. J.
Published: September 2017

A component of the globulin fraction of rabbit serum reacts with the protoplasmic constituents of the normal cell but not with the corresponding malignant counterpart. The phenomenon can be demonstrated by conjugating a serum globulin fraction with fluorescein isocyanate; non‐neoplastic tissues stain, but the neoplastic cells do not. This has been established particularly with experimentally produced hepatomata in rats and has been confirmed with other experimentally produced tumours.

The method has been applied to naturally occurring tumours in man, and similar results have been obtained ; that is to say, normal tissues stained with the fluorescein isocyanate‐globulin complex fluoresce brightly, but tumour tissues do not.

Films obtained from normal individuals, as well as those suffering from infectious conditions such as glandular fever, were compared, using this technique, with those of leuchæmias. Normal white cells and those from various infectious diseases fluoresced well. Among the leuchæmias, the cells of chronic myeloid, chronic lymphatic and monocytic leuchæmias all fluoresced brightly. A proportion of the cells of acute leuchæmias (the primitive cells) failed to fluoresce.

This observation suggests that the chronic leuchæmias are non‐neoplastic conditions but that the acute leuchæmias, from the point of view of this method of study, do conform with the postulate that they are neoplastic in nature.
LEFT VENTRICULAR HYPERTROPHY : THE DETERMINATION OF L.V. WEIGHT
Authors: MCPHIE JOHN
Published: September 2017

From an autopsy study of the weights of the isolated ventricles in 102 adults hearts, an analysis was made of the accuracy with which total ventricular weight, total heart weight and left ventricular thickness permitted the prediction of the left ventricular mass and the distinction between its normality and hypertrophy.

Normal figures were derived from the literature and from 16 normal cases in this series. The effsect of formalin fixation were studied in 11 cases.

From the results it was concluded that, in the absence of right ventricular hypertrophy, total ventricular weight was a reliable guide to left ventricular weight. Total heart weight was less reliable and involved an error in prediction of between ±10% and ±20%, which renders it but a crude indicator of left ventricular hypertrophy. Left ventricular thickness, whether measured at one or many sites, showed no useful correlation with the ventricular mass.
HÆMOLYTIC TRANSFUSION REACTION DUE TO ANTI KIDD
Authors: KRONENBERG H. , KOOPTZOFF OLGA , WALSH R. J.
Published: September 2017

Two hæmolytic transfusion reactions occurred in a patient suffering from rheumatoid arthritis and were shown to be caused by the development of an immune anti‐Kidd antibody in the patient's serum. The activity of this antibody disappeared when the serum was heated or kept for a short time in a refrigerator, but could be restored by the addition of fresh serum. The antibody was not present in a sample of serum collected from the patient three weeks after the last transfusion.
INTRAPULMONARY GAS MIXING STUDIED BY THE CLOSED‐CIRCUIT HELIUM TECHNIQUE
Authors: READ JOHN
Published: September 2017

Studies were made in normal subjects and in patients with various types of respiratory disease.

About half the normal subjects showed relatively minor degrees of inequality of ventilation.

Nine patients with pulmonary emphysema all showed markedly uneven ventilation of the lungs. The poorly ventilated space usually accounted for 50% or more of the functional residual capacity, and the tidal volume of this space was less then 4% of the volume of the space. The closed‐circuit method was modified to reveal the true functional residual capacity in severe emphysema.

Three out of five patients with diffuse pulmonary sarcoidosis and three out of six patients with diffuse interstitial pulmonary fibrosis showed ventilatory inequality intermediate in degree between the normal subjects and those with emphysema. The lungs of the remaining patients in each group were evenly ventilated.

Extensive bronchitis may produce a severe mixing defect, and this may be the only physiological abnormality in a patient who appears clinically to have pulmonary emphysema. The defect was reversible in one such case studied.

Increase of tidal volume may lead to disproportionately great improvement in the ventilation of the poorly ventilated space.
THE NATURE OF LEUKEMIA
Authors: Louise C. J.
Published: September 2017

The method of staining tissues with a fluorescein‐globulin complex by which malignant tumour cells may be distinguished from their normal counterparts, and which was used in a study of white cells in the peripheral blood in leukaemia in man, has been applied also to the leukxmia of animals.

It was also applied to tumours in animals, both those induced by the action of carcinogens and naturally occurring as well as some transplantable growths.

Naturally occurring leukemia and leukæmia following irradiation were observed in the mouse, which was studied most closely. In the naturally occurring disease, acute leukæmia accounted for about 95% of the cases. This was almost 00% in special strains and following irradiation and the application of other leukæmogenic agents.

The distinction between the two types of leukaemia was well defined, and, as in man, the cells from chronic leukæmia all stained well but those from acute leukæmia did not. This difference in incidence between man and the mouse is important when conclusions drawn from experimental studies in the rodents are to be applied to man.
THE ASSOCIATION OF HEPATIC AND RENAL DISEASE
Authors: MARTIN F. I. R. , TAFT L. I.
Published: September 2017

The association of hepatic and renal disease is classified as (a) primary hepato‐renal disease in which the hepatic disease causes the renal lesion, and (b) secondary hepato‐renal disease, which includes all other causes of generalized disease states affecting both the liver and kidney.

