USA > Ohio > Hancock County > Findlay > Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens > Part 75
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7,000
59
3.8
2.0
198
3,900,000
39
4.0
4,120,000
5,900
76
4.2
1.9
144
4,220,000
50
59
4.4
4,900,000
81
4.5
CASE II.
3,820,000
7,900
69
4.0
2.0
155
Acute
4,650,000
5,300
70
4.5
2.2
185
Chr.
3,920,000
5,000,000
7,100
90
5.1
2.3
148
2,300,000
30
2.5
2,500,000
32
2.7
38
3.1
=
4,200,000
7,300
73
4.1
2.0
186
4,100,000
51
3.7
3.8
4.3
3,300,000
7,800
62
3.7
1.7
139
R. B. C.
Hæmoglobin.
W. B. C.
Blood. Plasma.
1
1,950,000
40%
7300
2.0
1.5
2
780,000
43
8000
1.9
1.1
3
1,072,000
50
9200
2.3
1.3
4
2,225,000
61
6300
2.5
1.4
5
1,220,000
50
8700
1.7
1.2
II. Leukæmia.
Viscosity.
Case.
Type.
R. B. C.
W. B. C. Hæmoglobin.
Blood. Plasma
1
Myelogenous
3,000,000
339,000
60%
6.2
2.4
2
2,800,000
76,000
58
3.9
1.8
3
3,600,000
40,000
65
4.7
2.0
4
Lymphatic
2,320,000
46,400
56
3.6
1.9
Table I shows that in primary pernicious anæmia, as in secondary anæmias, the viscosity of the blood is low, and here, too, the coefficient of the plasma is subnormal.
Table II, on the contrary, shows that in leukæmia, though the viscosity of the blood may be decreased, due probably to the marked anemia, the readings are not as low as would be expected, and in some cases hyperviscosity may be noted. Rotky (l. c.) found similar changes and also noted an in- creased viscosity of the plasma. He finds an explanation for the relative and absolute high values in leukæmia in the marked leucocythæmia.
C. POLYCYTHEMIA.
If conclusions can be drawn from the observations on the influence of erythrocytic and hæmoglobin richness of the blood on viscosity, these cases should show high coefficients, and in the four cases examined this was true.
Viscosity.
3,610,000
11,400
44
3.7
ellitus
3,600,000
7,600
64
3.6
' liver
4,208,000
8,000
90
4.4
: liver
3,870,000
9,200
81
3.7
emens
4,180,000
10,100
70
4.1
is tabulation it is evident that the viscosity of the iminished in anæmic individuals, and that the is roughly proportional to the severity of the
le interest is the gradual return of the viscosity to- tal with the onset of convalescence, a fact pre- d by Determann (l. c.) and beautifully shown in ses.
CASE I.
R. B. C.
Hæmoglobin.
Viscosity.
3,496,000
40%
3.6
3,620,000
44
3.7
4.0
4,700,000
8,300
81
4.3
2.1
150
4,340,000
8,600
80
4.1
2.4
194
4,600,000
7,300
79
4.4
2.0
187
3,980,000
6,900
66
3.9
1.8
162
2,200,000
30%
2.5
3,000,000
9,000
72
2.8
1.9
110
3,120,000
5,400
55
3.2
1.7
151
3,000,000
3,450,000
40
3.3
4,750,000
6,500
77
68
3.6
1.9
174
4,000,000
60
4,650,000
78
Viscosity
R. B. C.
Hæmoglobin.
1.9
173
6,200
72
4.0
4.3
2.1
192
Digitized by
B. PRIMARY ANEMIA AND LEUKEMIA. I. Primary Pernicious Anæmia.
Viscosity.
Case.
Hæmo-
Viscos
3,700,000
5,100
40
3.5
3,900,000
6,800
60
3.2
4,272,000
8,100
76
4.2
=
..
3,910,000
6,900
Hæmo-
4,520,000
14
JOHNS HOPKINS HOSPITAL BULLETIN.
[No. 238
In 22 of the cases the viscosity of the blood was subnormal, in two about normal, and in only two above normal. In 13, there was hypervicosity of the plasma, a normal coefficient in 13, and hypoviscosity in none. These statistics are in complete agreement with those of Rotky (l. c.)
