AMERICAN HEART ASSOCIATION, INC. -...

AMERICAN HEART ASSOCIATION

of technics of the two-stage method is provided byFerguson.The application of zeta-potential measurements to

the study of blood coagulation is reported by Wood.Like the transactions of the two preceding con-

ferences, this book has the most valuable feature offrank, informal exchange of opinion between re-

search investigators, some of whom in their publi-cations hardly seem even to speak the same lan-guage. Under these circumstances, the coherenceand readability of the transactions are altogetherremarkable, and are greatly to the credit of theeditor.

FRANK D. MANN, M.D.

AMERICAN HEART ASSOCIATION, INC.1775 BROADWAY, NEW YORK 19, N. Y.

Telephone Plaza 7-2045

AMA EXIBITThe Association will be represented at the

Annual Meeting of the American MedicalAssociation in Chicago, June 9 to 13, by severalexhibit booths and a series of daily "Questionand Answer" sessions on various phases ofheart disease.The exhibit will be presented in conjunction

with the Illinois and Chicago Heart Associa-tions and will demonstrate how the associationsaid the physician in the prevention, diagnosis,treatment and management of the cardiovascu-lar diseases. There will be a visual summaryillustrating highlights of the achievements ofthe Association's research support program.Publications issued by the Association, whichare designed to help the physician, also will bedisplayed.The new series of heart models produced by

the Association as visual aids in the under-graduate and postgraduate education, as wellas for the teaching of fluoroscopy, will also beexhibited.

STIPEND INCREASESThe Research Committee of the Association's

Scientific Council recently voted to increase thestipends granted to Research Fellows and Es-tablished Investigators. Under the new scale,Research Fellows will start at $3,500 with in-

crements to reach a maximum of $5,500, andEstablished Investigators will be started at$6,000, with increments up to a total of $9,000.

NEW AFFILIATE

The Board of Directors of the Associationhas approved the affiliation of the MississippiHeart Association.

HEART BULLETIN

The first issue of the bimonthly Heart Bul-letin, designed particularly for the physicianin general practice, appeared in March.The bulletin is published by the Medical

Arts Publishing Foundation of Houston, a non-profit service organization affiliated with theUniversity of Texas.

Paul D. White, M.D., Boston, is Chairmanof the Advisory Board, members of which wereselected in cooperation with the Associationand the National Heart Institute. R. Lee Clark,Jr., M.D., is the editor.The Bulletin is available through subscrip-

tions purchased by a local or state agency-anaffiliated Heart Association, State Medical So-ciety, or State Health Department-for thephy-sicians in the state.

This bulletin does not duplicate any publica-tion of the Association.

