Victor C. Myers

Aluminum hydroxide in the treatment of peptic ulcer

1. Symptoms of peptic ulcer rapidly are brought under control with colloidal aluminum hydroxide therapy.

Creatine, Potassium and Phosphorus Content of Cardiac and Voluntary Muscle.∗

The study of the creatine content of human voluntary and left and right ventricular cardiac muscle, carried out by Seecof, Linegar and Myers, 1 has been extended to include determinations of potassium and phosphorus. It is evident from the studies of Fiske and Subbarow 2 and others that in resting muscle creatine exists largely as phosphocreatine. It is likewise evident that this compound must be bound to some base, and this would appear to be largely, if not wholly, potassium. At about the time we began our original study on the creatine of heart muscle, Calhoun, Cullen, Clarke and Harrison 3 pointed out that a diminished potassium content of heart muscle was invariably present in failing ventricles and suggested that this change may have been a contributing cause of such failure. Linegar and Myers 4 noted that the creatine concentration also drops in heart failure and would appear to parallel very closely the observations of the Vanderbilt investigators on potassium. It was then suggested that this drop in potassium and creatine may represent 2 phases of the same process. Studies have now been carried out on 72 human autopsy cases in which potassium and phosphorus have been estimated in addition to the creatine. Since the cases were complicated by wide variations in diagnosis, it seemed advantageous to group them according to heart weights, excluding cases with nitrogen retention, which may cause elevated creatine values. The data studied were compiled from 44 hearts ranging in weight from 200 to 825 gm., comparable changes being found in both left and right ventricular muscle. It was noted that as the heart weight progressively increases there was a diminution in the concentration of the 3 constituents, creatine, potassium and phosphorus, the ratio of the average decrease being 3 :2 :1 respectively.

The relative importance of the intestine and kidneys as excretory channels

Despite the fact that during the past twenty years a number of investigators have attempted to dispel the popular notion that the intestine, in comparison with the kidney, is relatively unimportant as an excretory channel, this rôle of the intestine would not appear to be properly appreciated. In connection with a study of metabolism in pellagra, 1 which we made several years ago under the auspices of the Thompson Pellagra Commission, fairly complete analyses of both the urine and feces were carried out. Thirteen subjects were studied. A lacto-vegetarian diet was employed, the experimental period extending from seven to ten days. Data on the water, nitrogen, sulfur, chlorine, phosphorus, calcium, magnesium and potassium outputs were obtained on both the urine and the stools, furnishing an interesting comparison of the kidneys and intestine as excretory channels. It is not believed that the findings differed especially from the normal, except in that group of cases which suffered from intestinal diarrhea. The average findings in five cases with well-formed stools, 74 to 79 per cent. moisture, and those with diarrheal stools, 79 to 89 per cent. moisture, have been grouped separately in the table below. An inspection of the table shows that in the first group of cases the total nitrogen and total sulfur parallel each other very closely, as probably might be expected from their common origin (protein). With diarrhea sulfur does not appear to be quite as well absorbed as the nitrogen. Although normally very little chloride is eliminated by the intestine, the amount found in the stools may be considerably increased in diarrhea. About one third of the total phosphorus output of the intestine and kidney is found in the stools. The percentage output in the feces of both calcium and magnesium is high, due, as we believe, to the lactovegetarian diet, which resulted in a poor absorption of compounds of these elements.

Observations on the excretion of an acid urine in alkalosis.

It has been customary to use the reaction of the urine as a guide to the therapeutic administration of sodium bicarbonate. In their most recent discussion of the subject Palmer, Salvesen and Jackson 1 state that the first significant effect on the pH of the urine, i. e., a rise to pH 7.0, can be taken as a safe and reliable guide for discontinuing alkali administration. This is probably true in the great majority of cases, but we believe that occasionally cases are encountered which do not readily excrete alkali, and that in such instances the reaction of the urine is not a safe criterion. We can record observations on two cases where the reaction of the urine remained strongly acid despite the development of an alkalosis. The data are self explanatory.

Variations in the enzymatic activity of duodenal contents. Preliminary report.