The low viscosity of the blood probably finds its chief ex- planation in the anæmia present, while in a few instances it is not unlikely the result of hydramia. As a further factor in bringing about hypoviscosity, Bachmann " considers glob- ulin. He says " crystallizable bodies have a lower viscosity than non-crystallizable ones. Globulin belongs to the first group, and since in nephritis a relative globulin increase occurs, this condition may contribute to a reduction of vis- cosity." As to the cause of the hyperviscosity of the plasma, we may. speculate on the presence of retained products of metabolism, perhaps protein, perhaps salt, their effects on the viscosity of the whole blood veiled by the greater influence of the formed elements, hæmoglobin, etc., but made clear when these are removed by centrifugation.
Interesting in connection with renal disease is the relation of the viscosity to blood pressure. In 18 of the cases there was hypertension (155-220 mm. Hg.), in two there was hypo- tension, and in six the tension was about normal. The study of the protocol of the cases shows that no constant relation exists-with hypertension there may be hypoviscosity or hyper- viscosity and vice versa. Many of the patients with increased pressure, however, showed lowered viscosity of the blood, due perhaps, as Bachmann has suggested, to the indirect influence of hydræmia -- " hydræmia leads to increased heart action and correspondingly to high pressure in order that, in spite of the thinning of the blood, the tissues may still be properly nourished."
E. CARDIAC DISEASE. I. With Œdema.
Disease.
R. B.C. W. B. C.
.. 2,840,000
8,000
40%
2.9
1.8
Anasarca: no cyanosis.
Aortic and mitral
insufficiency .... 8,900,000
6,000
51
8.8
1.5
ŒEdema of legs ; no cyanosis.
Mitral insuth-
3,520,000
6,600
58
8.9
1.7
Ascites: œdema;
Myocarditis.
4,200.000
7,800
69
4.4
1.8
Œdema of legs;
Aortic and mitral
insufficiency .... 4.800,000
10,400
63
4.4
1.2
Hydrothorax ; œdema of legs; no cyanosis.
Aortic Insuffi-
ciency.
8,120,000
8,900
48
8.6
1.3
Anasarca; hy-
Mitral insufficien-
cy; myocarditis. 3,680,000
12,800
8.9
1.5
Anasarca; no cyanosis.
Mitral stenosis and
insufficiency .... 4.580.000
14,100
67
4.3
1.4
Moderate cyan- osis.
Mitral insuff-
ciency.
4,670,000
9,600
69
4.9
1.6
Marked cyan- osis.
Myocarditis.
3.700,000
8,900
55
4.0
1.7
Œdema of legs ; no cyanosis.
Hypoviscosity occurs in this series almost without exception. The low values are doubtless due in part to the anæmia, in part to the hydræmia. The latter probably stands in a causal relation to the diminished viscosity of the plasma.
II. Without Edema.
Disease.
R. B.C W. B. C.
Hæmo- globin.
Viscos- ity.
Blood
Remarks.
Mitral insuffi-
ciency.
4,792,000
9,800
82%
4.7
150
No cyanosis.
Aortic insuffi-
3,496,000
11,000
45
8.9
195
No cyanosis.
Mitraland aortic
insufficiency ... 4,220,000
7,500
00
4.5
166
No cyanosis*
Myocarditis ..
4,520,000
10,200
58
4.7
180
Slight cyan-
Myocarditis.
9,984,000
8,600
71
4.0
189
No cyanosis.
Mitral stenosis and
insufficiency .... 5,280,000
12,000
92
5.0
140
Marked cy- anosis.
Mitral insuffi-
ciency.
5,000,000
7,400
90
5.0
170
Marked cy-
Myocarditis.
8,620,000
6,600
53
4.2
210
No cyanosis
Mitral stenosis and
insufficiency ..
5,400,000
9,500
99
5.2
185
Marked cy- anosis.
ciency.
5,200,000
14.000
91
5.1
190
Marked cy- anosia.
7
8
9
10 11
12
13
14
15 16
17 18
19
20
21
No.
R. B.C. W. B.C.
Hæmo- globin.
Blood. Plasma.
1 12 9
5.800,000
9,400
98
5.4
2.3
Young man, thin; acidosis.
8
5,640,000
6,900
100
5.9
2.8
Obese woman; acidosis.
4
4,520,000
8,600
89
4.3
1.7
Thin woman, young.
5
4,700,000
9,800
86
4.2
1.9
Obese woman, aet. 00.
6
5,000,000
7,700
92
4.8
1.8
Obese woman, aet. 4º.
