Moribund State Research Articles

Aircraft Engineering

French Aviation IT was probably more than happy coincidence which resulted in the Air League of the British Empire publishing its Memorandum on French Aviation just a month before the Twenty‐fifth International Air Show at Le Bourget was due to take place (see next page). At any rate, this forty‐two page Memorandum sets out to review the French aviation scene with the particular aim of showing which special factors have enabled the French industry to recover from its moribund state at the end of the Second World War and to attain a position of world leadership in certain sectors of aviation. Further, the paper makes specific suggestions about lessons which Britain may fruitfully learn from France.

Recovery of central nervous system functions impaired by lethal head x-irradiation.

SummaryThe effects of X-irradiation on the response to maximal electroshock and on EEG have been studied in head irradiated rats at various intervals following irradiation. A single application of 10,000 r to head of rats was found to induce a progressive increase in protection against maximal electroshock. This apparent anti-convulsant effect reached a maximum by about 48 hours post-irradiation and was then rapidly lost. Most of the animals died by the 7th or 8th day following irradiation. It is of interest that the irradiated animals progressively recover their ability to respond to maximal electroshock after the 48 hour period in spite of their otherwise increasing moribund state. EEG records following irradiation also suggest a similar recovery effect. These findings are interpreted as indicating that there is a progressive recovery of certain central nervous system functions impaired by a lethal dose of X-irradiation.

The Experimental Intoxication of Sheep with Sporidesmin, a Metabolic Product of Pithomyces chartarum: IV.—Histological and Histochemical Examinations of Orally-dosed Sheep

SUMMARY Following the oral administration of 1.0 mg. sporidesmin per kg. bodyweight to 56 sheep, sub-groups of 8 were slaughtered at intervals. Tissues from them were histologically examined and the changes found are described in sequence. For comparison the effects of dosage with greater and lesser amounts of sporidesmin are given. During the first 2–4 days after dosing, acute but largely reversible degenerations were seen in the liver parenchymal cells. At the same time marked pericholangitic inflammatory exudation, necrotizing cholecystitis and cholangitis were apparent. Granulative repair of these lesions had commenced and usually resulted in partial stenosis or obliteration of the large and medium-sized bile ducts with scar tissue. From the 10th day onwards, biliary obstruction and lesions of photosensitization were manifest. A unique range of vascular lesions was found in the liver and in the lower part of the urinary tract; they are believed to be due to injury by a toxin during its excretion. Vascular-occlusive lesions in the portal areas are considered to be associated with progressive biliary cirrhosis, seen in portions of many livers. While kidney lesions appeared mild, necrotizing inflammation in the bladder and ureters was commonly found; ureteral obstruction was occasionally seen to cause kidney tubular dilatation. The marked enlargement of the adrenal cortex, noted in the terminal stages of the disease, was associated with heavy deposits in these glands of sudanophilic material and a ‘sterol’ believed to be ‘cholesterylester’. Similar but less uniform changes to those described above were noted in 12 sheep dosed with 0.5 mg./kg. bodyweight. In 7 sheep dosed with 3.0 mg./kg., a moribund state was produced before granulative biliary obstruction had occurred. The early hepatic and urinary-tract lesions were markedly accentuated, but adrenal changes appeared mild. Evidence is provided which suggests that, among other changes, injury to cell membranes and increased permeability factors are highly important facets of sporidesmin intoxication.

Infarct-Necrosis of the Liver in a Patient with S-A Hemoglobin

Introduction Necrosis of hepatic cells may occur during severe infections, 2,6-9 after exposure to certain chemical agents, 1,2,6,7 and occasionally in association with alterations in the peripheral or hepatic circulations. 3-6,10-12 Massive necrosis of the left lobe of the liver occurred in a patient with S-A hemoglobin during the course of a Gram-negative septicemia secondary to pyelonephritis occurring pre- and postpartum. The course of the patient is described here because: Biopsy material obtained during the acute and healing stages demonstrated changes compatible with hepatic infarction; this degree of hepatic destruction with subsequent survival is unusual, and our patient made a complete recovery from what appeared to all who saw her to be a moribund state. Report of a Case A 17-year-old Negro woman was first seen in late June, 1961, during the seventh month of her first pregnancy with fever, nausea, vomiting, jaundice, clay-colored stools, and dark urine for 4-6

Diet, Glycogen Reserves and Resistance to Fatigue in Hatchery Rainbow Trout. Part II.

