Irving S. Wright

Tobacco allergy and thromboangiitis obliterans

Abstract 1.1. A study of the problem of specific hypersensitiveness of the skin to tobacco in 35 typical cases of thromboangiitis obliterans and 35 controls was made. 2.2. The patients with thromboangiitis obliterans did not show a higher evidence of positive skin reactions than the control group. 3.3. The high incidence of positive skin reactions to tobacco tests reported by other investigators and interpreted as allergic reactions is considered due to some of the many nonspecific reactions from chemical irritation. 4.4. Thrombo-angiitis obliterans is not caused by an allergic type of tobacco hypersensitiveness.

Papaverine hydrochloride: Its questionable value as a vasodilating agent for use in the treatment of peripheral vascular diseases

Abstract The effectiveness of papaverine hydrochloride intravenously as a vasodilator was studied in a series of eighteen subjects, which included thirteen who suffered from thromboangiitis obliterans, three who had arteriosclerosis obliterans, and two normals. Four patients with Raynauds syndrome were also observed, but are not included in the statistical analysis. Compared with the simple water immersion procedure for securing vasodilatation, papaverine hydrochloride is ineffective and uncertain in action.

Deproteinated pancreatic extract (depropanex)

Abstract (1) We have described an apparatus to measure claudication time. (2) Following one injection of deproteinated pancreatic extract, twenty-three of a series of twenty-seven patients with arteriosclerosis obliterans showed an improvement (prolongation) of their claudication time. This initial response was in most instances temporary. (3) Following ten or more injections of deproteinated pancreatic extract, nineteen patients showed improvement in their claudication time. (4) After a series of ten or more treatments, the claudication time was, in this series, prolonged to an average of more than three times that of the control tests. (5) Physiologic saline failed to produce an increase in claudication time under identical conditions (6) Further studies will be necessary to determine the extent to which improvement may be advanced, and the duration of the favorable effects after cessation of the treatment.

Pernio: A vascular disease☆

Abstract Evidence has been presented that pernio is a vascular disease, affecting the smaller vessels of the skin, causing anoxemia of the supplied tissue, and resulting in necrosis and ulceration. Later, a definite sclerodermic-like change in the skin may occur. It is precipitated by a downward change in temperature, not necessarily freezing, but by mere cooling. This may occur at a temperature which, under ordinary circumstances, would not cause an appreciable change in normal skin, but which causes definite changes in susceptible persons. Characteristically, exacerbations of this condition occur in the fall and winter, and regression in the summer. In long-standing cases, however, complete recovery may not occur in the summer. We believe that this is due to the extensive vascular changes in the tissues. We have been able to demonstrate giant cells in our sections, but we have found no evidence of tuberculosis. We have very carefully checked our patients clinically with this in mind, so that we can make the definite statement that our patients were free from clinical and roentgenologic evidence of active tuberculosis at the time their leg lesions were active. The following tentative criteria are suggested for the diagnosis of pernio. 1. 1. It may occur in both sexes, predominantly in females. 2. 2. It usually commences in adolescence or early adulthood. 3. 3. It is associated with cool or cold weather and may show spontaneous recovery in warm weather. 4. 4. The lesions have a predilection for exposed areas, particularly the lower third of the leg, around the internal malleolus and calf. They may extend down to the dorsum of the foot and toes, and up the legs to below the knees. 5. 5. The clinical course of these lesions may be characterized briefly as (a) the formation of a reddened area which later becomes elevated, hard, and very painful; (b) this becomes violaceous and fluctuating; (c) it opens, producing an ulcer; (d) this oozes, drains, and heals, becoming less painful; (e) a violaceous scar remains; and (f) the following winter ulceration tends to recur in the same area. 6. 6. There is a definite pathologic picture. Most characteristic is, first, an angiitis of the smaller vessels; secondly, necrosis of the fat; and, thirdly, the presence of giant cells. This pathologic picture, while characteristic of all our cases, must not be considered morphologically specific, for a number of other vascular conditions present similar histologic changes. They all represent a chronic irritative process in the subepidermal tissue. Wherther the irritative phenomenon is secondary or primary cannot be definitely stated. Treatment of this condition is not specific, but the best results in our hands have been achieved by triweekly treatments with acetyl-betamethylcholine chloride (mecholyl) by iontophoresis, and by protection of the legs with proper clothing from undue exposure. Living in a warm climate should minimize the occurrence of the lesions. Early recognition of this syndrome, and treatment as suggested, will help to prevent permanent disfigurement and long periods of incapacitation.

