PAROXYSMAL TACHYCARDIA.
1
89 PAROXYSMAL TACHYCARDIA.-GLANDULAR THERAPY. of diseased potatoes available from the harvest." " I never saw in school," Dr. Miller adds, " so many children who were not fit to be there, either tempted out by the provision of a midday meal or forced out for want of a sick certificate.... It is not recommended that gymnastics be taught indiscriminately to Lewis country children. Many of the children are fit to take part and would greatly benefit; on the other hand, many have too far to walk to school, and are tired. The exertion of the school day takes a good deal out of under-nourished children." Various relief funds came to the help of the islanders last year, , giving a midday meal and clothing to necessitous children, and offers of help have been renewed this year, but the trouble, though immediately relieved by such kindly measures, calls for deeper remedy. They are a proud people, too, and require careful handling, but even so, it should not be past the wit of man to devise some practical and acceptable means of helping them to help themselves. We must not forget that Lewis responded as one man to the call to arms at the very beginning of the late war. Many of the men were killed, and in her report Dr. Miller draws attention to the fact that the best-fed and best-clothed children are the children of war widows. PAROXYSMAL TACHYCARDIA. Paroxysmal tachycardia is often regarded as a functional disorder of the heart. Dr. John Parkinson described it as the best example of such at the Ottawa meeting last year 1 and was taken to task for doing so by Dr. A. Graham-Stewart and others in our own columns. Can a " functional " disease kill ? was the burden of this correspondence. A valuable paper on Paroxysmal Tachycardia, with Special Reference to Prognosis, by Dr. F. A. Willius and Dr. Arlie R. Barnes, of the Mayo Clinic, Rochester, Minnesota, affords the opportunity of returning to the subject. The authors give the results of observations on a series of 102 cases which were seen in the cardiac department of the Mayo Clinic between 1914 and 1923.2 The authors define simple paroxysmal tachycardia as a condition in which, from time to time, the normal mechanism is interrupted by a series of rapid irregular beats varying in rate between 100 and 200 each minute, the series starting and ending abruptly. The 102 cases were divided into four groups as follows : 1) 36 cases of nodal tachycardia which were sub- divided into five cases in which the P.-R. interval was diminished, 28 cases in which the P.-R. interval was zero, and 3 cases in which there was an E,.-P. interval ; (2) 7 cases of auricular tachycardia ; (3) 6 cases of ventricular tachycardia ; and (4) 53 cases of auricular flutter. All the cases were carefully examined, and were all verified by electrocardiographic tracings taken during the attacks. The clinical picture of the condition is well known, the most important characteristic being its sudden onset and abrupt cessation. In the symptomatology, the authors give prominence to vertigo, which was associated with the attacks in 18 cases, 15 of which were male patients and 3 female. Eleven of the patients were over 49 years of age and the incidence of arterio-sclerosis and hypertension was high. Stress is laid on the strong probability of cerebral arterio-sclerosis acting as a .determining factor in the occurrence of vertigo .associated with paroxysmal tachycardia-a point that has hitherto received little attention-and it is urged that a history of attacks of tachycardia should be carefully excluded in dealing with an elderly patient who complains of vertigo, especially if evidences of arterio-sclerosis are present. Besides vertigo there were other manifestations of cerebral anæmia. Five patients had syncope during attacks, two were delirious, one had epileptiform seizures, three had spells of unconsciousness in their paroxysms, and three said that everything became black before their ,eyes. One patient complained of numbness and 1 THE LANCET, 1924, ii., 481. 