Cecil K. Drinker

The Occurrence, Course, and Prevention of Chronic Manganese Poisoning

The commercial uses of manganese are many, but instances of poisoning have been collected from only three sources. This is possibly because the condition is rare and the symptoms so bizarre that the physician unacquainted with the possibility of poisoning by manganese and seeing a single isolated case, interprets the findings as an atypical instance of some more common type of nervous disease. A partial list of the uses of manganese compounds in this country and abroad is as follows: It has been employed in the manufacture of chlorine and oxygen, in making dry batteries, in glass works for cleaning and coloring molten glass, for coloring brown and black glasses, to destroy carbon in the production of enamel, as a paint for Fayence and porcelain, for glazing, for coloring and graining soaps in aniline and alizarin factories, in various processes connected with the manufacture of glass, oil, and varnish, and finally in the making of cement and glazed brick. Certain manganese colors, such as manganese brown, a hydrated peroxide of manganese, have had extensive use. Manganese bistre and manganese violet are other examples of dyes made from this metal. In Holland and Germany, manganese sulfate has occasionally been used as a fertilizer, but not very widely,

EXTRAVASCULAR PROTEIN AND THE LYMPHATIC SYSTEM

In this paper, I return to my first interest in the lymphatic system and the issues which have intrigued me most since entering this field. In 1927, it was my good fortune to be working for Professor Krogh in his modest laboratory upon a residential street near the center of Copenhagen. There he had conceived and carried out the sagacious experiments which laid the foundations for our present conceptions of the capillary circulation. At that time, Krogh was checking and improving the methods he had employed to measure the colloid osmotic pressure of extremely small amounts of blood serum, a very essential technique for his laboratory, where most of the experimental work was being carried out upon frogs, often small frogs with little blood. The measurements of colloid osmotic pressure of blood serum verified the luckily correct findings of Starling1 in 1896. The result of Krogh’s labors and that of his pupils established, beyond question, the balance between capillary blood pressure and the colloid osmotic pressure of the blood proteins for rapid movements of water out of and into the blood. In 1927, so far as I can recall our beliefs in these matters, i t was the general conviction that the walls of typical blood capillaries, throughout the body, did not permit the escape, except some very small traces, of the blood proteins. It was agreed that the capillaries of the liver and the intestines allowed leakage of these compounds, but these were considered special cases, and the capillaries in most parts of the body were considered practically impermeable to the blood proteins. It is appropriate to point out that quantitative analysis of the protein in liver and intestinal lymph was the means of measuring this quite specific leakage from capillaries in two large areas. In the early spring of 1927, Professor Krogh made an expedition on his bicycle and returned with a sack full of frogs. These, put in the small pond behind the laboratory, turned immediately and enthusiastically toward the task of producing more frogs. Many of them became quite edematous as this period passed, and in the laboratory

The migration of microfilariae (Dirofilaria immitis) from the blood vessels to the lymphatics

Abstract 1. 1. An experiment is reported in which microfilariae (Dirofilaria immitis) have been injected into the circulation of an uninfected dog. 2. 2. It has been shown in both donor and recipient that microfilariae readily leave the circulation and enter lymphatics. No evidence of a cellular reaction on the part of the host has been found in relation to living microfilariae.

On Filtration of Microfilariae by Lymph Nodes.

Abstract 1. 1. Experiments have been accomplished in which microfilariae ( Dirofilaria immitis ) have been perfused through the normal popliteal lymph nodes of dogs. It has been shown that there is no phagocytic filtration of the organisms and that they pass through the nodes with comparatively slight hindrance, differing from bacteria and even from the dogs own red cells which are phagocytosed in the nodes, leaving the perfusate practically free of them when collected from the efferent vessel. 2. 2. It has been shown that microfilariae of Loa loa although sheathed are more motile, i.e., they travel farther per minute, than do those of Dirofilaria which possess no sheath. 3. 3. By analogy it is suggested that microfilariae of Wuchereria bancrofti deposited in the lymph stream will not be measurably impeded by lymph nodes in their journey to the blood stream, and that if mechanically checked in nodes normal organisms will not suffer by such residence.

Physiologic Principles of Resuscitation and Oxygen Therapy

For the past 50 years the English-speaking world has employed practically exclusively the prone pressure method of artificial respiration. During the war the method lost favor. There was no conviction that it provided more than minimum lung ventilation and it was realized that no one knew the real efficacy of the procedure. Measurements on fresh cadavers, on unconscious patients unable to breathe, and finally on anesthetized and curarized volunteers confirmed the distrust of prone pressure artificial respiration and led to trial of other procedures. Out of these observations the Danish Holger Nielsen method emerged as tlae best, and is discussed.