Oscar Wilkinson
1912 Journal of the American Medical Association  
early in the course of paralysis does not in the monkey inoculated intraeerebrally with a highly active virus In ing about an arrest of the progress of the disease. The life-saving action of the epinephrin is shown in the case of the moribund animals, in which life was prolonged either for several hours or for several days by the restoration of the failing respiratory function. Finally, the effects of epinephrin in the experimental poliomyelitis support, the view that a state of hyperemia of
more » ... blood-vessels attended by an exudation of plasma and probably of cells also precedes the severer state of destruction of nerve-cells and interstitial tissue of the spinal cord. They indicate further that subdural injections of epinephrin in proper doses may be found capable of averting in human beings, the subjects of ascending forms of poliomyelitis, a fatal issue through the involvement, in the extending byperemia and inflammatory edema, of the nerve-cells Erom which the phrenic nerves take their origin. Should this temporary interruption of the active pathologic process coincide with the natural limitation of the disease, even life may be spared. The experiments do not indicate that epinephrin itself contributes in any way to the promotion of the limitation of Uie lesions. Epiiicphi in is not a curative drug in the sense that it acts on and neutralizes the poliomyelitic virus. Any favorable effect that it may produce results from its action on the blood-vessels and the consequent control of exudation. During the month of November, 1911, a case was brought to the female medical ward of the Metropolitan Hospital. The patient was a colored woman, aged 57; her family history was negative. The patient's personal history was practically negative, with the exception of having had variola fourteen years ago. Physical examination showed the very ear-marks of pulmonary tuberculosis; hence the patient was transferred to the service of Dr. W. S. Mills of the tubercular division. All laboratory manipulations failed to reveal the tubercle bacillus. Repeated examination of the sputa, etc., proved negative for tubercle bacilli. R\l=a^\les, distant bronchial breathing and, on percussion, cavity formation, or what appeared to be such, could be plainly mapped cut. The patient was treated in the regular routine manner as are all patients of a similar malady in this hospital and she appeared to be improving, while her dyspnea, at times, would show signs of disappearing. The patient died Jan. 14, 1912. A post-mortem examination, performed, with my assistance, by Prof. .lohn 11. Larkin of Columbia University, revealed remarkable pathologic findings. Dr. Larkin, pathologist to the City Hospital for a number of years, believes this to be the second case of its kind from over 10,000 post-mortems that he has performed, In this instance, not even the ordinary and usual calcified and healed tuberculous areas that are so common in the average postmortem examinations were found. The primary condition was ondotheliomu of the pleura with metastasis to most, if not all, of the viscera of the body. Autopsy.-Heart: Musculature in the left ventricle showed a metastatic nodular growth measuring about 2 mm. Lungs: Both apices were transformed into hard nodular masses; certain areas showed disintegration and that of the lower right lobe posteriorly showed nodular growth invading the pleura. No tuberculous areas were found in cither lung. Liver showed a number of nodular metastatic growths in the active stage of disintegration. Kidneys showed several metastatic growths, the pelves of both being involved; other viscera, etc., gave negative Undings. Anatomie Diagnosis.-Primary eiidotlielionia of the pleura with invasion of the upper lobe of the right lung, tumors showing active disintegration. Metastatic eiidotlielionia of the liver and kidneys and metastatic growtli in the septum of the left ventricle of the heart.
doi:10.1001/jama.1912.04270080051018 fatcat:omkbko257nfx3apvl765nh5egq