Pathological physiology of internal diseases

Front matter

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Preface To Students’ Edition

The present book was written primarily for medical practitioners who might be interested in the nature of the functional changes presented by _ their patients.

Experience has shown, however, that there is a demand for a book of this type in the medical colleges. The gap between physiology and biochemistry, on the one hand, and clinical medicine, on the other, is felt by students as well as by teachers. The present work helps to bridge this gap, because the manifestations of disease are discussed as alterations in normal physiology. I trust that it will prove valuable to medical students.

A. W.. Hew tert.

Chapter I. The Circulation PAGE

Heart Bape Wy 2 Dynamics of the Heart Muscle 2 2 Isometric and Isotonic Contraction. . . . . . 2 Reaction to Varying Arterial Resistance 6 Reaction to Varying Inflows MRS ante eet 7 Influence of Heart Rate . j ‘ a Ret hs gone tig adie 8 Normal Heart Shadow in Man ; : , ° i +) oe Incompleteness of Ventricular Systole . . . . . Mi Dynamics of Weakened Heart ag hig ne SS eae ees aa Smee mt Oardiae Weakness 2) soc) viaje eas Se Fatigue : eR SEER One ey thie Gao ee Functional Tusallic lency . elisa esa ieee Anatomical Changes in the M vocardigien ‘ ‘ ; eee Cardiac Dilatation . *. . Sig SEL ugha te! dk Pk ot ae enemy Ch BG: SIGRTE 8 es tia eee ep yeh 8) oe ae ee Weight of the Heart ; ’ Pa a wih eee ae Strength of the Fypertropliied Muscle CAO acer RA ie Tae Work of the Heart . , ; gr Gs on re eons

Effects of Exercise upon the Oirealation : ; i ‘ Pia Exercise and Cardiac ham ‘ eter ies Naa, once

Valvular Lesions . : : ; ; , ‘ Pa Aortie Stenosis , i ; . a aie i ae nee PMMMINEAO HUN sg A A ae eee Mitral Stenosis ; ; : ‘ : abe < hadakaseae Mitral Insufficiency . ; ay ale al: dee ge Valvular Lesions of the Right Heart ESA > Congenital Heart Lesions poe tgs Bight gee atthe > An Combined Valvular Lesions .. EE

Effect of Some Extraneous Factors upon the Heart 3 fire cee Arterial Hypertension . ; , : ; 1 lie ee ee Pulmonary Disease . , ; bist PEE CEE IM NNO: INOUE ON gah i a as wh se

Vili CONTENTS

Compensation and Decompensation Compensation Causes of Broken Compensation - Effects of Decompensation

Disturbances of Cardiac Rate and Rhythm : Fundamental Properties of the Heart Muscle Refractory Period The Pacemaker of the Heart Conduction Paths Heart Muscle and Nerves .

Clinical Methods for Studying the Cardiac Mechanism .

Mechanical Methods .

Electrical Methods Sinus Variations in Rate and Rhythm Normal Heart Rate ; Sinus Tachycardias Sinus Bradycardias Sinus Arhythmias Disturbances of Conduction Sino-auricular Block .

Auriculoventricular Block .

Lengthened A;-V; Interval .

Partial Block : Complete Heart Block ant Blocks in Branches of the His Houde

Causes of Auriculoventricular Block Nervous and Toxie Organic Causes

Ectopic Beats, Extrasystoles .

Homogenetic Beats and Rhythms

Heterogenetic Beats . ,

Auricular Extrasystoles :

Auriculoventricular Extrasystoles

Ventricular Extrasystoles .

Interpolated Ventricular Extr asyiitolss Retrograde Extrasystoles

Recurrence of Extrasystoles

Pathogenesis of Extrasystoles

Rapid Ectopie Rhythms Paroxysmal Tachycardia .©°.° *s Auricular Flutter ; See hae

Auricular Fibrillation : Pulse Deficit in Auricular Fibrillation Digitalis and Auricular Fibrillation .

Permanent and Paroxysmal Auricular Fibrillation ‘ Relation of Fibrillation to Ectopic Auricular Beats

Pathogenesis of Auricular Fibrillation

Ventricular Fibrillation .

Pulsus alternans

Heart Sounds and Heart Machizs Changes in Loudness and Pacis ; Split Sounds... ; Accessory Heart Sounds Gallop Rhythm Valvular Murmurs .

Accidental Murmurs

Some Manifestations of Heart Tiaaues: Cyanosis Cardiac Dyajnes Cardiac Edema Pulmonary Edema .