A system of enzyme analysis has been developed which permits an accurate estimation of the proteolytic, lipolytic and amylolytic activity of the enzymes of duodenal contents. When this system of analysis is applied to duodenal contents secured after stimulating pancreatic secretion with olive oil, it has been found possible to define the normal range of values with a reasonable degree of accuracy, and give these in terms of the normal taken as 100. Employing this method of recording the enzyme activities to pathological cases, abnormal values stand out very clearly from the normal. Very low values are found in pancreatitis and certain other conditions, while subnormal values are encountered in various gastro-intestinal disorders which may have an effect on the pancreas. In diabetes the enzyme activity may be subnormal, or considerably elevated.

Blood Regeneration in Nutritional Anemia. Influence of Iron, Iron and Copper, Nickel, Cobalt, Germanium, or Sodium Germanate.

Young rats were made anemic by feeding whole milk for a period of 6 weeks after weaning. When the erythrocyte count was about 3-4 million per cu. mm., and the Hb content 4-6 gm. per 100 cc., additions of Fe, Fe + Cu, Fe + Ni, Fe + Co, and Fe + Ge, Fe + Na2GeO3 were made. Erythrocyte counts and Hb estimations were made weekly on a few drops of blood obtained by clipping the end of the tail. A Levy counting chamber with double Neubauer ruling was used. Hb determinations were made by the acid hematin method, color comparison being made with a calibrated Newcomber disc. The results are summarized in the table. When 0.5 mg. Fe was given daily to anemic rats recovery of both erythrocytes and Hb was complete in 4.3 and 6 weeks; with 1 mg. the time for recovery was 3.5 and 4.8 weeks; and with 1.5 mg. it was 3.5 and 3.7 weeks, respectively. Since this iron solution was prepared from standard iron wire using hydrochloric and nitric acids, it would hardly seem that the effect of iron salts, as FeCl3, in blood regeneration could be due to the impurities these salts might contain, as Hart and coworkers suggest. 1 Mitchell and coworkers 2 had previously shown that some iron salts, e. g., FeCl3, were effective in blood regeneration in rats fed whole milk diets. Our results seem to confirm those of Mitchell in respect to this one iron salt. The experiments also appear to confirm those of Hart and his coworkers 3 on the supplementing action of copper when added to iron, but do not indicate that copper is unique in this respect. The data in the table show that traces of copper, nickel, cobalt, germanium and sodium germanate plus 0.5 mg. Fe all brought about regeneration of erythrocytes and hemoglobin in less time than did 0.5 mg. iron alone. A number of other elements have been studied.

Studies on the amylolytic activity of human saliva with a new method

Saliva is the one glandular secretion which can be readily obtained in the human subject under relatively constant conditions, and its amylolytic activity has therefore been a time-honored topic of investigation. Nevertheless the methods used for estimating this activity have been rather crude or tedious. A method is described below which is simple, delicate, and, we believe, very accurate. With it a large series of comparable figures may readily be obtained. The method is similar to that which has been employed here in estimating the diastatic activity of the blood. 1 The technique is as follows: A specimen of mixed saliva, obtained by the stimulation of paraffin chewing, is filtered and a small portion accurately diluted 1 to 100 with distilled water, and also another portion with 0.3 per cent. sodium chloride as an activating solution. After thorough mixing 1 c.c. of the diluted saliva is pipetted into a test-tube and the tube placed in a water bath at 40°. After 5 minutes 1 c.c. of 1 per cent. soluble starch solution is added and the mixture allowed to incubate for 30 minutes. At the end of this time 3 c.c. of saturated picric solution and 1 c.c. of 20 per cent. sodium carbonate are added and the tube placed in boiling water for 15 to 20 minutes. It is then allowed to cool and diluted with distilled water in an accurately graduated cylinder until the intensity of the color approximates that of the standard (glucose in picric acid treated with sodium carbonate and heated), after which it is compared with the standard in the calorimeter. After correcting for the reducing power of the soluble starch, the activity is recorded in terms of the percentage of starch converted to reducing sugar.