Two types of primary hepato‐renal disease are presented with clinical, biochemical and histological features : (a) glomerulonephritis associated with chronic liver disease, and (b) renal tubular damage (chohemic nephrosis) associated with jaundice.

Glomerulonephritis complicating chronic hepatitis may have an insidious onset and run a prolonged course. An immunological relationship to the hepatic disease may be present in some of these cases.

A considerable proportion of cases of obstructive or hepato‐cellular jaundice are associated with proteinuria, epithelial cells and casts in the urine, and some elevation of blood urea level. This occurs irrespective of such factors as operations, hæmorrhage, shock or sepsis. Histologically these cases usually show evidence of tubular damage. The causes of this renal damage and their mode of action are not at present understood.
EFFECTIVE TREATMENT OF A CASE OF METASTATIC THYROID CARCINOMA BY I131 AND DESICCATED THYROID
Authors: ADAMS D. D. , PURVES H. D.
Published: September 2017

The administration of desiccated thyroid inhibited the uptake, but not the release, of I131 (in five millicurie doses) by the metastases of a thyroid adenocarcinoma.

The desiccated thyroid was apparently responsible for a marked and sustained reduction in the size of the pulmonary and subcutaneous metastases.

It is suggested that in cases of thyroid carcinoma it may be better to try treatment with desiccated thyroid before I131 therapy, rather than after it.
THE EFFECT OF UNILATERAL RENAL ISCHÆMIA ON FLUID TURNOVER IN RATS
Authors: MCQUEEN E. G. , SPEDEN R. N. , VEALE A. M. O.
Published: September 2017

Modifications in fluid handling occur in rats following the induction of unilateral renal ischæmia, even though the other kidney remains intact. Some animals develop extreme degrees of polydipsia and polyuria. Amongst those drinking 0.5 % saline, “polydipsia”, defined as an intake more than three times the original, was observed during an observation period of four weeks in 16%. Amongst animals drinking water, this degree of increase in fluid turnover was observed in only 4%.

Apart from these animals, spontaneous fluid turnover was not demonstrably greater than that which could have been accounted for by diminution in functioning renal tissue consequent upon the induction of ischæmia. Alterations in fluid handling in these animals attributable to the hypertension are, however, demonstrable by measurement of the rate of rejection of an orally administered fluid load. Following the induction of ischæmia, rejection of both saline and water was greater than either before this procedure or after removal of the ischæmic kidney, and the degree of increase in both groups was the same.

Histological examination of the kidneys showed a close correlation between the onset of polydipsia and polyuria and the development of malignant hypertensive changes in the intact kidney.

Markedly increased fluid turnover apparently indicating the supervention of the malignant phase is described in a patient with unilateral renal disease, and the literature on this type of case is briefly reviewed.
THE EVALUATION OF THE PARTIAL ABSORPTION TEST FOR RH ANTIBODIES IN THE PROGNOSIS OF HÆMOLYTIC DISEASE OF THE NEWBORN
Authors: KIRK R. L. , VOS G. H. , KELSALL G. A.
Published: September 2017

The partial absorption test for titrating Rh antibodies in the maternal serum has been evaluated as a prognostic tool in a series of 290 cases of infants born to Rh‐immunized women. The P.A. test enables a more accurate prognosis to be made of the outcome for the infant than if the indirect antiglobulin titre of the maternal serum is used alone.

The statistical coefficient of correlation between the P.A. titre of the maternal serum at the time of birth and cord blood haemoglobin for liveborn Rh‐positive infants is ‐0.72.

The P.A. titre is unreliable in predicting stillbirths unless regular titrations have been carried out at least from the twentyfourth week of pregnancy. The unreliability is due to the rapid fall in P.A. titre in many cases after the foetus has died in utero. However, if the P.A. titre at the end of the second trimester is 1 : 64 or higher, the outcome is almost invariably fatal.

The use of the P.A. test in conjunction with the ordinary indirect antiglobulin titrations of the maternal serum enables a more accurate discrimination to be made between mild and severe cases of hæmolytic disease of the newborn. It also makes possible the more reliable diagnosis of an Rh‐negative infant in cases in which the father is known to be heterozygous D/d, and is a valuable guide for giving advice to parents of Rh‐affected infants on when to start another pregnancy.