Three of the cases show increased viscosity of the blood and of the plasma-one shows high normal values, and in the re- maining two, low readings for the blood, and normal ones for the plasma were obtained.
The increased viscosity of the blood is here probably due to the relative polycythemia, the result of concentration of the blood due to the polyuria. As to the factors concerned in the production of hyperviscosity of the plasma, concentration, lipæmia, and hyperglycemia all probably play a rôle. That lipæmia would raise the viscosity of the plasma is to be ex- pected from the observation of Burton-Opitz (l. c.") that "in dogs, food rich in fat raises the viscosity of the serum espe- cially." The same observer found "inconsiderable " rises in viscosity in dogs with artificially produced hyperglycemia.
G. JAUNDICE.
Viscosity.
Diagnosis.
R. B. C.
W. B. C.
globin.
2.1
Cholelithiasis
5,100,000
14,300
94%
5.2
2.0
Cholelithiasis
4,900,000
19,200
90
5.0
1.9
Cholelithiasis
4,820,000
10,200
90
4.8
2.0
Carcinoma of bile ducts. 3,700,000
26,000
73
4.6
2.4
Carcinoma of pancreas ..
2,920,000
9,400
58
5.3
2.2
Catarrhal jaundice
5,000,000
8,900
96
5.1
2.0
Catarrhal jaundice
4,780,000
14,000
86
4.9
Acute hepatitis
4,200,000
18,000
80
4.7
1.8
Luetic hepatitis
4,600,000
7,000
82
5.0
1.9
The high coefficient here is probably due to the cholæmis which was present in all of the cases.
Digitized by
28
90 30 31 39
33
41
42
13
44
45
47
5,130,000 4,660,000
48
49
50
4,620,000 3,980,000 4,320.000
be studied. The in and of cold sponge From these data 1. Typhoid fever riscosity of the blod
4 4,310,00 4,000,00 4,868,00 4.236,00 4,100,00 4,300,00 3,960,00 5,000,00 4,860,00 4,730,00( 4,120,00 3,980,00€ 4,980,00 4,530,00 4,420,000 4,500,00 4,720,00 4,930,00 4.460,000 4,570,000 5,080,000 4,000,000 4,800,000 4,880,000 4,240,000 4,590,000 4,780,000 4,630,000 4,690,000 4,760,000 4,511.000 4,316,000 4,920,000 4,130,000 3,895,000 5,400,000 4.540,000
No R. B. C.
1
4,690,00 4.272,00 4,120,00
3
5
6
In this group no constant alteration in the viscosity values are found. The low readings correspond in the main with the anemia, the high readings with the polycythemia and the cyanosis. The blood-pressure viscosity ratio, as in nephritis, is inconstant, though occasional instances of association of low viscosity with high tension does suggest a compensatory mechanism.
F. DIABETES MELLITUS.
Viscosity.
Remarks.
4,930,000
7,200
91%
5.2
2.2
Young man, obese.
23
24 95 26 27
Myocarditis. ..
Remarks.
globin.
Viscosity.
Hæmo-
Blood. Plasma.
ciency.
no cyanosis.
no cyanosis.
drothorax.
Hæmo- Blood. Plasma.
1
The unusually kins Hospital fı any characteristi
JANUARY. 1911.
pressure.
ciency.
oBis.
anosis.
Mitral insuffi-
3. The hæmoglob
2. The lowered with later gradual gres, is parallel sequent regeneration
4,290,000 4,730,000 3,960,000 3,820,000 5,000,000
H. ACUTE INFECTIOUS DISEASES. I. Typhoid Fever.
The unusually large typhoid fever service in the Johns Hop- ins Hospital furnished a long series of these cases in which ny characteristic changes in the viscosity of the blood could
mann (l. c.) has shown to be increased in this disease, varies considerably, and in the majority of instances is subnormal, in one patient being as low as 16.0 (normal=20). This author had found a high quotient in 10 out of the series of 11 cases, and having noted a subnormal quotient in pneumonia, stated
'o.
R. B. C.
W. B. C.
Hæmoglobin.
Viscosity Blood.
Hb
Viscosity after sponge.
Remarks.
1
4,690,000
4,300
80%
4.8
16.6
5.0
1st week.
2
4,272,000
3,750
76
4.2
18.0
4.4
1st week.
3
4,120,000
5,100
70
4.0
17.5
4.2
2d week.
4
4,310,000
6,200
74
4.4
16.8
4.5
2d week.