A micro colorimetric method of estimating the hydrogen ion concentration of the blood

A discussion of the bicolorimetric principle was first presented to this Society in November, 1921, 1 at which time we had the present work in mind. The method described below is essentially an adaptation of the colorimetric method of Cullen 2 for the determination of the PH of the blood plasma (or serum) to the bicolorimeter described by one of us. 3 As modified the final determination is carried out on 0.1 c.c. of plasma, and does not require more than 10 minutes after the blood has been obtained. The color comparison can be made with an accuracy of ± PH 0.02. Blood is drawn without stasis in a narrow 5 c.c. Luer glass syringe containing sufficient mineral oil to fill any air spaces, and is at once delivered into a centrifuge tube of special design under oil. This tube is made of Pyrex glass and has at the bottom a bulb of 2 c.c. capacity (30 mm. in length with an internal diameter of 11 mm. and a neck of 4 mm.). Tubes with bulbs of 1 and 5 c.c. capacity have also been used, the latter being employed when a simultaneous estimation of the CO2 content of the plasma is to be made. One drop of neutral 20 per cent. potassium oxalate is dried in the tube, after which three drops of mineral oil are added. In transferring the blood from the syringe to the centrifuge tube, the point of the needle is placed under the oil and sufficient blood delivered to bring the oil into the neck of the bulb. With the slight pressure exerted the blood readily takes up the oxalate and does not clot. The tube is centrifuged at moderate speed for about two minutes to separate the plasma.

Carotenemia. Its influence on the validity of the icteric index.

In a paper with Hess 1 one of us called attention to the occurrence of carotenemia. At the time it was pointed out that this might in certain cases cause confusion with icterus. Later it was observed that the carotenemia might be very intense in diabetic patients on the high vegetable diet of the time. It is obvious that carotene must exert some influence on the icteric index of the blood, a fact which has been appreciated by most of the workers in this field. Fiessinger, Walker and Thierry 2 from their work felt that the effect was negligible, Boeck and Yater 3 found that carotene accounted for from 10 to 55% of the icteric index, while White 4 concluded that the influence was negligible except in marked cases of xanthemia accompanying diabetes. The subject has been reinvestigated on 161 patients, 75 of whom were suffering from diabetes mellitus, the carotene being determined in terms of the icteric index (lipochrome index) and in mg. per 100 cc. of serum. In 43 diabetic cases on which icteric indices were determined carotenemia was found to account for an average of 45% of the corresponding icteric indices, the extremes being 19.3 and 70.5%. The average icteric index was 7.1. The average lipochrome index for the 75 diabetic patients was 3.4, corresponding to an average carotene content of 0.25 mg. per 100 cc. of blood. The average lipochrome index for the 86 non-diabetic patients was 1.7 with an average of 0.11 mg. carotene per 100 cc. of blood. In 10 of these cases with icteric indices below 10, carotenemia was responsible for an average of 20.6% of the corresponding icteric indices, while in 21 cases with icteric indices between 10 and 100 it averaged 8.6% and in 6 cases with icteric indices above 100 the lipochrome indices averaged only 1.2% of the corresponding icteric indices. From the above findings it would not appear that carotenemia alters the validity of the icteric index except in cases of marked carotenemia such as may be found in some diabetic patients, and then only if the icteric index is quite low.

On the Presence of Aluminum in Blood.

The question of the absorption of aluminum by the blood and its presence in other body tissues is one of considerable interest. A few figures have been reported for the dog, but they possess little value for the reason that the methods used were inadequate to estimate the very small amounts of aluminum found. Several very delicate color reactions for aluminum have recently been described. After considerable effort we have been able to utilize one of these reactions, that with aurin described by Hammett and Sottery, 1 for the estimation of small amounts of aluminum in biological material containing iron. Since the amounts of iron left by the ordinary means of separation give a color very similar to that of aluminum, it must be removed more completely. The presence of iron has, however, been utilized to advantage in carrying down aluminum in the first precipitation. For this reason it is necessary to add iron when it is absent. The method employed for blood is carried out briefly as follows: 5 cc. of blood are digested in a large Pyrex test tube over a micro burner with 2 cc. of sulfuric acid and 3 cc. of perchloric acid, until oxidation is complete. This requires less than 15 minutes. The digestion mixture is diluted with a little distilled water and transferred quantitatively with washing to a smaller Pyrex test tube, the volume being made up to about 15 cc. One cc. of saturated ammonium acetate is now added and the solution made alkaline with conc. ammonium hydroxide. The tube is placed in a vigorously boiling water bath until the excess of ammonia is expelled. The precipitate, which at first has tendency to rise, will settle out on shaking.