500

CIRCULATION-THE JOURNAL OF THE AMERICAN HEART ASSOCIATION

~~~~~~~..............

congeStive

heart

fCiure.

"Aminophyllin may be given in the form of rectal sup-positories... both for its diuretic effect and for its broncho-dilating action, which relieves dyspnea."

Orgain, E. S.: The Treatmentof Congestive Heart Failure, NorthCarolina M. J. 8:125 (March) 1947.

As a diuretic and myocardial stimulant for the relief of pulmonary edema or paroxysmaldyspnea of congestive heart failure and as a bronchodilator in bronchial asthma, SearleAminophyllin has proved itself an efficient therapeutic agent.

For rectal administration, Searle Aminophyllin is available in the form of nonirritating,promptly disintegrating-

SEARLE 4AMINOPYL NSUPPOSICONES®500 mg. (7½ grains)

Searle Aminophyllin is also available in ampuls, powder andtablets. Uncoated tablets are identified by the imprint SEARLE.

SEARLERESEARCH IN THE SERVICE OF MEDICINE

*Contains at least 80% of anhydrous theophylline.G. D. Searle & Co., Chicago 80, Illinois.

xXWX


HEART DISEASE IN PREGNANCY

A. MORGAN JONES, M.Sc., M.B., F.R.C.P.

Deputy Director of the Department of Cardiology, Lecturer in Clinical Cardiology and in Applied

Physiology, University of Manchester.

Is it safe for a woman with heart dis-ease to bear children?

Basing his attack on this question on clinicalexperience with over 1500 pregnant patients withorganic heart disease, with a detailed study of 352consecutive cases treated and followed up, Dr.Jones strikes straight at the core of the problem.A clear picture results of what is and what is

not hazardous in these cases. This concise studycomes straight to the point in such matters as:circulation, cardiovascular signs and symptoms,and diagnosis of organic heart disease during preg-

GRUNE & STRATTON

nancy; causes of maternal death; assessment offitness for pregnancy; management of confine-ment and termination; antenatal supervision;problems of the post-partum period; effect ofpregnancy on the course of rheumatic heart dis-ease.

This book will correct the exaggerated pessi-mism of the physician who sees only a few casesof heart disease in pregnancy, point out the speci-fic dangers to the overly optimistic. Clinicallyorientated, it will enable any physician to make aclear appraisal of the specific problems involvedin his cases.

76 pages illustrated $1.50

381 FOURTH AVE., NEW YORK 16, N.Y.

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XXXV1


The THORACIC SURGICAL PATIENT

Preoperative, Anesthetic, and Postoperative CareBy LEW A. HOCHBERG, M.D., Formerly Clinical Professor of Surgery (Thor-acic), State University of New York Medical School, and Visiting Thoracic Surgeon,Kings County Hospital, New York. Foreword by FRANK B. BERRY, M.D.

HERE IS A BOOK written not for the accomplished thoracic sur-geon alone but for all those charged with the care of the thoracic sur-gical patient-surgeon, physician, anesthetist, physiatrist. Givingonly enough details of surgical technic to fill in background and makethe main text more meaningful, THE THORACIC SURGICAL PATIENTstresses instead the considerations which surround and cannot bedivorced from surgery-and which critically affect in many instancesthe success or failure of operation.

These considerations determine the

THE CHAPTERS

Physiology and PathologicPhysiology

Endoscopy

Anesthesia

Injuries to the Chest

The Chest Wall

Empyema Thoracis

Collapse Therapy

Pulmonary Resection

Surgery of the Esophagus

l Diseases of the Mediastinum

Diaphragmatic Hernia

Cardiovascular Surgery

Rehabilitation

375 pages

bibliography

index

$8.75

plan of most of Dr. Hochberg's chapters: a general surveyof each subject of discussion; preoperative preparation; abrief statement on surgical procedure; postoperative care;and complications-their recognition and management.Thus a book which is for the entire surgical team, in the

larger sense of the term. As Dr. Frank Berry puts it in theForeword: "It fills a long-standing gap and may be read andstudied with profit by teacher, clinician and student alike."Three chapters, of great importance and yet ordinarily

not given such emphasis in surgical texts, deal with "Physiol-ogy and Pathologic Physiology," "Anesthesia," and "Re-habilitation." The first of these, as Dr. Berry says again,"might well appear as a monograph by itself, for it describesin full the basic principles of preparation and treatment uponwhich modern thoracic surgery rests."