It is recommended that exchange‐transfusion should be carried out in all cases in which the maternal indirect antiglobulin titre at the time of birth is 1 : 256 or higher. Exchange‐transfusion is not warranted if the maternal indirect antiglobulin titre is less than 1 : 128 at the time of birth. Where the maternal indirect antiglobulin titre is 1 : 128, exchange‐transfusion is not necessary if the P.A. titre is zero.
OBSERVATIONS ON KURU. III : PATHOLOGICAL FEATURES IN FIVE CASES
Authors: FOWLER MALCOLM , ROBERTSON E. GRAEME
Published: September 2017

Five brains and two spinal cords together with various pieces of viscera from kuru patients have been examined. There was widespread atrophy of neurons in the central nervous system. The affected cells were shrunken and often vacuolated. The structures most prominently involved included the cerebellar cortex (particularly the vermis and flocculo‐nodular lobe), the dentate nucleus, thalamus, corpus striatum, globus pallidus and parts of the cerebral cortex (particularly the anterior central gyrus). In the two spinal cords, degeneration of the spino‐cerebellar and lateral cortico‐spinal tracts was found. Most of the cranial nerve nuclei were spared, and the substantia nigra was minimally involved. No evidence of an infective cause was discovered. Other organs, apart from the central nervous system, showed no significant changes.
MARFAN'S SYNDROME: THE NATURE OF THE AORTIC DEFECT
Authors: HURLEY J. V.
Published: September 2017

Defects of the aortic wall involving one or more elements were present in five of seven cases of dissecting aneurysm of the aorta occurring in association with Marfan's syndrome ; in two of them no histological abnormality was seen. No significant difference was found in the hexosamine content of the walls (determined in five cases) as compared with that of normal aortas from subjects of the same age group.

Although gross malformation of the aortic wall was present in a minority of cases, both in this series and in previously recorded cases, the basic defect common to all examples of Marfan's syndrome appears to involve the mucopolysaccharides of the intercellular substance. The chemical findings suggest that the defect may be in the degree of polymerization of these polysaccharides, rather than in alteration of the total amount present.
POSSIBLE SITES OF MACROGLOBULIN SYNTHESIS: A STUDY MADE WITH FLUORESCENT ANTIBODY
Authors: CURTAIN C. C. , O'DEA J. F.
Published: September 2017

This paper describes experiments on the localization of macroglobulins by the fluorescent antibody technique in the tissues of two patients, one showing Mikulicz's syndrome and the other suffering from myeloma.

The first patient had the macroglobulin in large quantities in mature and immature plasma cells in the bone marrow. It was considered that the macroglobulin was a product of a plasmacytosis reactive to the pathological process in the patient's parotid gland.

The second patient had both a macroglobulin and a myeloma globulin in his serum. The fluorescent antibody studies suggested that these two abnormal proteins originated in different plasma cells in the bone marrow, which were, however, morphologically identical with orthodox staining. Neither protein could be demonstrated in frozen sections of other tissues obtained at autopsy.
PULMONARY FUNCTION IN PATIENTS WITH A SINGLE FUNCTIONING LUNG
Authors: HOLLAND R. A. B. , BLACKET R. B.
Published: September 2017

Pulmonary function was studied in nine subjects with a loss of functioning lung tissue ; five of these had had a pneumonectomy, one had a large pleural effusion, and three had a pneumothorax. Lung volumes and ventilations and blood gas concentrations were determined, as well as the steady‐state physiological dead‐space diffusing capacity for carbon monoxide.

After pneumonectomy there tended to be an inflation of the remaining lung, which did not affect any subdivision of lung volume particularly.

Diffusing capacity was reduced after pneumonectomy, but in three cases, only to the lower level of normal for persons with two lungs. In no case was its reduction sufficient to cause lowering of the arterial oxygen saturation, and its reduction did not call for increased ventilation.

The physiological dead space after pneumonectomy was higher than in normal subjects. This necessitated some increase in ventilation.

Diffusing capacity was reduced in pneumothorax, increasing as the lung reexpanded.

In one patient with a pleural effusion, the diffusing capacity was severely reduced.
DISSECTING ANEURYSM OF THE AORTA
Authors: HURLEY J. V.
Published: September 2017

Comparison of the histological appearances of the aorta from 38 subjects of dissecting aneurysm and of a small series of aortas from control subjects revealed no characteristic histological abnormality accompanying aortic dissection. Alterations involving one or more elements of the media were present in a number of cases, but similar changes were seen in control subjects. In a substantial proportion of cases of dissecting aneurysm the aortic wall was of normal appearance.

These histological findings are contrasted with the gross change in resistance to “splitting” forces demonstrable macroscopically in many cases of aortic dissection.

It is postulated that the underlying medial defect predisposing to aortic dissection is a generalized and reversible one, involving fine collagen fibres and the intercellular substance of connective tissue. The clinical, macroscopic, histological and experimental aspects of the disease are discussed in relation to this hypothesis.
THE USE OF AN ALDOSTERONE ANTAGONIST IN PATIENTS WITH CIRRHOSIS
Authors: PLAYOUST M. R. , BLACKBURN C. R. B.
Published: September 2017

The steroidal spirolactone SC 8109, an aldosterone antagonist, was used in two cases of hepatic disease and ascites resistant to ordinary medical treatment. In both cases there was an increased sodium excretion in the urine, while one of the patients had a significant weight loss and a reduction of her ascites. This substance should prove useful in the further evaluation of aldosterone in the pathogenesis of fluid retention in œdematous states, and possibly in their treatment.
AUTOIMMUNITY IN HUMAN THYROID DISEASE
Authors: MACKAY IAN R. , PERRY BEVERLEY T.
Published: September 2017

The occurrence of circulating antibodies to thyroid antigens was investigated by the tanned‐red‐cell hæmagglutination (T.R.C.H.) and complement fixation (C.F.) tests, whole thyroid extract being used as antigen. Whole thyroid was found to be equivalent to thyroglobulin as an antigen in the T.R.C.H. reaction.