Cardiac Sensations Palpitation Cardiac Pain

The Blood Vessels

Physiological Consideration .

Transient Arterial Hypertension .

Chronic Arterial Hypertension Relation to Renal Disease Immediate Cause of Chronic Hypertension Arterial Changes Secondary Lesions

Hypotension Syncope .

Effects of Hemorthase d Surgical and Traumatic Shock Circulatory Failure in the Infectious Diacases

The Pulse Pressure Local Vascular Changes

Form of the Arterial Pulse .

References ; ; ‘ s 4 ‘

Chapter II. Digestion and Absorption

Disturbances in the Esophagus Fg ath Physiological Considerations . Be, Mechanical Obstructions of the Bsophagus Spastie Obstructions ;

Cardiospasm ;

Atony of the Esvphagas ; : Insufficiency of the Cardiac Sphinater .

Aérophagia ool ieee ek Esophageal Divertiouls

Disturbances of Gastric Secretion .

Physiological Considerations .

Stimulants to Gastric Secretion

Nervous Secretion Chemical Secretion Properties of the Gastric Juice .

Hyperacidity and Hypersecretion . : Relation of Hyperacidity to Gastric Motility : Effect of Hyperacidity on Gastric sesane Symptoms of Hyperacidity :

Causes of Hyperacidity Hypersecretion

Achlorhydria and Related Conditions Relation to Gastric Motility Effect on Gastric and Intestinal Digestion Symptoms of Achlorhydria Pe Causes of Achlorhydria

Excessive Secretion of Mucus .

Disturbances of Gastric Motility .

Physiological Considerations .

The Control of the Pylorus

Gastric Motility in Secretory Dilebidees

Gastric Atony Nature of Atony ,

Effect on Gastric Position .

Effect on Gastric Motility .

Etiology of Atony Pyiorie Obstraction®. 2. 0. so) De ee

Causes : : 7 E 4 : ¢ ¥ Effect on Motility pC fe SAS Ae a

CONTENTS xl

PAGE

Acute Dilatation of the Stomach . j z é ‘ a. 166 RINNE 6 Ve eg Se ee Mechartism . j ‘ : j ‘ : 5 . =; 188 Rawen of Vomiting’ «... 9805 90 ARES os ee eee Continuous Vomiting 5 een og ol es eek eae ee ee Gastric Motility after Gastro-enterostomy . . . =. 160 Peptic Uleer . ; ‘ ; : : ; , > ; 43362 Pathogenesis. ; : : : . ‘ p21, 162 Relation to Gastric Beewablan : : : p 4 2202 Vascular Disease ; : : ; ; ‘ : P., 164 Nervous Theories . : ‘ : ‘ ; 2 ACE Infectious and Toxic Sacre ; 5 f ; , Prana Conclusion : , j ; 57 266 Motor Activities of the ick in Uleer s ‘ , ‘2 3466 Carcinoma of the Stomach’ . : : ; : 25. ee Effects on Gastric Form and Motility : : : : = 168 Effects on Gastrie Digestion . P ; ‘ ‘ oo ae Gastric Sensations . : , a ; ‘ p aD fy i Appetite, Hunger and Repletion te EM Ce crater © 4! Gastric Pain . : P ; ; , ’ , rege The Intestines ; P d . ’ : $y EE Functions of the Sinadl Eterna : ‘ F , : ee 194 Functions of the Large Intestines . . © gage ATS The Exclusion of Pancreatic Juice from the Tibnes : eG SK The Exclusion of Bile from the Intestines. j Pee fy 6 Disturbances in the Functions of the Intestinal Miron . 180 Motor Disturbances of the Intestines . . ; P eee | mupeological Oonsiderations-.- 0 ae ee a BL Pere Cereenes © SS. RS et Oe ee ree Large Intestines a Be aay ela ae ae eee ee Tare |) Chronie Constipation ; ; 4 : Nae: : . 184 mesmomenesis of Constipation... 0 6 ge ey i oe TB Lack of Normal Stimuli . , F A i. ay e285 Mechanical Causes. : P , ; p ; 3: 26 Functional Motor Disturbances , , , ‘ ees | OR eRe Sigs a ee lis es. See ee

Ch) temtidiie Blame ti. ee Say ee WS va

(ec) ‘Transvecve Stasis =<. 3s eo AS

Cp Set RO so oo TR a hog a gen ee Symptoms of Constipation By eins yin rid + gai apne arise sae

Diarrhea . paca ; “ : ; j ; ; ee ||, '

xii CONTENTS

Pathogenesis of Diarrhea pea hy Mele Poet ae Excess of Stimuli Increased Irritability of the Intestines Motility Changes in Diarrhea

Intestinal Obstruction ; Motor Disturbances General Symptoms

Intestinal Paresis

Intestinal Pain

Intestinal Atito-intoxieation

Chapter III. The Metabolism Methods of Study

The Rate of Metabolism .