Violent or prolonged exercise increased blood lactate content of hatchery–reared rainbow trout, confirming earlier findings. In stream tests, two groups of hatchery–raised rainbow trout were planted in a mountain stream containing a resident population of cutthroat trout. One group had been raised on a fortified pelleted ration, the other on the standard raw liver diet. In 5 weeks 7.1% of the pellet–fed fish were recovered dead or moribund, and 20% of the liver–fed fish. Adverse environmental conditions (high water) did not prolong the usual two–week acclimatization period for the pellet–fed trout, as shown by cessation of mortality at the end of that time. The liver–fed trout continued to die in appreciable numbers until three weeks had elapsed. After the 2–week acclimatization period the pellet–fed trout accommodated to high–water conditions as well as or better than the resident trout in respect to blood lactate level, whereas liver–fed trout maintained a higher than normal lactate level. Ten hatchery–raised trout, 2 from the pellet–fed group and 8 from the liver–fed group, were recovered from the stream in a moribund state. These had blood lactate levels four or more times as high as the non–moribund trout on the same date. An Appendix table gives a summary of the Gorge Creek trout plantings in 1952–57.

Amine buffers in the management of acidosis. Study of respiratory and mixed acidosis.

During the progression of a state of uncompensated acidosis, the marked increase in hydrogen ion concentration reflects severe metabolic alterations which eventually result in irreversible cellular damage. To date, the control of some acidotic states has been difficult because of the limitations of sodium buffers. Although amine buffers have been used for many years by biochemists, physiologic applications of these compounds have only recently been stimulated by the work of Nahas.¹The purpose of this presentation is to report the use of an amine buffer, tris(hydroxymethyl)aminomethane,* in the clinical management of acidosis due to a variety of causes. <h3>Materials and Methods</h3> Six infants and children with acidosis due to a variety of disease processes (Table) were treated with Tris (THAM) buffer. All of these patients except the baby with probable hyaline membrane disease were considered to be in a moribund state, and their clinical condition was deteriorating in spite

The Electrocardiogram as an Indicator of Acceleration Stress

By means of a transistor amplifier mounted before the slip rings of an animal centrifuge it was possible to obtain recordings of the EKG of rats under acceleration stress. With this information, a physiological end point for the tolerance of the rat to 20 G (positive acceleration) was defined as the time to reduce the heart rate of the animal from an initial state ranging from seven to nine beats per second to a final moribund state of 2 beats per second. The instrumentation and techniques employed permit the option of recovering the animal alive after approaching the limit of tolerance to acceleration.

Effect of Prolonged Incubation of Newcastle Disease Virus Infected Chicken Embryos on the Stability of the Virus in the Allantoic Fluid

IN THE cultivation of viruses in embryonated chicken eggs it is a common practice to harvest the infected embryonic fluids or tissues when the embryos are in the moribund state or as soon as possible after death of the embryos. Such practice is to avoid heat inactivation of the propagated virus and also to minimize any possible interference of viral activity by tissue components upon prolonged incubation of the dead embryo. Our failure to obtain high hemagglutination (HA) titers from allantoic fluid harvested before death of Newcastle disease virus (NDV) infected chicken embryos suggested the present investigation to study the effect of prolonged incubation of infected chicken embryo on the HA and infectivity activities of NDV strain cultivated in the allantoic cavity of embryonated chicken eggs. To study further whether the virus particles had undergone disintegration after the prolonged incubation, the virus was sedimented by high-speed centrifugations and the resuspended …

Experimental therapy of the gastrointestinal syndrome produced by lethal dose of ionizing radiation.

The gastrointestinal syndrome and its therapy were studied in dogs, one control group of eight dogs receiving 1300–1500 r of Co60 gamma radiation and another group of eight dogs, 1800 r of 2 mev roentgen radiation. The dogs developed acute gastrointestinal symptoms of anorexia, nausea, vomiting and copious diarrhea (often sanguineous). Death occurred in all these dogs on the 3rd or 4th days after irradiation, associated with fluid and electrolyte loss with acute dehydration and vascular collapse. Experimental therapy was carried out in a group of 11 dogs receiving the same dose of gamma radiation using parenteral infusions of balanced electrolyte solutions, plasma, protein hydrolysates, antibiotics and vitamin supplements. Dogs responded dramatically. The survival times were increased in many dogs into the 2nd week when death occurred, presumably associated with the effects of pancytopenia. Gross and microscopic studies on dogs killed in the moribund state on the 3rd and 4th days showed marked congestion of the serosa and mucosal ridges, particularly of the small intestine, with sanguineous fluid in the peritoneal cavity and in the intestines of some dogs. Microscopically the villi of the mucosa were flattened with areas denuded of epithelium. In the treated dogs living into the 2nd week, congestion was much less pronounced, and complete, or nearly complete, regeneration of the mucosa was noted. The rigorous therapeutic regimen was undoubtedly responsible for extending the lives of the irradiated dogs beyond the period of mortality associated with the gastrointestinal syndrome. Submitted on March 21, 1956