In Hashimoto's thyroiditis and myxœdema, the incidence of positive T.R.C.H. reactors (titres greater than 100) was over 70% and in thyrotoxicosis 47%.

In thyrotoxicosis, the incidence of positive reactors was influenced by therapy (radio‐iodine or surgery), but was independent of age, sex, toxicity and the type of goitre.

The present study indicates that “leakage” of thyroid components with immunological response occurs frequently in thyroid disorder and occasionally in health, but per se has no pathogenic significance.

It is postulated that, under certain circumstances, perhaps associated with weakness of immunological homœostasis, immunologically competent cells reaching and reacting with thyroid tissue give rise to damage, thus rendering more antigen accessible and so leading to “colonization” of the tissue with lymphoid cells and self‐perpetuating disease
VENO‐ARTERIAL SHUNTING OF BLOOD IN CHRONIC LIVER DISEASE
Authors: BLACKBURN C. R. B. , READ JOHN , MCRAE J. , COLEBATCH H. J. , PLAYOUST M. R. , HOLLAND R. A. B.
Published: September 2017

Seventeen out of 43 patients with chronic liver disease had arterial oxygen unsaturation at rest breathing room air. This incidence is higher than has been recognized in the past. The degree and basis of this arterial oxygen unsaturation were studied further in 14 patients, of whom seven had arterial oxygen unsaturation at rest. An alveolar‐capillary diffusion defect played some part in its production in one patient, and the ventilation‐perfusion inequality of chronic airway disease was partly or wholly responsible in five others.

After allowance had been made for respiratory factors, there remained at least six, and possibly 10, patients out of 14 in whom an abnormal degree of veno‐arterial shunting of blood could be demonstrated. The dimensions of this shunt ranged up to more than 20% of the cardiac output. On theoretical grounds, it is likely that a significant part of the veno‐arterial shunting is intrapulmonary.
THE RELATIONSHIP BETWEEN BLOOD FIBRINOLYTIC ACTIVITY, SERUM LIPOPROTEINS AND SERUM CHOLESTEROL IN ATHEROSCLEROTIC ARTERIAL DISEASE
Authors: NESTEL P. J.
Published: September 2017

Blood fibrinolytic activity, serum beta‐alpha lipoprotein ratios and serum cholesterol levels have been compared in patients with myocardial infarction, and in patients with intermittent claudication. Fibrinolytic activity was significantly less in patients with intermittent claudication than in patients with myocardial infarction. Serum cholesterol levels and serum lipoprotein ratios were significantly higher in patients with intermittent claudication than in patients with myocardial infarction. The significance of these results is discussed.

Coefficients relating fibrinolytic time to serum cholesterol level and serum beta‐alpha lipoprotein ratio were highly significant in patients with intermittent claudication, but not significant in patients with myocardial infarction. When the data from both groups were combined, the coefficients relating fibrinolytic time to serum lipoprotein ratios and to serum cholesterol levels were found to be highly significant. This suggested that the presence of a significant correlation between fibrinolysis and lipids depended on the inclusion of subjects whose fibrinolytic times and lipid levels were high.
THE CARDIOMYOPATHIES : A REPORT OF FIFTY CASES
Authors: HICKIE JOHN B. , HALL GEORGE V.
Published: September 2017

"The cardiomyopathies" is the term applied to an ill‐defined group of cardiac disorders which have in common a non‐coronary, non‐rheumatic, non‐hypertensive myocardial fault. They are not rare and should be considered in any unusual cardiac state. They may present by sudden death, with acute or chronic cardiac failure, with arrhythmias or with purely electrocardiographic changes. The clinical picture is classically one of pulmonary œdema or gross right‐heart failure, usually with a low output state. The X‐ray film does not show any distinguishing features, and the electrocardiogram most commonly shows T‐wave changes.

In the present series there are two congenital groups, 10 cases in all—one associated with the hereditary ataxics and muscular dystrophies, and a second in which there is a predominant endocardial or myocardial abnormality or a combination of both—for example, fibroelastosis, idiopathic hypertrophy and endomyocardial fibrosis. Endomyocardial fibrosis may also be an acquired disorder. Myocarditis made up the largest group in the acquired series (19 cases). It may be associated with general or upper respiratory tract infections, with parasitic infestations or with pregnancy, or it may follow operation. There is a high incidence of sudden death. Collagen diseases (nine cases) may present in this way with cardiac failure the outstanding feature. This may respond to steroid therapy. Metabolic disorders (12 cases), such as primary amyloidosis, haemochromatosis and alcoholic cardiomyopathy, have also been included. There is much need for progress in this field.
URINARY AMINO‐ACID EXCRETION IN HEALTH AND DISEASE
Authors: HILLCOAT B. L.
Published: September 2017

Urinary amino‐acid excretion was studied by paper chromatography in 208 normal and 78 abnormal subjects.