Physiological Variations in.a Giv yen 'fadividual (a) Muscular Exercise (b) Effect of Food The Basal Metabolism , Normal Basal Metabolism .

Pathological Variations in the B anal: Metsholins Obesity Pathogenesis ; Effect on Body Gunton i Starvation ; Partial Tenslidon The Protein Metabolism The Protein-building Stones ; Amino Acid Requirements of the Body : Nitrogenous Equilibrium Protate Requirements of the Body’.

Protein Starvation ‘ Excessive Protein Destruction .

Autolysis .

Imperfect Deccemposition of ‘Aicdab shields Hepatic Disease, ete. .

Cystinuria .

Diaminuria Aleaptonuria Ochronosis .

Melanin

Diseases Due to Deficient Diets Inorganic Salts Lipoids Beriberi Scurvy < Some Ti tarhaness i in the Eipoids 4 Lipemia ‘ Fatty Degeneration .

Cholesterin - Cholesterinemia Loca] Cholesterin Deposits Acidosis ._..

Formation of Aides in the Body Lactic Acid. ; The Neutrality of the Blood (1) The Blood Salts (2) Elimination of Acids (3) Increased Ammonia Formation Definition of Acidosis Evidence of Acidosis ESE BiG” sae Saran ia (2) Respiratory Changes . (3) The Urine . ?

Symptoms of Acidosis References xili

PAGH

Chapter IV. Disturbances in Carbohydrate Metabolism Diabetes General Considerations

Renal Glycosurias Phlorhizin Glycosuria Other Renal Glycosurias Renal Glycosurias in Man ; : Alimentary Glycosuria and Related Caniitiens ‘ Alimentary Glycosuria Alimentary Levulosuria .

Alimentary Galactosuria .

Glycosuria from Discharge of the Glycogen Reodevaine

_ Nervous Glycosurias Glycosuria from Central Dinesuo Emotional Glycosuria Glycosuria from Disease of the Hypophysis Epinepbrin Glycosuria

Diabetes mellitus, Pancreatic Diabetes ‘ : ; Experimental Pancreatic Diabetes .

The Pancreas in Human Diabetes .

Hyperglycemia in Diabetes Classification of Diabetes Derivation of Sugar in Diabetes

Carbohydrates

Proteins ,

The D:N Ratio .

Fats : Energy Requirements i in Dinteton : Energy Supply i in Diabetes Glycogen in Diabetes ‘ Respiratory Quotient in Diabetes ‘ Effects of Exercise .

Theories of Diabetes Symptoms and Complications of Diabetes

Emaciation and Polyphagia

Polyuria and Thirst . ;

Diminished Resistance to infection i

Nutritional Changes .

The Acetone Bodies Diabetic Coma

Conditions in which ‘Neekin Bodies Oc ‘cur

Interrelationship of the Acetone Bodies Derivation of the Acetone Bodies Cause of Diabetic Coma .

Pentosuria References

Chapter V. The Purin Metabolism. Gout Normal Purin Metabolism Catabolism of Nucleoproteins

Sourees of Purin Bodies .

Conversion of the Purin Bodies’ . i . "

Normal Excretion of Uric Acid . ; > ‘ Increased Purin Metabolism . . . . : . ; The Purin Metabolism in Gout

Eticlogy of Gout

Uric Acid Excretion in Bout: Urie Acid in the Blood

Local Deposits of Urates..

Cause of the Acute ‘Attacks’ . . .. . ." %

Effect of Atophan Theory of Gout References

Chapter VI. The Liver and Pancreas Functions of the Liver Disturbances in the Secretion of Bile

Important Constituents of the Bile Bile Pigments : Bile Salts Cholesterin .

Jaundice .. ems Pas eg aes Obstructive J sundice Hemolytic Jaundice Infectious Jaundice Jaundice in Organic Liver Disease Icterus neonatorum . ; are Symptoms of Jaundice j Functional Disturbances of the Hepatic Cells ; Urobilin in Hepatic Disease .

Carbohydrate Metabolism in Hepatic Disease Nitrogenous Metabolism in Hepatic Disease Other Functional Disturbances in Hepatic Disease Fibrinogen . Pe Sen tua Tabane: as ‘Blood Lipase...