2 Boston Medical and Surgical Journal, 1924, cxci., 666. another became aphasic during a paroxysm. In 40 cases in which the date of onset was noted, the average time during which the attacks had occurred was 12 years. In three cases the attacks had recurred over a period of 40 years or more, the longest period being 43 years. In considering prognosis, the after-histories of 84 cases of the 102 seen in the clinic were obtained. This large number is noteworthy, as unless the percentage of after-histories is high, they are of little prognostic value. From the data furnished by the circularised questionnaire, the authors conclude that attacks of paroxysmal tachycardia do not appear to have contributed much to cardiac failure or to incapacity. The death-rates were high in cases of paroxysmal tachycardia associated with aortic and coronary disease (57 per cent.) and with endocarditis (46 per cent.). The final conclusion is that the estima- tion of the prognosis of paroxysmal tachycardia depends very largely on the estimation of the type and degree of the underlying cardiac damage. This conclusion is a reasonable one which might command general acceptance. ____ GLANDULAR THERAPY. ECONOMISTS are fond of talking about the laws of supply and demand and, within certain limits, an increased demand produces an increased supply. During the last few years the tremendous increase in glandular therapy has led to a demand for prepara- tions of the various ductless glands, and the huge supply which has resulted shows no signs of the shortage which economically one would be led to expect when dealing with animal products. It has been said that if the parathyroid glands of all the animals in the world were added together they would not equal the quantity in the market, but this is probably a n exaggerated statement which in any case would be difficult to prove. If we except insulin, pituitary gland extracts probably re- present the most success- ful and satis- factory of the preparations of the ductless glands. Now the anterior lobe of the human pituitary in an adult weighs on an average about one-third of a gramme. The usual weight given for the whole gland is 0-5 g., and the anterior lobe forms about two-thirds of this. The usual preparations of the anterior lobe contain five grains, " representing this weight of fresh glandular substance," or almost exactly the weight of the whole anterior lobe in the human subject. The quotation given above is taken from a pamphlet recently issued by Oxo, Ltd., on the pituitary gland, and a picture in this pamphlet of a bottle containing 100 tablets, each consisting of 5 gr. of the pituitary of the ox, makes it of interest to know the size and weight of the bovine pituitary gland. It is perhaps to dispel the distrustful suggestions contained in the above remarks that the pamphlet includes a picture of the pituitary gland of man compared with that of the common hump-backed whale. The endocrine sceptic would probably prefer to see the gland of an ox used for comparison purposes, and perhaps in future editions of these interesting booklets in the " Oxoid" series, dealing with the various glandular products of this reputable firm, pictures of the ductless glands of the bovine species will be introduced. The guarantee of " quality, potency, uniformity, and reliability " of these prepa,ra-
Transcript of PAROXYSMAL TACHYCARDIA.
89PAROXYSMAL TACHYCARDIA.-GLANDULAR THERAPY.
of diseased potatoes available from the harvest."" I never saw in school," Dr. Miller adds, " so manychildren who were not fit to be there, either tempted outby the provision of a midday meal or forced out forwant of a sick certificate.... It is not recommendedthat gymnastics be taught indiscriminately to Lewiscountry children. Many of the children are fit totake part and would greatly benefit; on the otherhand, many have too far to walk to school, and aretired. The exertion of the school day takes a good dealout of under-nourished children." Various relieffunds came to the help of the islanders last year, ,giving a midday meal and clothing to necessitouschildren, and offers of help have been renewed this year,but the trouble, though immediately relieved by suchkindly measures, calls for deeper remedy. They are aproud people, too, and require careful handling, buteven so, it should not be past the wit of man todevise some practical and acceptable means ofhelping them to help themselves. We must not forgetthat Lewis responded as one man to the call to armsat the very beginning of the late war. Many ofthe men were killed, and in her report Dr. Miller drawsattention to the fact that the best-fed and best-clothedchildren are the children of war widows.
PAROXYSMAL TACHYCARDIA.