Non‐specific amino‐aciduria, defined as the excretion of a total amount of amino‐acids exceeding 30 units on the scale described, was found in cases of Wilson's disease and hepatic coma and in one mentally retarded child. Non‐specific amino‐aciduria as an isolated finding is of little diagnostic value, but in conjunction with clinical data may be helpful.

Specific amino‐aciduria, the excretion of one or more specific amino‐acids in abnormal amounts although the total amino‐acid excretion may still be normal, was found in cases of cystinosis, cystinuria, phenylketonuria and beta‐amino‐isobutyric "secretion". The pattern of a specific amino‐aciduria is diagnostic.

Chromatography has its greatest clinical application in diagnosis in the specific amino‐acidurias and in treatment in phenylketonuria, and has little or no application in prognosis at the present time, apart from helping diagnosis.
THE FAILURE OF EXPERIMENTAL RENAL TUBULONECROSIS TO PRODUCE OLIGURIA IN THE RAT
Authors: FINCKH E. S.
Published: September 2017

Acute tubulonecrosis was produced in rats by temporary clamping of the renal artery and by the subcutaneous injection of glycerol. Comparison of the mean urinary output of these animals with that of controls, both immediately after the renal damage was initiated and at 24 hours, when tubulonecrosis was clearly established, showed that there was a statistically significant increase rather than a decrease in volume. These results are interpreted as showing that tubulonecrosis itself is not an important cause of oliguria. It is concluded that it is misleading and incorrect to use the term "acute tubular necrosis" as synonymous with the acute anuria syndrome.
FIBRINOLYSIS, BLOOD CLOTTING, SERUM LIPIDS AND BODY BUILD IN NATIVES OF NEW GUINEA AND AUSTRALIANS
Authors: GOLDRICK R. B.
Published: September 2017

Measurements of height, weight, body bulk and fatness (skinfold thickness) and of serum lipids and fibrinolytic activity of fasting blood, were made in three groups of males—40 healthy Australians, aged 25 years, 35 atherosclerotic Australians, aged 60 years, and 40 healthy natives, aged 25 years. Measurements of the “Stypven” clotting time were also made in the Australians and compared with previous observations among the natives.

The atherosclerotic group had the highest concentrations of serum cholesterol, phospholipid and beta lipoprotein cholesterol (paper electrophoresis and cholesterol elution), and the lowest serum P/C ratio. The concentration of alpha lipoprotein cholesterol was highest in the healthy Australians and lowest in the natives, while the serum P/C ratio was higher, and the serum cholesterol lower, in the natives than in the healthy Australians.

Ultracentrifugal studies revealed that the higher serum P/C ratio in the natives was due to their high‐density lipoprotein, which carried as much phospholipid as, but less cholesterol than, the corresponding fraction in healthy Australians. Increasing fatness among young Australians was associated with a decrease in alpha and an increase in beta lipoprotein cholesterol.

Clotting times differed significantly in all groups, being longest in the healthy Australians and shortest in the natives. Alpha lipoprotein was associated with prolongation of clotting in the “Stypven” test.

Fibrinolytic activity was similar in both groups of Australians, but was greatly increased in the natives. Slowing of the rate of fibrinolysis was associated with increasing body fatness and body bulk in the Australians. In the natives muscle, not fat was the major contributor to body bulk, and increasing body bulk was associated with an acceleration of fibrinolysis.

The results are discussed especially in regard to the thrombogenic and lipid theories of atherogenesis.
PULMONARY DIFFUSING CAPACITY IN CHRONIC OBSTRUCTIVE LUNG DISEASE: STUDIES AT REST AND ON EXERCISE BY THE STEADY STATE, PHYSIOLOGICAL DEAD SPACE METHOD
Authors: HOLLAND ROBERT A. B. , BLACKET RALPH B.
Published: September 2017

Studies of 19 cases of chronic obstructive lung disease are reported. The mean value for the ratio of residual volume to total lung capacity in the series was 0·61, and the mean maximum breathing capacity was 31 L/min.

Arterial blood gas findings were confirmatory of those of other workers, arterial oxygen unsaturation at rest, frequently relieved on exercise, being common. Minor degrees of carbon dioxide retention were common.

An increase in physiological dead space and in the ratio of dead space to tidal volume was found in nearly all cases at rest and in most cases on exercise.

Diffusing capacity for carbon monoxide (DCO) was estimated by the steady state “Filley” method. Resting DCO was reduced in all cases, the reduction being extreme in some. The mean was 7·2 ml./min./mm. Hg. In all patients able to exercise, diffusing capacity rose, but the values on exercise were well below those of normal subjects exercising at the same level of oxygen consumption. DCO reduction did not correlate with arterial oxygen unsaturation or with the degree of airway obstruction.