Elimination of F Phenoltetrachlorphthalein Cholemia Gall-stones Frequency Composition and Biructure Pathogenesis of Gall-stones : Secondary Infections in Cholelithiasis ;

RIE oe Oa aye bo ih a ee ak ple A ti Diseases of the Pancreas . she ee 3 R Fat Necroses . ; : , A -

Acute Hemorrhagic Nesectis of the cacti * ‘References

ON C2 Co CO bo bo bo eS) bo bo Co bo bo xvi CONTENTS

Chapter VII. Disturbances of Respiration mempwration Prope... . 6 nw ee). ee eee

The Dead Space. Pats ; ; ‘ : . 846 Changes in Lung Volume , . s The Regulation of Pulmonary Ventilation >» (0.

Afferent Nervous Stimuli . ; ; ; , : . 849 Chemical Regulation. . . So ar Changes in the Respiratory Cetiter ) i : : . 3850 Transportation of Gases in the Blood . . . . . 8651 Periodic Breathing .. ow, 6a SS Respiration and Acid Intoxication eee ee Respiration at High Altitudes. . . « «© ‘« | s— Mountain Sickness... 2 valle pep tw <5 nn Increased Atmospheric Preesiivs et a Caisson Disease... .

Diminished Oxygen-carrying Capantio of the Blood . Carbon Monoxid Poisoning . . . : . «3a Methemogiobinemia .. . .... . . « «nn Anemia , (ods ; ee Respiration in Cnsidinc Disease oi. as) hie ae Cardiac Asthma «ag oe ee rr Orthopnea .. . 7 j2°° 5) Stenosis of the Upper ie Passages ec Bronchial Asthma .. Cp eS OS Pulmonary Emphysema. .. 9 . . . 3) Loss of Respiratory Surface. ©. . . . 3.

Diseases of the Pleura oo ee ey ee Pleural Pain . : ‘ eee ‘ : ; ; . 383 Pieuritic Effusions’. ©... .

Pneumothorax . Dae, eae ee eee 5 ae ; . 9387 SNE SERIE me gerne Sash mes : . 38T Closed eg oe SO ge es SS

Protective Respiratory Mechanisms . ; F ‘ : ‘ . 891

Mechanical , ; ‘ ‘ : ‘ ; , F . 891 Cilia . : ; , : ; ‘ ; : : ‘ . se Smooth Muscle . ‘ i . , ; ‘ : , . Boz 4 i Ceres: ve

CONTENTS xvii

Chapter VIII. Disturbances of Kidney Function - .PAGE

muveiological Considerations .° 2. ew eT 8O8 Polyuria. . SR ae al | Pa, SR No aa Diabetes idaipidus Berge eget ear the "UN ng yee: «hg ee EMRE 5 8g cle GR NAS OL Pts ea Anuria . . ; : ; , : : . ‘ ‘ . 409 Albuminuria . gotten aha ea “pias. | Physiologic ‘AVicaisinaies Shine ta eerie tg ee Sc ie 8 | Pathologic Causes of Albuminuria. . . . . . 414 Cylindruria . er oie Cera ae eartegt th fay Experimental Nigkeitis: 3 REE? fultryeoMm reli fesse <8 3k Retention of Nitrogenous Waste Products MRR att iene Sr Retention of Individual Nitrogenous Products. , . 424 Miitrogen Waste in the Tismmes 6 wk a ct 4S Symptoms of Nitrogenous Retention . . . . . 425 Relation to other Renal Functions. . . . ° ~ 425 Prognosis pe ee ha Oh Re pea hace ghia) be ce ae Salt Retention. Nephritic Edema Se re abe oe oye. | Normal Relations . Te wat te lg tiled hoe Salt Retention in Wiclivilis ears ; . 430 Differences Between Salt and Ni steogenin Betentions ‘cipig a ee Demeuemia of palt Retention . 2 3) fe ie ta eB Dry Retention . ; ; ; a eee anes j . 436 Sodium Bicarbonate dima Lk OR EE EM LeRe ll ASE Primary Water Retention ahs ght ORY ER aed eas cee Renal and Extrarenal Factors : ehh ane Relation of Edema to other Nephritic Manifestations shat AOD munmome and Renal Disease. =... a OO ee iO fenal Purctionin Heart Disease. -.-.:-. 9.” % . 441 Renal Function in Eclampsia : ; ; sentibe : . 442 Uremia . Me i Uremia With M gtlked Witigencus éichiien oa Sh gh alee Uremia Without Marked Nitrogenous Retention . ‘ . 446 Renal Caleuli : gn alah aig 18 ae ae Precipitation of Salts i in the Urine gOS CORA: ae eo ae meememmition of Caleuli- , 05. ie ee eh ga, Hydronephrosis gh CASIO Sek! SIPS a te ae ge Experimental Production es gh Cerio, UR Sr tel ee SEN 0k AMER 6h ge gs se ne ce es te eee Symptoms ee Ma te gat gels Tight ee aa, 5 nae eeu nea a TN gn gS a ee lg hej cowie Ug argent ean

