Southern Society for Clinical Research 4.01 symptoms of gastric retention developed during the first several days of treatment and then sub- sided. Usual therapeutic dose has been 100 mg. every six hours emphasizing one dose during the middle of the night. Maintenance dose instituted after several weeks of treatment has been 50 mg. every six hours. Clinical results at present are remarkably encouraging. EFFECTS OF PYROGEN-INDUCED FEVER ON

CEREBRAL FUNCTION IN NEUROSYPHILIS.

Albert Heyman, M.D., and (by invitation) .yohn L. Patterson, Jr., M.D. and Fenwick T. Nichols, Jr., M.D. Atlanta, Ga. (From the

Departments of Medicine and Physiology,

Emory University School of Medicine,

and Grady Memorial Hospital.) The effects of pyrogen-induced fever on the

cerebral blood flow and oxygen consumption were determined, utilizing the nitrous oxide technic, in thirteen patients with asymptomatic neurosyphilis and fourteen patients with de- mentia paralytica. The mean elevation of tem- perature in both groups of patients was 3.9’~. Each patient was studied at normal body tem- perature and in the flush phase of fever.

In the patients with asymptomatic neuro- syphilis the mean cerebral blood flow and oxygen consumption were normal in the afebrile state and showed only minimal changes during fever. In the patients with dementia paralytica the mean cerebral blood flow and oxygen con- sumption, which were abnormally low in the afebrile state, increased by 30 per cent and 23 per cent, respectively, during fever.

It is concluded that during induced fever the brain in asymptomatic neurosyphilis does not share in the increases in cardiac output and total oxygen consumption which are known to occur. By contrast the brain in dementia par- alytica shares to some extent in the increases in both of these functions. The beneficial effect of fever therapy in dementia paralytica may have some relation to these findings. It is tentatively assumed that the normal brain has a response to fever similar to that of the asympto- matic patients. VITAMIN Blz AND PTEROYLGLUTAMIC ACID

DEFICIENCY IN MACROCYTIC ANEMIAS. [Jlfar Jonsson, M.D., (by invitation) and R. Wayne Rundles, M.D. Durham, N.C. (From

the Department of Medicine, Duke

I_Jniversity School of Medicine.) A series of observations suggests that the basic

SEP.I‘KX4RF.R. 1950

deficiency in pernicious anemia is different from that in other macrocytic anemias associated with megaloblastic erythropoiesis.

In patients with pernicious anemia followed for as long as one and one-half years vitamin Bls has duplicated in all respects the therapeutic results of liver extract. Incomplete responses and relapses such as occur with pteroylglutamic acid therapy have not occurred. Intrinsic factor has been shown to increase the absorption of B12 (extrinsic factor) in pernicious anemia. While pernicious anemia ordinarily develops only when intrinsic factor is absent, a patient was studied who had a macrocytic anemia, megalo- hlastic bone marrow, atrophy of lingual papillas and severe neurologic disease characteristic of pernicious anemia but who had abundant free HCl in the gastric contents. Assay showed in- trinsic factor to be present. All manifestations of the deficiency responded to B12 injections.

Of six infants with megaloblastic anemia. one failed definitely to respond to Blz but responded promptly to pteroylglutamic acid.

In an adult woman who used alcohol heavily nutritional macrocytic anemia developed that failed to respond in a month’s time to large amounts of liver extract intramuscularly. She responded rapidly to pteroylglutamic acid by mouth. An episode of nutritional macrocytic anemia developed in an alcoholic male for the third time while he was being given ordinarily adequate amounts of Blz and liver extract in- tramuscularly. He responded to pteroyl$utamic acid by mouth.

These observations are consistent with the hypothesis that pernicious anemia is due to B12 deficiency, however it arises, and other macro- cytic anemias are due to pteroylglutamic acid deficiency. Each compound may serve as a partial therapeutic substitute for the other. ADRENAL INSUFFICIENCY SIMULATING C:.~R-

DIAC DISEASE. Laurence H. Kyle, M.D. and Katharine Q. Knop, M.D. (introduced by Harold Jeghers, M.D.). Washington, D.C. (From the Departments of Medicine and

Pediatrics, Georgetown University School

of Medicine and the Georgetown Uni-

versity Hospital.) All three children in one family have shown

a similar clinical picture resulting in death. The first child, a ten-day old boy with “hypospadius and undescended testes,” began to vomit, be- came severely dehydrated and died. The cli-nical