Some of the lowering of DCO is attributed to the presence of non‐uniformity in the lungs, but a true reduction does appear to be present. Possible explanations are discussed of the frequent finding by others that single‐breath DCO is little reduced in this condition.
CUSHING'S SYNDROME
Authors: STEINBECK A. W.
Published: September 2017

Nineteen cases of Cushing's syndrome have been studied. The clinical features before and after operation have been analysed. The plasma steroidal dihydroxyacetones (SDHA) have been estimated, before and after an intravenous infusion of corticotrophin when possible.

In Cushing's syndrome, plasma SDHA levels are likely to be raised, but may fall within the normal range or be doubtfully elevated. Also fluctuation in levels is possible. In hyperplasia, after corticotrophin the levels may progressively increase throughout the infusion, exceeding normal values throughout and with greater than normal increments in concentration. However, the individual levels, although raised, may not show the typical progressive increase: in some cases, they may even fail to show a normal increase. In a case of adrenocortical carcinoma, corticotrophin had no effect on plasma SDHA levels, and in a case of adenoma, the levels increased progressively throughout the infusion.

Difficulties in the interpretation of raised plasma SDHA levels are discussed. The possible value of SDHA estimations in differential diagnosis is indicated, and their limitations in diagnosis are also considered.

Studies with an 11β‐hydroxylase inhibitor in the case of an adrenal adenoma are referred to, as well as the possible interpretations of the corticotrophin test after adrenalectomy.

Diagnostic difficulties are discussed briefly, and clinical reasons are given for preferring total to subtotal adrenalectomy in adrenocortical hyperplasia.
INNOCENCE AND THE STAPHYLOCOCCUS
Authors: PLUECKHAHN V. D. , BANKS JOAN
Published: September 2017

A bacteriological and clinical survey is described of infection due to Staphylococcus aureus in 8473 babies delivered over the period 1956 to 1959 in a 95 bed maternity hospital. The incidence of minor staphylococcal disease was 41% at the commencement of the survey, and was reduced to 7·9% with the institution of accepted means of control.

A “carrier rate” of 90% of infants by the third and fourth days of life was present in 1957, and remained at this level in 1959 despite the reduction in the incidence of staphylococcal disease.

“Rooming in” and its part in the control of staphylococcal disease in the new‐born are discussed.

Despite the consistently high incidence of minor staphylococcal disease in the new‐born, the resultant morbidity in the first six months of life was low (0·3%) and the mortality less than 0·1%.

The incidence of breast abscess in 7438 mothers was 1·3%.

Phage pattern 80/81 and the question of “virulence” are discussed.

It is stressed that much remains to be discovered with regard to the modes of transmission of the staphylococcus and the part played by factors other than those directly related to the organism.
TRIPARANOL AND NICOTINIC ACID IN THE MANAGEMENT OF HYPERCHOLESTEROLÆMIA
Authors: DOAK P. B. , NICHOLSON G. I. , NORTH J. D. K.
Published: September 2017

Triparanol has been studied alone and in conjunction with nicotinic acid in 50 cases of ischemic heart disease with associated hypercholesterolæmia. Triparanol caused an average fall of 32 mg. per 100 ml. in apparent serum cholesterol level. There was a wide variation between individual patients in response to triparanol. Nicotinic acid caused a further fall of 28 mg. per 100 ml. in apparent serum cholesterol level. Desmosterol (24‐dehydrocholesterol) and true serum cholesterol were measured in 20 patients during treatment with triparanol. Desmosterol interferes with the measurement of serum cholesterol, and the fall in apparent serum cholesterol level (29 mg. per 100 ml.) during treatment with triparanol in these 20 patients is less than the fall in true serum cholesterol level (51 mg. per 100 ml.).
THE EFFECT OF SALICYLATE ON THE PLASMA PROTEIN‐BOUND IODINE LEVEL IN VARIOUS STATES OF ENDOCRINE DISORDER IN MAN
Authors: HETZEL BASIL S. , GOOD BRIAN F. , WELLBY MAURICE L. , BEGG MALCOLM W.
Published: September 2017

The effect of salicylate on the plasma protein‐bound iodine (PBI) level has been compared in patients with various states of thyroid, adrenal and pituitary gland function. The salicylate was administered in a dosage of 6 grammes daily for four days as the calcium acetyl salt. This dosage produced a consistent fall in plasma PBI level in normal subjects (mean levels of 6·0 μg. per 100 ml. before, fell to 4·5 μg. per 100 ml. after four days on salicylate therapy).

In comparison with six normal subjects, a significant but smaller fall in plasma PBI level was found in a group of six hypothyroid subjects maintained on desiccated thyroid (mean levels of 5·7 μg. per 100 ml. before, fell to 5·1 μg. per 100 ml. after four days on salicylate therapy). Taken in conjunction with other evidence, this finding suggests that salicylate is inhibiting thyroid secretion via thyrotropic hormone (TSH) depression in the normal subjects and also altering the peripheral distribution of thyroid hormone in both groups.