Treatment of severe eclampsia complicated by pulmonary edema

1. A case of eclampsia with severe complications is presented.2. The use of ethanol-oxygen vapors was found very useful in the treatment of pulmonary edema in eclampsia.3. Digitalis and {ce:italic}Veratrum viride{/ce:italic} are discussed in relation to their use in this case.4. As has been reported in the literature, a dramatic improvement followed termination of the pregnancy in this severe eclamptic patient with pulmonary edema.5. It is suggested that in these complicated cases intravenous Pitocin induction of labor rather than cesarean section be instituted if the patient shows no sign of rapid improvement under the usual toxemia regimen. The moribund state of the patient is no contraindication to the use of the drug.6. Careful fluid and electrolyte studies should be maintained and all medication given intravenously if intractable edema is present and the oral route not available.

THE TOXIC REACTIONS OF THE NEWER SULFONAMIDES

In the past four years 1,936 patients in the medical wards at the Cincinnati General Hospital have been treated with sulfathiazole, sulfadiazine, sulfapyrazine, sulfaguanidine and succinylsulfathiazole. Sulfapyridine is now considered obsolete and is no longer used in this service, sulfanilamide is rarely employed and only a preliminary report can be given on sulfamerazine, since its use has been recent. This particular study was undertaken to determine the relative incidence of untoward reactions to the various drugs and the relation of the mild and readily recognizable symptoms to severely toxic or lethal reactions. Difficulties were encountered in this evaluation because many patients admitted to this service are critically ill as the result of acute infection or are in a moribund state of chronic disease, and thus the division of symptoms due to drug and those due to disease is difficult. Also the drug is usually discontinued at the first sign suggestive

Pulmonary pathology with special emphasis on bronchial asthma

1. 1. In addition to our original series—thirty-one males and seventeen females—of so-called “fatal asthma,” we wish to add an entirely new one which has been accumulated in the past five years. Each individual has been subjected to a more critical post-mortem examination because of the interest created by our original work. The new series contains four female children, twenty-five adult females, and fifty-seven adult males. None of these case records has been previously published. 2. 2. The diagnosis of “asthma” has been made on each patient and frequently has appeared on the death certificate. We have carefully reviewed the records for each patient and have indicated in the chart whether the diagnosis was at any time tenable, and if so, whether the condition was present in the last ten to twelve hours of life. A great majority of these individuals have been under our personal observation for an extended period of time. 3. 3. The series of four children seems too small a group to permit many conclusions, but they have failed entirely to demonstrate evidence of “general lymphoid hyperplasia.” 4. 4. The adult females averaged 46.2 years at death, and this figure is approximately a mid-point between the average of all cases published prior to 1937 and our series of forty-eight patients reported at that time. The duration of dyspnea in those who probably had had asthma varies from six to sixty-five years with an average of nineteen years. Protracted and rather typical asthma may leave few stigmata in the pulmonary tissue. In others, atypical asthma of relatively short duration may result in many changes in the lungs. In but seventeen of the twenty-five patients in this group did the diagnosis of bronchial asthma appear possible. 5. 5. The male patients were similarly grouped and their average age at death was 55 years, a figure considerably in excess of the average of 48 years which represents all cases reported prior to 1937, and still somewhat in excess of the average age of 52 years for our original series published at that time. Although, in general, the life expectancy of females is greater than that of males, the trend seems definitely to be the reverse in our own as well as other series of “fatal asthma.” In approximately 42 per cent (twenty-four patients) of the males, it appeared that asthma had been present at some time during life. In fact, it averaged approximately thirty years in duration. 6. 6. A wide variety of conditions simulated the clinical and pathologic findings of asthma. Among the male patients especially, these conditions may have been present in many instances for a long period before the onset of asthma. They varied from most marked interstitial emphysema in the youngest male, to extensive atelectasis of all five lobes in the third male of the series. As other examples of the predisposing conditions, one might mention distortion of the thorax and pressure from without the respiratory and pulmonary vascular tree, as well as conditions due to actual diseases of the lung and of the heart and great vessels. Pulmonary fibrosis due to a long-standing tuberculosis or pneumoconiosis, as well as proved bronchitectasis are some of the more common pulmonary conditions which have induced the symptoms of asthma. Rheumatic heart disease of long duration, as well as hypertension and syphilitic aortitis with or without aneurysm, are the more conspicuous among the circulatory dysfunctions which engender asthma, and this condition may be clinically a counterpart of true allergic asthma rather than the orthodox cardiac asthma. 7. 7. Conspicuous abnormalities of the heart and circulation rarely, if ever, result from bronchial asthma. 8. 8. A considerable number of patients in this, as well as in other series, died shortly after the use of morphine sulfate. It would appear that this drug is definitely contraindicated, although it must be admitted that several individuals were in a near moribund state when the drug was employed. 9. 9. We are in complete accord with the concise conclusion of Tuft 7 that “there is at present no known pathologic picture either gross or microscopic which may be considered characteristic or pathognomonic of asthma.”