References ; i 4 4 a exis : ‘ . 461

XViil CONTENTS

Chapter IX. Disturbances of Heat Regulation—Fever

Physiological Variations in the Temperature of the Body .

(a) In Different Animals : ° (b) Normal Variations of Dancerntate 3 in Men 2 Regulation Against Overheating and Overcooling Normal Regulation of Body Temperature Regulation Against Overheating Sunstroke 5 ; Regulation Against Overcooling Freezing ‘ Effect of Spinal Cord Section The Conception of Fever Types of Fever

Heat Regulation in Fever ; Sudden Changes of Temperature : Imperfect Heat Regulation in Fever

Metabolism in Fever ; Nitrogenous Metabolism .

Non-nitrogenous Metabolism .

Acidosis Salt and Water ‘Retention

Causes of Fever ‘ ; Lesions of the Central Sarvous Syetese ; Simple Chemical Substances .

Injection of Foreign Protein .

Infections . ; ;

Significance of Fever References

Chapter X. Infection and Immunity Conception of Infection

General Considerations .

Local and General Infections Septicemia Acute and Chronic Tnteckions The Portals of Entry Skin .

Mucous Mitnteraiios Near Body Surface, Gastro-intestinal Canal Respiratory Passages

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ANT

478 478

481 481 483 483 484

485 487

CONTENTS ae

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Defensive Properties of Infectious Microérganisms . . ©. 500 Virulence . : rise a ero a

_ Offensive Properties of istentlante ibicoseionniieed eV Saat Tey eg IR a ng idk a pe EB SR eae COMIN 688g teh eh cr ee ee ee Endotoxins ‘ PE ba) Ti gts ihe tate! pe icet ay ene Non-specific Protein Polson eMtes cant aad oh gine Immunity, Resistance and Susceptibility . . . . . 503 Natural Immunity .. : dis, thine. Cagheae a eine Raa. eee Naturally Acquired Taeaiuuils ; i ; : i . 506 Artificially Acquired Immunity : oA gS SRS ee eo Active Immunity Pe 5 A Wee oie hE eee en eens RONAN IRE oer i Np thy Sat ad et a Mechanism of Antitoxic Immunity . . . . . . 512 Toxin and Antitoxin : ; (fee eee Oa Neutralization of Toxin by Atidionis eel ah ee ae Oe eennn) GE “AIRROC AE eg ete Bactericidal Properties of Blood Serum . . . . . 517 Mmboceptor and Complement. .. . . « «. &19 eonemolysin Autohemolysin . . . =. . .« « 620 Specificity of Cytolysins. 521 Immunity and the Bactericidal Properties of the Blood Serum 522 I RAO 5. oa ae Sa a pl ca Agglutination. . ee a a hc ee The Precipitin a paki te eo fa Salen tte cal ek eae ee PY Si gi Sip Cc ge gs io wed pelt Repke eereeemeaeee General Principles rt eho (0) 1) Seg be aie eee Chemotaxis in Higher Avuade Py Leg ieee Ga: RE Phagocytosis in Higher Animals . .. . §..+s: « 582 Relation of Phagocytosis to Immunity . : RY gina . 583 Opsonins . are or ees Bacterial Resistance to Phagoeytosis ci pertains 2 ert een Sere Anaphylaxis and Protein Sensitization RAGE Wit ba ee AES | emerey Of: Anapivelesie 55.08 s 3. 23 fa Ws ae Anaphylactic Reaction in Different Animals. . . . 588 EO SEM ter Ss tiner Pee tx Ui nec Ss 6 hh Bel eRe

Rabbit MACAO atl see cy eRe CEA, Met Sea | Sas SNRs Reg age a gtr Ua ee VA on ee Dre MUNYA gs a RR, aa <= ORE MNS IAMER SS ire Se tid tree ett i tle Puureee 02 Avamvlaxia: 5 he 6S ie pee ek 2

Xx CONTENTS

Protein Sensitiveness in Man .