In eight untreated hyperthyroid subjects, a significant fall in plasma PBI level (proportionately greater than in the normal group) was also noted (mean levels of 13·9 μg. per 100 ml. before, fell to 9·6 μg. per 100 ml. after salicylate therapy). This observation indicates the susceptibility of the hyperthyroid gland to TSH depression.

In two hypoadrenal patients maintained on cortisone, in two patients with hypothalamic lesions and in one acromegalic, responses similar to those observed in normal subjects were found. In another patient with a chromophobe adenoma of the pituitary and mild hypothyroidism, no fall was observed : this could be due to some interference with TSH secretion by the tumour.

The possibility that these effects of salicylate on the plasma PBI level may be due to alterations in plasma binding of thyroid hormones is considered, but this hypothesis does not account for all the findings in hyperthyroidism. The possibility remains that salicylate has a direct effect on TSH secretion.
THE SURVIVAL OF 51Cr LABELLED AUTOTRANSFUSED RED CELLS IN PATIENTS WITH THALASSÆMIA
Authors: HILLCOAT B. L. , WATERS A. H.
Published: September 2017

The fate of 51Cr‐labelled autotransfused red cells has been studied in five children with thalassmia, two of whom had undergone splenectomy before the present study. The value of this procedure in the clinical assessment of such patients is discussed.

Thirty to forty per centum of the labelled red cells left the circulation in the first two days, and the mean cell life was greatly reduced, ranging from three to six days. There was no correlation between the degree of anemia and the rate of red‐cell destruction, and there was no apparent difference between the red‐cell survival in the patients who had undergone splenectomy and those who had not.

Excess red‐cell destruction occurred in the spleen in the most severely anæmic patient, and in the liver in both of the patients who had undergone splenectomy.
PURULENT MENINGITIS : PRINCIPLES AND RESULTS OF REVISED STANDARDIZED TREATMENT IN 281 CASES
Authors: FORBES J. A.
Published: September 2017

This paper describes the methods and results of standardized treatment of 281 patients with purulent meningitis. In treating these patients, antibiotics were administered intramuscularly, but not intrathecally whatever the causal organism or the severity of meningitis, the intravenous administration of fluids was avoided and corticosteroids were used as an adjunct to antibiotics. The intramuscular injection of penicillin and chloramphenicol formed the initial treatment, which was varied subsequently according to the causal agent and the likelihood of associated infection such as pneumonia.

The importance of the prevention or treatment of relatively common complications, such as airway obstruction and mixed infections in “open” sites, is emphasized. Cranial surgical procedures were avoided : exploration of the subdural space was considered unnecessary. In general, attempts were made to reduce management to the simplest essential measures, particularly in the case of infants, excessive handling of whom may lead to poor results.

The overall mortality rate in 281 patients with purulent meningitis was 3·2%. Amongst patients with pneumococcal meningitis, the mortality rate was 7·1%. Other rates were as follows : Hamophilus influenza meningitis, 2·7% ; meningococcal meningitis, 1·4% ; unidentified purulent meningitis, 2%.

The ages of the patients are grouped in relation to the causal organisms and mortality. Subsequent review of these patients has shown that serious sequeke are infrequent and almost confined to pneumococcal meningitis. Patients with purulent meningitis who have a prior history of head injury should receive penicillin prophylactically after apparent cure of the meningitis.
ALDOSTERONE AND THE CIRCULATION
Authors: STUART-HARRIS C. H. , COX J. R. , LEONARD P. J. , SINGER BERTHA
Published: September 2017

Studies have been made in Sheffield on volunteers placed on a dietary regime inducing sodium depletion, in order to observe the effect of alteration in the volume of the body fluid compartments on the measured output of aldosterone in the urine. Fluid volumes decreased during sodium depletion. Subsequent treatment with vasopressin injections and free fluids during continued sodium restriction induced an increase of fluid volumes in some only of the volunteers. Aldosterone output increased during salt depletion and fell during hydration, but continued to increase in those who failed to retain excess water. Changes in the extracellular fluid volume, but not in the plasma volume, were inversely correlated with changes in aldosterone output. Total exchangeable sodium measured before and after sodium depletion and after attempted hydration permitted an estimate of the intracellular sodium by means of the calculated extracellular sodium. The latter decreased and increased pari passu with changes in the extracellular fluid volume to a much greater extent than did the total exchangeable sodium. Changes probably occur therefore in the electrolyte composition of the cells during hydration and salt depletion. The view is expressed that intracellular electrolyte changes rather than fluid volumes may trigger the mechanism which controls the release of aldosterone.