NEUTROPHILIC LEUKOCYTOSIS IN SPINAL FLUID ASSOCIATED WITH CEREBRAL VASCULAR ACCIDENTS

The present paper records 6 cases in which softening or hemorrhage within the brain was associated with the presence of polymorphonuclear neutrophilic leukocytes in the spinal fluid in such numbers as to suggest the diagnosis of meningitis or at least of some degree of meningeal irritation. We believe that this leukocytosis represents an aseptic reaction of the meninges to the damage within the brain. Except for the first, the cases are reported in slight detail for sake of brevity. REPORT OF CASES Case 1. —L. L., a Negress aged 49, was admitted to the medical service of the Baltimore City Hospitals on Sept. 13, 1937, in a moribund state. The only history available was that the patient went to bed on Saturday night, September 11, in her usual state of health, which was excellent. Apparently she lost consciousness during the night and never regained it. There was no history of

Canine, Murine, and Human Leptospirosis in California

In March, 1936, Dr. S. T. Michael of the hospital of the Society for the Prevention of Cruelty to Animals solicited assistance in the diagnosis of a highly fatal malady which affects with increasing frequency the older dog population of San Francisco and vicinity. Unfortunately, only dead animals or dogs in a moribund state were available until early in 1937. The examinations were consequently limited to autopsies, search of the tissues stained by the silver method, and attempts to isolate from the heavily contaminated organs by guinea pig passages, the leptospira readily demonstrable in dark field preparations of the kidneys, the spleen and occasionally the blood. The postmortem findings made on 67 dogs arranged themselves into 2 groups: the Icteric Type (24 females and 9 males), which corresponds to the so-called Weil's disease or “yellows” or canine jaundice observed in England by Okell, Dalling and Pugh, and in Holland by Klarenbeek, and the hemorrhagic type (27 females and 9 males) resembles greatly the Stuttgart disease or dog typhus. Although leptospiras have been demonstrated in the kidneys and occasionally spleen, liver and blood, both in dark field preparations and in properly stained sections prepared from cadavers belonging to both types, cultures have only been obtained directly from the blood of 6 dogs which were definitely jaundiced. Contrary to the impressions conveyed by published reports, the isolation of these spirochaetes was connected with great difficulties since the organisms produced transitory non-fatal infections in very young guinea pigs. On passage the infectiousness was occasionally enhanced but the rodents rarely died, and then in exceptional instances with icterus or hemorrhages.

Prolongation of Short=timed Peroxidase Reaction of Leucocytes as a Sign of Avitaminosis B and Effect of Vitamin B on it. A Clinical Experiment

1. The prolongation of the shortest stain-time for the peroxidase reaction of blood leucocytes was very frequently found among mothers secreting milk negative to Arakawa's reaction and among infants nursed with the same, while it was not found among mothers secreting milk strongly positive to the Arakawa reaction. 2. The administration of vitamin B was able very soon to restore the prolongation in question to normal. 3. The prolongation in question was not found in those cases that had been taking vitamin B for some time already, whatever the diseases might have been. 4. The prolongation in question was mostly associated with the diseases or conditions which had something to do with avitaminosis B. 5. The prolongation in question was not a sign of agonal condition or of a severe moribund state.