5
4,000,000
3,600
69
3.9
17.7
3.9
2d week.
6
4,868,000
7,000
83
4.5
16.2
4.6 .
2d week.
7
4,236,000
4,600
80
4.1
19.5
4.2
3d week; furunculosis.
8
4,100,000
8,000
75
3.9
18.9
4.1
4th week; phlebitis-relapse
9
4,300,000
6,680
67
4.2
15.9
4.5
3d week
0
3,960,000
7,600
63
3.9
16.1
4.1
3d week; hemorrhage.
1
5,000,000
8,200
89
4.9
18.1
5.0 Tub 80°
1st week; psychosis.
2
4,860,000
4,300
84
4.7
17.8
5.0
2d week.
3
4,730,000
3,980
84
4.7
17.8
4.8
2d week.
4
4,120,000
4,600
82
4.0
20.5
4.4
2d week; bronchitis.
5
3,980,000
3,700
76
4.2
18.0
4.3
1st week; bronchitis.
6
4,980,000
5,100
91
5.0
18.2
5.0
2d week.
7
4,530,000
5,420
88
4.5
19.5
4.9
2d week; phimosis.
8
4,420,000
6,200
83
4.3
19.3
4.5
2d week.
9
4,500,000
6,700
81
4.5
18.0
4.7
2d week.
0
4,720,000
6,300
86
4.8
17.9
4.9
2d week.
1
4,930,000
3,570
89
5.0
17.8
3d week.
2
4,460,000
4,680
80
4.5
17.7
3d week.
3
4,570,000
4,000
83
4.3
19.3
3d week.
4
5,080,000
6,600
95
5.0
19.0
1st week.
5
4,000,000
7,400
79
4.0
19.7
2d week.
6
4,800,000
9,000
86
4.6
18.7
3d week.
4,880,000
8,300
90
4.9
18.4
3d week.
8
4,240,000
6,700
82
4.1
20.0
3d week.
9
4,590,000
5,900
86
4.2
20.4
3d week.
0
4,780,000
7,100
83
4.5
18.4
3d week; cholecystitis.
1
4,630,000
8,500
85
4.5
18.8
3d week.
4,690,000
11,100
83
4.0
20.7
3d week.
:3
4,760,000
10,300
81
4.1
19.7
3d week.
4
4,511,000
9,700
79
3.9
20.2
4th week.
5
4,316,000
8,800
79
4.0
19.7
4th week.
6
4,920,000
6,900
84
4.4
19.0
4th week; relapse.
7
4,130,000
7,600
80
4.0
20.0
4th week; hemorrhage 12th day.
3
3,895,000
8,040
76
4.0
19.0
4th week; well.
4th week; well.
4.540,000
6,000
80
4.2
19.0
4,290,000
5,700
77
3.8
20.2
4th week; well.
4,730,000
10,000
87
4.3
20.2
4th week; well.
3,960,000
4,600
74
3.8
19.5
4th week; epistaxis.
3,820,000
4,900
76
3.8
20.0
4th week; emaciated.
5,000,000
6,800
93
4.6
20.2
4th week; well.
5,130,000
3,200
93
5.0
18.6
6th week; well.
4,660,000
4,980
88
4.8
18.3
6th week; well.
4,620,000
6,600
87
4.5
19.3
5th week;
well.
3,980,000
7,300
84
4.0
21.0
4,320,000
4,160
74
4.3
17.2
studied. The influence of restricted diet, of febrile reaction 1 of cold sponges and tubs could also be noted.
From these data the following conclusions may be drawn :
Typhoid fever produces no characteristic change in the cosity of the blood.
. The lowered values noted during the course of the disease h later gradual restitution to normal as convalescence pro- ¿ses, is parallel to the development of anæmia and the sub- tent regeneration of the blood.
The hemoglobin-viscosity quotient
Hb , which Bach-
that-" these few observations show that a differential diag- nosis between these diseases can readily be made by a compari- son of their quotients." In this we do not concur.
4. Cold sponges or tubs, whether followed by a good reaction or by cold and shivering, cause an elevation of viscosity. This
is in agreement with the observations of Determann (1. c.") ..
5. The restricted diets-consisting of milk, albumen and mush-apparently have no marked effect on the viscosity of the blood.
6. The leucopenia is apparently of no importance in this connection.
Digitized by
7
2
4th week.
5,400,000
3,750
92
4.2
21.9
8th week; well; perforation.
7th week; cholecystitis; well.