The paper reviews the changes observed in aldosterone output in patients with heart failure and also discusses the therapeutic use of aldosterone antagonists.
CONGENITAL HEPATIC FIBROSIS
Authors: HICKIE JOHN B. , GARVAN J. M.
Published: September 2017

A family with a high incidence of hepatomegaly, normal liver function and stillbirths is described. In one member biopsy material confirmed the diagnosis of congenital hepatic fibrosis. This patient's sister probably died of the same disorder. Unusual hepatic sinusoidal prominence was present in the patient described and in one of her daughters, from whom biopsy material is available. Regional adiposity also occurred in three generations.

Congenital hepatic fibrosis should be suspected in patients with firm hepatomegaly and normal liver function. It is a familiar vascular anomaly of the liver. It may be symptomless, or it may cause death in childhood or adult life from portal hypertension or renal failure secondary to polycystic disease of the kidneys.
PROGNOSIS IN AUTOIMMUNE HÆMOLYTIC ANÆMIA
Authors: DACIE J. V.
Published: September 2017

Factors reported to influence the prognosis for patients with autoimmune hæmolytic anæmia are reviewed and compared with experience at the Postgraduate Medical School, London. In the idiopathic warm‐antibody type of hæmolytic anæmia, prognosis depends on the amount of antibody formed and its quality. Of 50 patients in the London series, 23 died, mostly within two years of the onset of the disease, whilst 10 underwent clinical and hæmatological cure. The idiopathic cold‐antibody type of disease is in general not so serious ; nine patients in the London series of 16 have survived for five years or more, and not all deaths have been related to the disease or its treatment. The prognosis in cases of secondary autoimmune hæmolytic anæmia is dominated by the nature of the underlying disease.
DIAGNOSIS AND TREATMENT OF STROKES: RADIOLOGICAL ASPECTS
Authors: BLADIN PETER F.
Published: September 2017

A series of 150 consecutive patients admitted to hospital with the diagnosis of “stroke” was investigated radiologically by vascular and ventricular contrast studies. Comparison of clinical and radiological diagnoses showed that in many cases clinical impressions were incorrect. This particularly applies to the unsuspected presence of lesions such as aneurysms and subdural clots.

In cases of suspected cerebral ischæmia, it has been shown that a complete survey of cervical and cerebral vessels is necessary to gain an overall idea of the position of the atheromatous lesions causing interference with cerebral blood flow. This is of great importance with regard to corrective surgical therapy.

In many cases no actual occlusion of any vessels was found ; but the survey indicates the common occurrence of ectasia in both carotid and vertebral systems. The pathological lesion was found to be a defect in the elastica of the affected vessels. In view of the paucity of actual occlusions demonstrated compared with the frequency of a clinical diagnosis of “cerebral thrombosis”, it would seem that a reappraisal of nomenclature and pathological ætiology is in order.

The position of radiological investigation with regard to practicability and safety is discussed, and it is concluded that it has a great deal to offer both diagnostically and therapeutically.
CALCIUM METABOLISM AND THE BONES AFTER PARTIAL GASTRECTOMY
Authors: DELLER D. J. , BEGLEY M. D.
Published: September 2017

The incidence of skeletal rarefaction was investigated in 100 control subjects and in 100 patients studied two to 15 years after partial gastrectomy. The two groups were comparable in age, sex and social class. Skeletal rarefaction was assessed subjectively by visual inspection of the X‐ray films and objectively by the measurement on the X‐ray films of the degree of wedging of the dorsal part of the spine, the degree of biconcavity of the lumbar part of the spine, and the cortical bone thickness of the shaft of the femur and the metacarpal.

Rarefaction of the bones was twice as frequent in the gastrectomy group as in the control group. Furthermore, the skeletal abnormality was more severe in the patients after partial gastrectomy, as evidenced by the number of crush fractures of the vertebræ, the history of fractured bones following minimal trauma, and the presence of pain in the bones.

Radiological evidence of bone rarefaction was more frequent in women than men in both the control group and the gastrectomy group. However, this difference of frequency in the sexes became less obvious in the post‐gastrectomy group, in which the percentage of men showing rarefaction more closely approached the percentage in women.

Changes in the bones became increasingly frequent with advancing age in both of the groups that were investigated. Even so, bone disease was present at an earlier age in the patients after partial gastrectomy than in the control subjects.

The incidence of skeletal rarefaction increased with the interval of time after partial gastrectomy, although there was no correlation between the age of the patient and the length of time after operation.

Loss of weight, anæmia, the “dumping” syndrome and diarrhœa were more frequent in the patients with skeletal changes after gastrectomy than in the patients with normal bones.

Judged by clinical criteria, 11 patients after partial gastrectomy appeared to have spinal osteoporosis and 18 patients had a syndrome resembling osteomalacia. Males predominated in the group with the condition resembling spinal osteoporosis, whereas the majority of patients with clinical features of osteomalacia were women. There was a long latent interval between operation and the development of skeletal symptoms. Eight patients had crush fractures of the spine and one patient had rib fractures and Looser's zones in the fibulæ. The high incidence of psychological disturbance, anæmia and undernutrition made evaluation of the skeletal symptoms difficult.