Vitamin G Saturation—Kidney Retention after an Intravenous Test Dose of Ascorbic Acid

Conclusions 1. The intravenous test dose method for the determination of Vitamin C saturation in the body by the study of the urinary excretion eliminates the factor of uncertain absorption of the ascorbic acid from the gastro-intestinal tract, but the problem of faulty kidney elimination remains. 2. In order to properly evaluate this factor a study of the blood curve for possible renal retention is essential. 3. A test is outlined which permits a more complete study of Vitamin C saturation. 4. Results illustrating certain types of curves obtained with and without renal retention are presented and interpreted. Thus far retention of Vitamin C has been noted in patients with marked nitrogenous retention only. 5 . All patients with nitrogenous retention do not have Vitamin C retention, but renal retention of Vitamin C may occur. To our knowledge this has not been demonstrated before.

Selective Filtration of Vitamin C by the Placenta

Summary 1. Additional data are presented to demonstrate the selective action of the placenta in filtering vitamin C from the maternal body. 2. Although this selectivity tends to take place at all levels of deficiency or saturation, latent scurvy may be present at birth, as the level of vitamin C in the placenta is, in the final analysis, dependent upon the maternal reserves of this substance. The vitamin C used in these studies was Cebione, supplied through the courtesy of Merck and Company, Rahway, New Jersey.

Deproteinated pancreatic extract (depropanex): II. Effect of intravenous administration in rabbits

Abstract In utilizing any therapeutic agent, the most efficacious method of administration is naturally desired. In the use of pancreatic extracts, intravenous administration has been associated with unfavorable reactions in the past. N. W. Barker and R. W. Graham 1 stated that when pancreatic extracts were injected intravenously into animals, toxic effects were noted. J. B. Wolffe. 2 similarly, has warned against the intravenous administration of these extracts. However, with the development of deproteinated pancreatic extract, which is practically protein-free, as well as free of insulin, histamine, and acetylcholine, the possibility of intravenous administration was considered more favorably. The present study was instituted in order to note the effects of large amounts of deproteinated pancreatic extract when administered intravenously to rabbits.

The effect of acetyl-b-methlyl choline (Mecholyl) on the gastric secretion in animals and in man

1. There was no outpouring of mucinous, alkaline gastric secretion in 6 rabbits after subcutaneous injections of 2 and 4 mgm. of mecholyl chloride. 2. There is no marked change in the free and total acid of the gastric contents in rabbits after these dosages but because of large amounts of solid gastric residue these figures are not wholly accurate. 3. In 3 cats no free hydrochloric acid was present in the fasting gastric specimen nor did any appear after subcutaneous injections of 2, 4 and 10 mgm. of mecholyl chloride. 4. When proper care is taken to prevent the swallowing of saliva there is no marked change in character in the gastric secretions in human subjects following the subcutaneous injection of 25 mgm. of mecholyl chloride. 5. There is in most instances a slight to marked rise in free and total acidity following such an injection. 6. There is a marked increase in flow of saliva which becomes mucinous and more alkaline. 7. The accidental swallowing of less than one-half of the saliva more than neutralizes the rise in gastric acidity and the purposeful swallowing of the entire amount is suggested as a possible therapeutic measure in cases of hyperacidity.