16
JOHNS HOPKINS HOSPITAL BULLETIN.
[No. 238
.
II. Pneumonia.
In pneumonia the occurrence of marked salt retention and of cyanosis would, other things being equal, lead to increased viscosity of the blood. Leucocytosis is rarely so marked as to enter into consideration as a factor.
Hb
Remarks.
R. B. C.
W. B. C.
Hæmo- globin.
Viscosity. V
Crisis.
Rt. lung
4,240,000
19,240
71%
4.3 16.5
Crisis.
Rt. lower lobe.
4,900,000
26,000
78
4.6
16.9
Rt. lung.
Empyema
5,220,000
42,000
96
5.5
17.4
Lt. lung.
Empyema
5,010,000
32,000
93 5.1
18.2
Rt. lung and
Lt. lower lobe.
5,100,000
20,000
90
5.2
17.2
Both
upper lobes
4,600,000
16,400
80
4.9
16.3
Lysis.
Rt. lower lobe.
4,720,000
12,300
78
4.8
16.3
Crisis.
Rt. lower lobe.
4,490,000
14,300
72
4.6
15.6
Crisis.
Rt. upper lobe.
4,700,000
10,200
76
4.9
15.9
Both
lower lobes
5,000,000
19,300
84
5.2
15.4
Rt. upper lobe
pleural effusion
5,600,000
22,200
96
5.9
16.3
Rt. lower and middle
and Lt. lower lobes. 3,900,000 Lysis.
11,600
65
4.7
17.8
Rt. lower lobe
5,430,000
13,400
94
6.0
15.6
Both lower and Rt. upper lobes
3,800,000
18,300
67
3.9
16.0
Lysis.
Rt. upper lobe.
4,750,000
28,000
75
4.9
15.3
Crisis.
Lt. lower lobe
4,240,000
21,000
72
4.0
18.0
Crisis.
Rt. lower lobe
4,160,000
16,000
72
4.3
16.7
Lysis.
Rt. lower lobe
3,920,000
14,600
66
4.0
16.5
Crisis.
Rt. lung
4,804,000
17,100
82
5.0
16.4
Crisis.
Rt. lower lobe.
4,920,000
12,000
88
4.7
18.6
Thirteen of the cases showed increased viscosity of the blood and in all the hæmoglobin-viscosity quotient was diminished. The latter finding is more constant than in typhoid fever, but from it no safe inference can be drawn.
III. Malarial Fever.
Viscosity.
No.
R. B. C.
W. B. C.
Hæmoglobin.
Blood.
Plasma.
1
3,800,000
5500
65%
3.9
2.1
2
4,300,000
6400
80
4.4
1.9
3
4,700,000
5900
82
4.9
2.4
4
4,100,000
7900
74
4.2
2.2
5
3,900,000
8100
68
5.0
2.0
6
4,520,000
6800
72
4.3
1.8
7
4,600,000
5200
76
4.5
1.9
8
4,200,000
4900
70
5.2
2.0
9 x
4,900,000
5900
85
4.5
2.0
10
4,700,000
7300
81
4.6
1.9
Here there is either normal or subnormal viscosity of the blood, and normal or hypernormal viscosity of the plasma. The lowered readings for the blood where present, are prob- ably due to the anæmia, and the high readings in three of the cases may find an explanation in the increased volume of the infected erythrocytes. The high viscosity of the plasma may In the result of hemoglobinamia present in these cases.
CONCLUSIONS.
The viscosity of the blood and of the plasma is reduced in anæmias, either primary or secondary. With regeneration of the blood, normal values are restored. In leukæmia there is hypoviscosity of the blood with hyperviscosity of the plasma. Leucocythæmia may explain the hyperviscosity of the blood, which is found in a few cases.
The viscosity of the blood and of the plasma is increased in polycythæmia.
Hypoviscosity of the blood and hyperviscosity of the plasma is almost constant in cases of nephritis; the former due to the anæmia, the latter to retained products of metabolism. Though in many instances hypoviscosity occurs in cases with hyper- tension, this interrelation is often absent.
In cardiac disease without œdema, no constant change is the viscosity is to be found, the coefficient apparently varying with the anemia and the carbon dioxide content of the blood. In cases with hydramia, there is hypoviscosity of the plasma.
In diabetes mellitus, the viscosity of the blood and of the plasma is increased, in many cases probably the result of con- centration of the blood due to polyuria, of hyperglycemia and of lipæmia.
