THE SUGAR CONTENT OF THE BLOOD IN CERTAIN DISEASES OF THE SKIN
Journal of the American Medical Association
In 1896 Flexner1 reported an ameba found in artificially obtained pus from an abscess on the floor of the oral cavity. Doflein,2 in 1901, observed a similar ameba in an abscess with fistulas opening on the right lower jaw. The latter case resembled, somewhat, the following, although there are certain differences in the two parasites observed: History.\p=m-\E.W., a negro woman, aged 23, servant, admitted to the Roper Hospital in Charleston, April 20, 1915, beginning about one year before had
... year before had frequent attacks of toothache. The lower jaw on the left side began to swell about a month previous to admission, when she exhibited a hard nonmovable tumor the size of a hen's egg attached to the inferior maxilla. Nothing abnormal was noted in the mouth or throat. The cervical lymph nodes were palpable. The temperature, normal in the morning, went up to 99 and 100 in the evening. A diagnosis of osteosarcoma was made, and the left half of the mandible resected and sent to my laboratory. Examination of Specimen.-From articulation to canine tooth the bone was thick, with rough surface into which ran small clean-cut sinuses containing thick white granular pus. The thickening was most prominent about the middle of the body of the bone, where it was of tumorous appearance. Over this prominent portion on the outside was a hard fibrous mass attached to the bone and to the surrounding muscles. In this were several larger sinuses leading into the bone. Saw cut revealed the bone to be of a compact cancellous nature, like new growing bone, honeycombed with small pus sinuses. The first molar tooth was missing and the third was represented by a decayed root, level with the soft tissues of the gum. Microscopically, the composition of the tumor mass was of newly formed and forming bone trabeculae, fibrous tissue, mainly old, encroaching on surrounding muscle, lymphocytic infiltration, largely in localized foci, and small areas of necrosis and pus in which were rounded hyaline nonnucleated bodies somewhat larger than leukocytes. The appear¬ ance was that of inflammatory overgrowth of bone and con¬ nective tissue of a progressive nature, showing areas of necrosis and pus formation corresponding to the previously mentioned sinuses. Microscopic examination of the pus revealed no recog¬ nizable bacteria ; nor did animal inoculation give any results. It contained in addition to granular materials, neutrophilic leukocytes and a goodly number of eosinophils, some recog¬ nizable tissue cells, and numerous ameboid cells. These, when rounded, were about 40 microns in diameter, with a distinct clear ectoplasm and coarsely granular endoplasm of retractile bodies. No nucleus was recognizable. These cells were ameboid, throwing out, slowly, large broad single pseudopodia which were seen to engulf red blood cells and leukocytes. The cell moved from place to place by projecting one of these pseudopods into which the endoplasm flowed, it then becoming the body. Stained with Leishman's fluid, the cytoplasm was very faint, vacuolated, and contained red blood cells and fragments of leukocytes. No nucleus was observed. Unfortunately, these specimens were destroyed before I had completed my study of them or had opportunity to use other stains. That this ameba was not of those commonly found in the mouth was plain to me because of its size, was more active than those of amebic dysentery and developed long finger¬ like pseudopodia of apparently the same appearance as the protoplasm in general. Doflein conjectures that both his and Flexner's para¬ sites were dysenteric amebas?" although there was no history of dysentery in either case. Neither was there history of dysentery in the present instance, and the variance in morphology of the ameba connected with the history disputes such an opinion in this case. Since it is well known that diseases of the skin, such as furunculosis, occurring in various areas of skin are associated at times with a transient or even a permanent glucosuria, as in diabetes mellitus, and since it is known also that a hyperglycemia may be present, under certain conditions, even in the absence of a glucosuria, it occurred to me that it might be of interest to make investigations along these lines in certain dermatoses. It was intended to ascertain, if possible, any changes from the normal, in those conditions in which the cause, or underlying etiologic factor, was more or less unknown. The tests, therefore, were made merely to answer the question whether there was an increase or a decrease in the sugar content of the blood, compared with the normal. The cases were selected at random, but in practically all it could be assumed that there might be some disturbance in metabolism or some systemic disorder. The patients were selected from both sexes at the outpatient service of the Johns Hopkins Hospital, and nearly all were white adults. The blood was obtained, invariably from a vein in the forearm, approximately from one to three hours after the last meal eaten. This probably had some influence on the degree of glucose percentage. The urine was exam¬ ined in every instance.