Paroxysmal tachycardia is often regarded as a
functional disorder of the heart. Dr. John Parkinsondescribed it as the best example of such at the Ottawameeting last year 1 and was taken to task for doing soby Dr. A. Graham-Stewart and others in our owncolumns. Can a " functional " disease kill ? was theburden of this correspondence. A valuable paper onParoxysmal Tachycardia, with Special Reference toPrognosis, by Dr. F. A. Willius and Dr. Arlie R. Barnes,of the Mayo Clinic, Rochester, Minnesota, affords theopportunity of returning to the subject. Theauthors give the results of observations on a seriesof 102 cases which were seen in the cardiac departmentof the Mayo Clinic between 1914 and 1923.2 Theauthors define simple paroxysmal tachycardia as acondition in which, from time to time, the normalmechanism is interrupted by a series of rapid irregularbeats varying in rate between 100 and 200 eachminute, the series starting and ending abruptly. The102 cases were divided into four groups as follows :1) 36 cases of nodal tachycardia which were sub-divided into five cases in which the P.-R. interval wasdiminished, 28 cases in which the P.-R. intervalwas zero, and 3 cases in which there was an E,.-P.interval ; (2) 7 cases of auricular tachycardia ;(3) 6 cases of ventricular tachycardia ; and (4) 53 casesof auricular flutter. All the cases were carefullyexamined, and were all verified by electrocardiographictracings taken during the attacks. The clinicalpicture of the condition is well known, the mostimportant characteristic being its sudden onset andabrupt cessation. In the symptomatology, the authorsgive prominence to vertigo, which was associated withthe attacks in 18 cases, 15 of which were male patientsand 3 female. Eleven of the patients were over49 years of age and the incidence of arterio-sclerosisand hypertension was high. Stress is laid on the strongprobability of cerebral arterio-sclerosis acting as a.determining factor in the occurrence of vertigo.associated with paroxysmal tachycardia-a pointthat has hitherto received little attention-and it isurged that a history of attacks of tachycardia shouldbe carefully excluded in dealing with an elderlypatient who complains of vertigo, especially ifevidences of arterio-sclerosis are present. Besidesvertigo there were other manifestations of cerebralanæmia. Five patients had syncope during attacks,two were delirious, one had epileptiform seizures, threehad spells of unconsciousness in their paroxysms, andthree said that everything became black before their,eyes. One patient complained of numbness and
1 THE LANCET, 1924, ii., 481.2 Boston Medical and Surgical Journal, 1924, cxci., 666.
another became aphasic during a paroxysm. In40 cases in which the date of onset was noted, theaverage time during which the attacks had occurredwas 12 years. In three cases the attacks had recurredover a period of 40 years or more, the longest periodbeing 43 years.
In considering prognosis, the after-histories of 84cases of the 102 seen in the clinic were obtained.This large number is noteworthy, as unless thepercentage of after-histories is high, they are of littleprognostic value. From the data furnished by thecircularised questionnaire, the authors conclude thatattacks of paroxysmal tachycardia do not appear tohave contributed much to cardiac failure or toincapacity. The death-rates were high in cases ofparoxysmal tachycardia associated with aortic andcoronary disease (57 per cent.) and with endocarditis(46 per cent.). The final conclusion is that the estima-tion of the prognosis of paroxysmal tachycardiadepends very largely on the estimation of the typeand degree of the underlying cardiac damage. Thisconclusion is a reasonable one which might commandgeneral acceptance.
____
GLANDULAR THERAPY.
ECONOMISTS are fond of talking about the laws ofsupply and demand and, within certain limits, anincreased demand produces an increased supply.During the last few years the tremendous increase inglandular therapy has led to a demand for prepara-tions of the various ductless glands, and the hugesupply which has resulted shows no signs of theshortage which economically one would be led toexpect when dealing with animal products. It hasbeen said that if the parathyroid glands of all theanimals in the world were added together they wouldnot equal thequantity inthe market,but this isprobably a n
exaggeratedstatementwhich in anycase would bedifficult toprove. If weexcept insulin,pituitarygland extractsprobably re-
present themost success-
ful and satis-factory of the preparations of the ductless glands.Now the anterior lobe of the human pituitaryin an adult weighs on an average about one-thirdof a gramme. The usual weight given for thewhole gland is 0-5 g., and the anterior lobe formsabout two-thirds of this. The usual preparations ofthe anterior lobe contain five grains, " representingthis weight of fresh glandular substance," or almostexactly the weight of the whole anterior lobe in thehuman subject. The quotation given above is takenfrom a pamphlet recently issued by Oxo, Ltd., on thepituitary gland, and a picture in this pamphlet of abottle containing 100 tablets, each consisting of 5 gr.of the pituitary of the ox, makes it of interest to knowthe size and weight of the bovine pituitary gland.It is perhaps to dispel the distrustful suggestionscontained in the above remarks that the pamphletincludes a picture of the pituitary gland of man
compared with that of the common hump-backedwhale. The endocrine sceptic would probably preferto see the gland of an ox used for comparison purposes,and perhaps in future editions of these interestingbooklets in the " Oxoid" series, dealing with thevarious glandular products of this reputable firm,pictures of the ductless glands of the bovine specieswill be introduced. The guarantee of " quality,potency, uniformity, and reliability " of these prepa,ra-
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