In icterus there is generally increased viscosity of the blood and in the plasma, probably the result of cholæmia.
In typhoid fever the viscosity varies with anæmia, is in- creased by hydrotherapy, and apparently is uninfluenced by diet. The (Hb) quotient is more often decreased than increased. Hb In pneumonia the viscosity is generally above normal due to cyanosis and salt retention. Here, too, the V quotient is low.
In malarial fever the viscosity of the blood is usually normal or subnormal, rarely above normal. The viscosity of the plasma is normal or increased, the last as a result of hæmo- globinæmia.
In no disease studied could a pathognomonic alteration in the viscosity of the blood be demonstrated.
BIBLIOGRAPHY.
1. Determann: Ztschr. f. klin. Med., 1910, LXX, 185.
2. Hess: München. med. Wchnschr., 1907, LIV, 1590.
3. Determann: München. med. Wchnschr., 1906, LIII, 905.
4. Hess: Deutsches Arch. f. klin. Med., 1908, XGIV, 404.
5. Bence: Ztschr. f. klin. Med., 1906, LVIII, 203.
6. Rotky: Ztschr. f. Heilkunde, 1907, XXVIII, 106.
7. Hirsch u. Beck: Deutsches Arch. f. klin. Med., 1901, LXIX. 503.
8. Determann: Ztschr. f. klin. Med., 1906, LIX, 283.
9. Kottmann: Cor. Bl. f. schweiz. Aerzte, 1907, XXXVII, 97.
10. Robert-Tissot: Folia Hæematologica, 1907, IV, 499. 11. Adam: Ztschr. f. klin. Med., 1909, LXVIII, 177.
12. Burton-Opitz: Am. Med., 1907, n. s. II, 179.
13. Burton-Opitz: Arch. f. Physiol., 1900, LXXXII, 447.
14. Müller & Inada: Deutsche med. Wchnschr., 1904, XXX, 1754. 15. Koryani & Bence: Pflügers Arch. f. Physiol., CX, 513. 16. Hamburger: Quoted by Adam, see 11.
17. Limbeck: Arch. f. exper. Path. u. Pharmakol., XXX. 509.
18. Burton-Opitz: Proc. Soc. Exper. Biol. & Med., 1906, n. s. IV, 103.
19. Bachmann: Deutsches Arch. f. klin. Med., 1908, XCIV, 409.
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SARCOMA AND TUBERCULOSIS. REPORT OF A CASE.
By J. P. SIMONDS, M. D.,
Superintendent, Laboratory of Bacteriology and Pathology, Indiana State Board of Health, Indianapolis.
Rokitansky,' in 1846, declared that tuberculosis and car- oma are very infrequently found occurring in the same ient. He even believed the two conditions were almost ompatible, and tabulated his reasons for this opinion. A ' years later, Lebert ' disputed Rokitansky's statement be- se he found 15 cases of tuberculosis among 173 patients h carcinoma. He believed that a patient with cancer could tract tuberculosis as well as any one else, but considered the urrence of carcinoma in the progress of tuberculosis rare. These observations stimulated the reporting of cases of cinoma associated with tuberculosis, so that to-day the lit- ture on that subject is quite abundant. The association of coma with active tuberculosis seems to have been observed y much less frequently. An examination of the post mortem ords of about 2500 cases of sarcoma of various organs col- ed from the literature yielded 19 which showed this com- ation. In about 100 other cases the tuberculous process not active.
The cases found in the literature may be grouped in three ses. In the first, the tumor and tuberculosis are primary the same organ in which the two processes may be either arate or intermingled. Secondly, sarcoma and tuberculosis primary in adjacent organs and the tumor may or may not w into the one with tuberculosis. In the third group the ons are primary in remote organs and there may or may be sarcoma metastases in the tuberculous organ.