The Effect of the Removal of the Suprarenals and Accessory Cortical Tissues Together upon Some Blood Constituents of Rabbits

In male rabbits the one suprarenal gland was removed together with the accessory cortical tissues in a three stage operation, and after recovery the blood constituents were determined: the total nitrogen, non-protein nitrogen, urea nitrogen, the preformed and total creatinine, uric acid, chlor, inorganic phosphorus (in serum), sugar, haemoglobin and water, and again after recovery the second suprarenal gland was extirpated, and either in still apparently normal condition and in a weakened or even a moribund state blood was drawn out, and followed by analysis. When tested in the incomplete cortical tissue deflciency, either before extirpating the second suprarenal gland or when accessory cortical mass was left behind after extirpation, the blood constituents were found wholly normal. In the rabbits suffering from complete cortical tissue deflciency the following changes were found as occurring: (1) Haemoglobin content increased, but it was not very considerable, the maximum being found as 24 per cent of the initial. It is not likely to increase rapidly at the terminal stage. (2) Water content diminished invariably, but slightly. It is doubtless that the blood is concentrated in the rabbit in the complete cortical tissue deflciency, but its degree was by no means significant, contrary to the view of some writers who made use of other kinds of animals. (3) Blood sugar was found decreased in the enfeebled state of rabbits suffering from the deficiency. (4) Total nitrogen and protein nitrogen increased in the cortical tissue deficiency. When the rabbits were apparently still more or less healthy the increase was not large. (5) Non-protein nitrogen increased, and its degree of increase was distinctly greater than that of the total nitrogen (and protein nitrogen), and when the animal was already weak, the increase was also large, generally speaking. (6) Urea nitrogen increased in the complete suprarenocortical deficiency in about the same ratio with the non-protein N, but in the cases of urea N there does not exist any definite relation between the clinical symptoms and the magnitude of increase of urea N. (7) Preformed and total nitrogen increased invariably, and its degree more or less depended upon the weakness of the animals, roughly speaking. (8) Uric acid increased also, but the intensity of increase finds some similarity to that of urea N in relation to the clinical symptoms. (9) Chlor decreased, and its magnitude depended apparently on the interval allowed to elapse after the complete removal of all the cortical tissues till to the blood collection. (10) Serum inorganic phosphorus increased in the deficiency and the increase was greater when the animals were weak. Thus in the suprarenocortical deficiency, of the blood constituents the total N, protein N, non-protein N, urea N, preformed and total creatinine, uricacid, and serum inorganic phosphorus increased in concentration, and the chorides and sugar diminished. The haemoglobin content increased and the water reduced. Of these the ratio of increase and decrease respectively to the initial value was found materially wholly or nearly same in the nonprotein N, urea N, serum inorganic phosphorus and chlor. And there was further detectable some relationship, though not quite so definite, between the severity of the clinical symptoms and the magnitude of increase in the concentration of the non-protein N, creatinine and serum inorganic phosphours, while it was difficult to find such a relation for urea N and uric acid. Between the latter two exists seemingly somewhat of a parallelism. The magnitude of increase of chlor depended chiefly upon the length of time elapsing after the beginning of the complete deficiency.

RARE CARDIAC ANOMALY

In the remarkable case of congenital cardiac disease here recorded a complete absence of the interauricular septum is associated with other anomalies of a very unusual character, the whole forming a combination which, we believe, is unique in the literature. CASE REPORT Clinical Data. —A female infant, 17 days old, of Italian parentage was brought to the New York Nursery and Child's Hospital in a moribund state. The family history was negative. The child was of full term, normal delivery. Three days before admission the parents noted for the first time slight cyanosis of the extremities and somewhat difficult respiration. On admission the infant presented extreme general cyanosis and Cheyne-Stokes' respiration. Both sclerae and conjunctivae contained extravasations, and several hemorrhagic spots were noted over the body. The apex beat was extremely faint—best heard to the right of the mid-clavicular line at about the sixth interspace. A faint prolonged systolic murmur

GOITER.

The general impression to be obtained from a review of the surgical literature of America would be that diseases of the thyroid gland are greatly on the increase. This is probably not the case, but the public has learned that operations on goiter are not as fatal as were supposed from the results obtained when operations were made as a last resort on patients suffering from this disease and in a moribund state. The fact is that the mortality attending the operation (excluding cancer and advanced cases of exophthlamic goiter) compares very favorably with other major surgery; and, in the hands of those experienced, with much of the so-called minor surgery. SURGERY OF THE THYROID. The surgery of the neck never seemed to enjoy the popularity of that of the abdomen, and goiter operations are not even to-day sought by the majority of surgeons. Those who were competent did not