402 Southern Society for Clinical Research

diagnosis was intestinal obstruction. The second child, a boy, showed similar symptoms at the same age. Because of marked bradycardia, a loud apical systolic murmur and electrocardio- graphic evidence of A-V and intraventicular block, a diagnosis of congenital septal defect was made. Autopsy revealed no cardiac lesion. The third boy was similarly affected. Bradycardia was prominent and the electrocardiogram was interpreted as showing auricular fibrillation and bundle block; after the administration of fluids the heart rate and electrocardiogram became normal. There was elevation of serum potassium and NPN with depression of sodium and chloride. Administration of desoxycorticosterone resuhed in marked clinical improvement and change of serum electrolytes to normal. Urinary 17-ketosteroids were elevated and 1 1-oxysteroids absent.

These children are believed to have had con- genital adrenal hypoplasia, a condition which frequently leads to adrenal failure. It is believed that this syndrome is frequently overlooked, especially in boys, clinical features being at- tributed to intestinal obstruction. Simulation of cardiac disease has not previously been noted. CONGENITAL IDIOPATHIC HYPOPROTHROM-

BINEMIA. Jessica H. LewiS, M.D. and John H. ~erg~so~, M.D. Chapel Hill, N.C. (From

the Department of Physioiogy, University of North Carolina Medical School.) Two patients, unrelated and of different sexes,

who had suffered from hemorrhagic manifesta- tions since infancy were found to have markedly prolonged prothrombin times (Quick), indicat- ing “prothrombin concentrations” of 1 to 2 per cent. In one patient, R. S., the coagulation time (37’~) was prolonged to eighty-eight minutes (glass) and three and a half hours (silicone), while in the other patient, M. T., the coagula- tion time was only slightly prolonged to thirteen minutes (glass) and forty-five minutes (silicone). Results of other hemostatic tests: bleeding time, platelet count, tourniquet test, clot retraction, plasma fibrinogen, serum antithrombin, ability to normalize hemophilic coagulation, absence of anticoagulant or progressive antithromboplastin were normal in both patients. Special studies were made of these “prothrombin” deficiencies by mixing the plasmas with aged plasma, dicu- marol@ plasma, BaS04 plasma and by adding Seeger’s bovine prothrombin and Ac-globulin. It was concluded that no deficiency of Quick’s labile factor existed in either case but that pro-

thrombin, probably Quick type B, was markedly diminished. Although both patients had re- ceived frequent small doses of synthetic water soluble vitamin K derivatives without apparent benefit, therapeutic trials of 1,000 mg. of synkayvite and 1,000 mg. of vitamin K-l oxide intravenously were made in one patient, M. T., and no shortening of prothrombin time was observed. EFFECTS OF BLEEDING IN DIFFERENT Pos-

TURES ON SODIUM EXCRETION AND GLO- MERULAR FILTRATION. Thomas Lombardo, M.D. and William Viar, M.D. (introduced by T. R. Harrison, M.D.). Dallas, Tex. (From the Department of Internal Medi- cine, Southwestern Medical College.) Minimal bleeding (ZOO cc.) in the sitting

posture caused definite decline in sodium excre- tion without change in glomerular filtration. Bleeding Iarger volumes in the recumbent or Trendelenburg positions caused temporary de- cline in glomerular filtration in most of the subjects. The decline in sodium excretion was maximal two to three hours after the filtration rate had returned to normal. The alterations in sodium excretion are therefore to be ascribed to changes in tubular activity. EFFECTS OF BANTHINE ON GASTRIC SECRE-

TIONS AND GASTROINTESTINAL MOTILITY IN MAN. C. Keith Lyons, M.D. (by invi- tation) and Keith S. Grimson, M.D. Durham, JV.C. (From the Department of Surgery, Duke University Schooi of Medicine.) Banthine, a quaternary ammonium com-

pound, beta-diethylaminoethyl xanthene 9- carboxylate methobromide, has been tested in 120 patients in studying effects of 100 or 200 mg. by intravenous, intramuscular or oral adminis- tration and comparing effects with those of atropine or dibutoIine. As judged by gastro- metric balloon methods and by roentgeno- graphic study, banthine given intramuscularly eliminated or effected a marked reduction of peristalsis lasting several hours. Atropine intra- venously or intramuscularly produced a less consistent reduction lasting around half an hour but dibutoline effected for an hour as complete a cessation of activity as banthine. Banthine given orally produced marked reduction or elimination of peristalsis lasting several hours; whereas, atropine orally effected only slight temporary changes and dibutoline orally was not effective.

AMERICAN JOURNAL OF‘ MEDICI?GF.