Serum Disease Hay Fever . : Sensitiveness to other Pesteins ; ; Hypersensitiveness to Bacterial Proteins The Tuberculin Reaction Some Phenomena of Infection Cause of Symptoms .

Soluble Toxins ; Substances Derived from Beetorial Disintegratiia ; Substances Derived from the Host .

Incubation Period Anaphylactie Fever .

Circulatory Changes : Other Analogies between Laféetion ond Protein Intoxication Specificity of Infections .

References

Chapter XI. The Blood Quantity of Blood

Plethora Oligemia Hydremia ; 3 ‘ Coagulation, Piscinbosis and he Hendibiebiadl Divekdes Extravascular Clotting Thrombosis ; - Hemorrhagic Diseases with Betuetion 3 in 1: Blood Platelets Hemophilia ; Hemorrhagic Diseases from Diminished ‘Fibrinogen Other Hemorrhagic Conditions

Pathology of Red Blood Corpuscles

Increased Destruction Hemolysis Rate of Destruction Types of Destruction .

Manifestations of Increased Hessoleais

Causes of Hemolysis. 1. Hemolvysis by Hieviotinls: Salt Solutions 2. L ipoids and Lipoidal Solvents wr, 3. Snake Venom Riaies

551 551 551

552 553 553 553 554 554

572 572 573 573

575 575 576 576

4, Bacterial Hemolysins 5. Hemolysis by Specific Gaeute ers 6. Non-immune Sera .

Paroxysmal ITemoglobinuria Blackw ater Fever Hemoglobinuria from shen! ae eticinoalobin and Red Cell Destruction

Niemalacd Destruction of Erythrocytes Without Wei iout

Signs ; :

Regeneration of Red Corpuscles : TEiinical Evidence of Increased Fisccneesticn . Anatomical Evidence of Increased Regeneration The Stimulus to Regeneration Types of Regeneration ,

Anemia General Oo sadaistions Classification of Anemias .

Anemia from Hemorrhage Simple Toxic Anemia Megaloblastie Toxic Anemias Pu autiata Anemia Other Megaloblastic neaiis Pathogenesis of Pernicious Anemia : Anemias from Defective Red Cell Formation .

Aplastic Anemia .

Chronic Hemolytic Jaundice .

Family Hemolytic Jaundice Acquired Hemolytic Jaundice .

Pathogenesis

Relation of Spleen to Anemia .

Effect of Splenic Excision on Notnial Knbiiale Splenic Anemia and Related Conditions .

Effect of Splenectomy U he Pathological Hemolysis Chlorosis Polycythemia Classification Symptomatic Poly ries Cyanosis Altitude Intoxications Cryptogenic Polveytliemins Pathogenesis of Polycythemia

XXxii CONTENTS

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The Transfusion of Blood a dee. oo ee) hee Dangers of ‘Transfusion © 5:03.02.) SP

(a) Themolysis © 0208 Se (b) Agglutination ‘ . 606 (c) Coagulation and Protuin Tntoxications. ee Beneficial Effects of Transfusion — . j , . 608 Pathology of the Leukocytes . é j . : oe Classification and Origin : ; ; . 609 CMMNECRCNENE he hop TS Ae ee a a . + ii Order 254 ee Some Biological Pais of vie Sabsivics ; : — Chemotaxis ; a se Ferments . : ; A ; ; alia » 1. ee Leukocytosis and Leukopenia . : : ‘ ‘ : . Le Physiological Leukocytoses ‘ ‘ : 5 , .: Pathological Leukocytoses og 6 (a) Neutrophilic Leukocytoses . ; . . a (b) Eosinophilic Leukocytoses_ . . (c) Lymphocytoses f 615 (d) Increases in the Large Vcsouneloars ani Tretat tomals 0. a ee ee Leukopenia ; a) Shee eileen 9) eee or Pathogenesis of Leukocytosés bi dwt wits: lS ec er Pathogenesis of Leukopenia . .. . . +... <i Leukemia and Allied Conditions. prea : ‘ .: 617 General Considerations. . .. .. .. i |e 3 Chronic Myeloid Leukemia ot ey lee bt Chronic Lymphatic Leukemia. . . . .. Sem Acute eukemia . sk se es Chloroma . ow ee ie nn

Etiology of Levkeinis’ yok am. wht eps eer

Hodgkin’s Disease . wep Sate a ss ee ee . .

Chapter XII. The Glands of Internal Secretion The Chemical Regulation of Body Functions . ; ; : . 631

General Considerations . ‘ ; ; : ‘ F é . Caz The Ductless Glands ; : ; ; ; ¢ : . 632 .