Hildebrand ' and Schick ' each reported cases of primary oma of the lung associated with pulmonary tuberculosis. the former's case the two processes were intermingled. nent " observed an endothelioma of the parotid gland and entire region of the lower jaw with a focus of tuberculosis · the center of the tumor. In two cases of lymphosarcoma he intestine reported by Storck " and Franco," the tumor tuberculosis were intimately associated. Freudweiler" d tuberculous caseation and lymphosarcoma in the same h gland removed at operation. Mueller and Ricker' re- d a small sarcoma from a breast. Later two nodules ared in the scar, one sarcomatous the other tuberculous. fer 10 10 excised an epithelioma which had developed on a I lesion, and a mixed spindle-giant-celled sarcoma de- ed in the scar.
hrbuch der allgemeinen Pathologie, Wien, 1846, Erste Auflage, S. 424, u. 552.
ichow's Arch., 1852, IV, 214.
lug .- Diss., Marburg, 1887.
lug .- Diss., Greifswald, 1890.
rue de la tuberculose, 1895, III, 134; quoted by Franco, l. c. jungsberichte der k. k. Gesellschaft der Aerzte in Wien,
Abs. in Lubarsch and Oestertag's Ergebnisse, 1898, V. 214. chow's Arch., 1908, CXCIII, 377.
ted by Franco, l. c.
ted by Franco, 1. c.
chow's Arch., 1898, supplement to Bd. CLI, 272.
Pulmonary tuberculosis associated with sarcoma of the medi- astinum has been observed by Harris," Fowler and Godlee," and Bushnell and Broadbent." In Harris' case the tumor also involved the left lung. Ricker " reported a lymphosarcoma of the cervical glands with tuberculosis of the adjacent lymph nodes. An endothelioma of the pia arachnoid of the lumbar cord with tuberculosis of the lumbar vertebrae was reported by Dufour.15 Bobbio 16 described a spindle-celled sarcoma following three operations on a fistula caused by a tuberculous scapula.
Retroperitoneal sarcomas associated with tuberculosis of the lungs have been reported by Phillipson " and McCallum.18 In the latter's case there were metastases in the lungs. Jscovesco " reported a case of tuberculosis of both lungs with sarcoma nodules on the pleura. The site of the primary tumor was not stated. Lazarus-Barlow," in 121 cases of sarcoma, found two associated with active pulmonary tuberculosis. The primary tumor in one case was an endothelioma of the tongue with no metastases; in the other, a round-celled sarcoma of the ischio- rectal fossa with metastases in the lungs and other organs.
In addition to the above 19 cases, Rapok " has analyzed 141 sarcomas operated on at the Strassburg Surgical Clinic. Among them he found 15 cases associated with tuberculosis. There were 669 tumors of all kinds treated during the same period and 66 of the patients also had tuberculosis. In Rapok's series, the percentage of patients with sarcoma showing tuber- culosis was a little higher than the average for all tumors.
Bang " analyzed all the cases with tuberculous lesions that came to post mortem at the Commune Hospital in Copenhagen in the 10 years from 1886 to 1895. During this period 6006 autopsies were done and of these 2340 showed tuberculosis in various stages in some part of the body. He found 54 true sarcomas and 34 brain tumors (some of which were probably sarcomas), with which some tuberculous lesion was associated. But in no case was the tuberculosis active.
The following case was first seen by the author at the autopsy table. For the clinical history he is indebted to the house physicians of the St. Louis City Hospital :
The patient was a negress about 60 years old. The family and personal history were negative. When admitted to the
11 St. Bartholomew Hosp. Rep., 1892, XXVIII, 87.
12 Diseases of the Throat and Chest, London, 1898, p. 684.
13 Jour. Path. and Bact., 1909, XIII, 204.
14 Quoted by Franco, l. c.
15 Quoted by Franco, l. c.
1º Giornal della R. accad. di Med. de Torino, 1906, XII, Series 4, p. 452.
17 Lancet, 1885, I, 937.
18 Trans. Assoc. Amer. Physicians, 1907, XXII, 391.
1º Quoted by Franco, 1. c.
20 Arch. Middlesex Hosp., 1904, II, 224, and 1906, VII, 17.
21 Deutsche Zeitschr. f. Chirurg., 1889-90, XXX, 465.
22 S. Bang, Tuberkulosins Sammentraef med forskellige andre Sygdomme belyst ved 6006 Sektionsfund, Copenhagen, 1901.
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18
JOHNS HOPKINS HOSPITAL BULLETIN.
[No. 238
hospital, November 20, 1907, she was emaciated almost to the last extreme. Her temperature was normal, pulse 70, and res- piration 26.
The present trouble began two months before admission, when she first noticed a swelling in the epigastrium. It seemed as if food would not pass this point. She lost weight rapidly from the first. About two weeks after she first noticed the swelling, she vomited twice in one day, the first time, a large amount of greenish material, and a few hours later, almost pure blood. She had not vomited since that time. Ascites developed, and during the last seven weeks, she had been tapped three times.
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