Evidences of Internal Secretion . ; ; : ‘ . 6382

Types of Glandular Disturbance . . . . =. «© 688

Disturbances of the Thyroid Gland . . « «© © Hypothyroidism ek CR aie ye iigo ag garg aoa gga ae aaa Myxedema of Adults... ivieoete Mild Types of Hypothyroidism . ; Sporadic Cretinism

Relation of the Thyroid to Sparadio Onctwied siid Myxedema pM Dieiuanie te ast Sareea eae tats

Hyperthyroidism Experimental Hi vnaeliceiidies

(1) Effects of Thyroid Administration (2) Thyroid Stimulation P Exophthalmie Goiter .

Manifestations

Pathogenesis of Rxvpbihalinic Giatine ‘ Etiology of Exophthalmic Goiter

The Active Principle of Thyroid Secretion

Endemic Cretinism, Endemic Goiter and the Goiter Heart Endemic Cretinism

Endemic Goiter . E 2 The Goiter Heart ; . :

SPM UUROREM. 2 602404 Se be Ee oe Symptoms of Tetany ‘ Experimental Tetany After Pavalhsisidentonsy Metabolism in Experimental Tetany Etiology of Tetany in Man Parathyroid Medication .

The Thymus and the Status lymphaticus Effect of Thymus Excision : Thymic Asthma and Thymic Death ete The Thymus in Graves’ Disease . . .

Dene cyMpnAtiCns 605 mmemnencaey CHAM gs ee ee Action of Pituitary Extracts . . . .«. .

Experimental Hypopituitarism ; aitiow Froéhlich’s Syndrome and Related Coiditions ‘ Acromegaly Ps RA ster Other Types of Pituitary ‘Disease ;

The Pineal Gland .

Somatic Changes in Pineal. Tumors at Soa ache

636 636

639 639

639 640

641 641 643 645

647 647 647 648

649 649 650 650 651

652 652 653 653

654 655 655 657 658

659 659 eae CONTENTS

The Adrenals .. . . . . | *° Pa aaa aa a aS) Excision of the Adrenals. .

Addison’s Disease. . ° Hyperfunction of the Pepe ‘

Internal Secretion of the Sex Glands .

Interrelations of the Internal Secretions References nase ; é F

LIST OF ILLUSTRATIONS Fic. 1.—Curve Showing the Relation of the Initial Length to the Tension and Enerry Set Free During an Isometric Twitch of a Voluntary Muscle . : 2.—Voluntary Muscle Working Under Conditions Similar to Those ees Upon the Heart Muscle : 3.—Schematic Relation Between the Volume and the Intrav entricular Pressu: "e During Systole and Diastole 4.—Effect of Raising and Lowering the Arterial Resistance Upon the Volume and Output of the Ventricles in the Heart-lung Preparation 5.—The Effect of Altering the Venous Supply to the Heart in the Heart: lung Preparation 6.—Schematie Representations of Henderson’s Conception of Diastolic Filling of the Ventricles 7.—Schematic Representation of the Reletion Betw een the narnia Ga W eakened (Atonic) Heart Muscle 8.—Compensatory and Excessive Dilatation from Raising the ‘Blood Pressure in a Heart-lung Preparation . 9.—Effect of Bicy cle Riding Upon the Pulse Rate and the Sy stoli c Blood Pressure 10.—The Effect of Bicycle Riding Upon the Blood Flow per Minute, the Pulse Rate and the Systolic Output at Each Beat. . : : a Aik RNa 11.—Shows the Effect of a Short Hard Run (100 Yards) Upon the Pulse Rate and the Blood Pressures’. : : . 12.—Effect of Bicycle Riding Upon the Blood Flow i in the Arm ‘of Man : 13.—Effect of Exercise Upon the Blood Flow in the Arm of Man 14.—Effect of Exercise Upon the Size of the Heart . 15.—Effect of Experimental Aortic Stenosis Upon the Intraventricular Pressure Curve 4 ; 16.—Effect of Mitral Stenosis Upon Ventricular ‘Filling : j . 17.—Orthodiagraphs of Normal Heart Shadow (Left) “and of Heart Shiiae tone a Marked Dilatation of the Left Auricle Caused by Mitral Stenosis . 18.—Diagram of the Specialized Heart Tissues. : ; 19 —Normal Venous Pulse Showing a Well Marked h Wave . 20.—Normal Electrocardiograms . 21.——Electroecardiograms Characteristic of Left Ventricular Hy pertrophy 22.—Electrocardiograms Characteristic of Right Ventricular Hy pertrophy . 23.—Respiratory Trregularity in a Young Adult. The Waves are Normal . 24.—Respiratory Irregularity in a Young Adult. Lead IIT 25.—Sino-auricular Block . ; : ‘ . ; : 26.—Lengthened Vs-As Interval (About 0.37 Second) : . : 27.—Partial Heart Block . ; ‘ ; : : ; ‘ : -@ 28.— ‘Complete Heart Block : 29.—Block in the Right Branch of the His Bundle ; 30.—Probably a Block in the Left Branch of the His Bundle : , 31.—Rhythm Proceeding from the Upper Part of the A-V Node with Transition to Normal Rhythm , 32.—Rhythm Proceeding from the AV Node with Transition from the Normal Rhythm bn ceed pslaaneeas 33.—Auricular Extrasy stole 34.-—Ventricular Extrasystoles

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XXVi ; LIST OF ILLUSTRATIONS

Fig. . PAGE 35.—Interpolated Ventricular Extrasystole . . . . ; . . . . 7 36.—Retrograde Extrasystole . : , 70

37.—Transition from a Normal Rhythm to a | Pulsus bigeminus which Is Caused by the Regular Oceurrence of a Ventricular Extrasystole After Each

Normal Beat .. .? Ta 38.—Paroxysmal Tachycardia with Transition to a Normal Rhythm . ; ae _ 39.—Auricular Flutter. Lead III . 5 3 : ‘ : F i : : : 76 40.—Auricular Flutter. Lead II . , aaa Np ‘ ; +n 41.—Auricular Fibrillation with Rapid Ventricular Action A ‘ ; ; . a 42.—Auricular Fibrillation with Slow Ventricular Action . : ; : an 43.—Coarse Auricular Fibrillation . ; ; : : : : ; L oa 44.—Pulsus alternans ; : , i : F : ; : : ee 45.—Electrie Records of Heart ‘Sounds ; ? : 2 46.—A Record of Auricular Sounds in a Case of Complete Heart Block . 89 47.—Change in the Murmur of Mitral Stenosis During Paroxysmal Auricular Fibrillation . 91

48.—Usual Distribution of the Pain and Sensory Disturbances i in Angina Pectoris 98 49.—The Effect of Intermittent Anuria Due to Divine setae Disease upon the Blood and Blood Pressure. F . 105 50.—The Central Carotid Pulse of the Dog . : |) a 51.—The Carotid (Upper) and the Peripheral Arterial Pulse (Lower) . ; - AZO 52.—Sustained Volume Pulse in the Arm of Man . ; : ; : . 120 53.—Pointed Volume Pulse in the Arm of Man during Fever . be ae P . Ie 54.—Dicrotic Pulse in Fever . : : ; : . an 55.—Markedly Collapsing Pulse of Aortic Insufficiency : 121 56. —Kinematographie Records of the Gastric Outlines in Man Showing the

Progress of the Peristaltic Waves a, b, and e, d . 149 57. —Tracings of the Shadow Cast by the Cat’s Stomach at Hour Intervals After

a Meal : : 151 58.—Diagrams Showing the F illing ‘of the Normal, Orthotonie Stomach (Upper

Line) and of the Atonic Stomach (Lower Line) . ‘ 153 59.—Diagram Showing the Filling of a Dilated Atonic Stomach Caused by

Pylorie Obstruction from Uleer . ‘ . A X ; . 156 60.—Record of Hunger Contractions of the Human Stomach ure ; ; . ia 61.—Areas of Referred Pain as Given by Head . : é ia 6la.—Diagram Representing the Process of Rhythmic Segmentation k : 181 62.—The Effect of Tyroid Medication on the Gaseous Metabolism of a Spéradic

Cretin . 214

63.—Effect of Complete Starvation Upon the Body Weight, the Rate of Metabolism, the Tension of Carbon Dioxid in the Alveolar Air, and the Excretion of Ammonia in the Urine . 221 64.—Typical Curves of Growth of Rats Maintained on Diets Containing a Single

Protein. 228 65.—Shows the Effect of ‘Adding Tryptophan Alone and the Combination of

Tryptophan and Lysin to Diets Containing Zein as the Sole Protein . 229 66.—The Necessity of Certain Lipins for Normal Growth . 2 241 67.—Daily Output of Endogenous Urie Acid in a Gouty Patient Showing a

Marked Increase During the Acute Paroxysms . 312 68.—Effect of Administration of 3 gm. Atophan at 9 A. M. on the Uric Acid in