Cardiologists and all others with special interest in theheart and circulation will find much of value in every chapter,but perhaps will appreciate most the comprehensive sectionon "Cardiovascular Surgery." It includes discussion of pre-and postoperative care, considerations of surgical procedureand the problems of postoperative complications as theyrelate to: constrictive pericarditis, aortic aneurysm, mitralstenosis, mural thrombi of the auricular appendage, patentductus arteriosus, coarctation of the aorta, pulmonary sten-osis and atresia, anomalies of the aortic arch, and coronaryartery disease.Whatever the physician's interests, if they touch at all on

surgery of the chest he will find here specialized experienceinterpreted in broad terms, considering the patient not justas a "surgical case" but as a clinical entity.

*-vi

xxxviii CIRCULATION-THE JOURNAL OF THE AMERICAN HEART ASSOCIATION

MODERN MEDICAL MONOGRAPHSa new idea in medical publishing,

providing the practitioner with concise, i

up-to-date sources of referenceThe Pathogenesis and on special subjectsTreatment of Thrombosis

IRVING S WRIGHT, M.D., Professor of ClinicalMedicine, Cornell University Medical College 3Accelerated Conduction

Thms monograph reviews the mechanism o0 throm-bosis and techniques of treatment, with attentionfocused also on certain hitherto unemphasized aspectsof thrombosis. Of special interest is the section onNewer Anticoagulants and the "Clinical and Labora-tory Guide to Anticoagulant Therapy," giving prac-tical instruction in the use of each of the available anti-coagulants, step-by-step directions in controllinghemorrhage, and techniques for determining pro-thrombin and clotting time.

2 Clinical Progress in

Cardiovascular Diseases

Edited by HERRMAN L. BLUMGART, M.D., Pro-fessor of Medicine, Harvard Medical School

Here, from the pages of Circulation, are outstand-ing contributions of immediate and practical importto any clinician interested in the heart and circulatorydisorders. The chapters include: Atherosclerosis, ASymposium (Experimental Atherosclerosis, HumanAtherosclerosis and the Diet, Blood Lipids andHuman Atherosclerosis); Management of Acute Car-diac Emergencies; Surgery for Mitral Stenosis; Man-agement of Cardiac Patients in Relation to Surgery;Emotion and the Circulation.

MYRON PRINZMETAL, M.D., et al., Institute forMedical Research, Cedars of Lebanon Hospital, andUniversity of California Medical School, Los Angeles

This study of the Wolff-Parkinson-White Syndromeand related conditions illuminates the basic abnor-mality. Investigating both the mechanism and theclinical significance of accelerated conduction in avariety of forms, the authors present new data andoffer a new explanation of an important phenome-non.

4 Circulatory Dynamics

CARL J. WIGGERS, M.D., Professor and Director,Department of Physiology, Western Reserve UniversityCollege of Medicine

Dr. Wiggers lays down a firm foundation for an

understanding by either practitioner or investigatorof the physiology of circulation. The main sectionsare: Basic Hemodynamic Principles in the Interpre-tation of Circulatory Disorders; Determinants ofCardiac Performance; Dynamics of Ventricular Con-traction under Abnormal Conditions.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

ORDER FORM: Please send on approval from the first series IEo Wright: Pathogenesis and Treatment of Thrombosis $8.001

Su tEA EL [o Blumgart: Clinical Progress $4.50

Ilo Prinzmetal et al.: Accelerated Conduction *4.00* 381 Fouth AvenNew York 16 NY.IFourthAvenue, NewYork16, N. . 0Wiggers: Circulatory Dynamics $4.00 I

I 0 check enclosed 0 charge my account I| NAME AND ADDRESS .......................................................................................

I .........................................................................................................a _ _ _ _ I__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


The Starr-Type Horizontal

BALLISTOGARDI 0GRAPH

direct measurement ofcardiac output

* *0 *e @OO * .SaO@a@@ 0

* Standard hospital bed height-rigidextension feet-may be used as anoperating table.* Rolls easily and quietly on largerubber casters-useful as a litter whenpatients must be moved to anotherroom for BCG determinations.* Convenient and comfortable fornon-ambulatory patients.* Simple to operate- may be usedwith any standard recording device.

TECHNITROL MODEL 128Horizontal Ballistocardiograph

with durable "Hammertone" finish, completeless recorder, f.o.b. Philadelphia

$1000.00

1. Starr, L.: Am. J. Med. Sci. 214:233, 1947.

2. Paine, R.M., & Shock, N. W.: Circulation 1:1026,1950.

TECHNITOL is proud to have added its contribution tothe furtherance of cardiac research ... the construc-tion, in quantity, of the High-Frequency UndampedBallistocardiograph. Full-scale production of thisprecision instrument has made possible a substantialsaving in the cost of its skilled fabrication, bringingthe price-for the first time-within reach of thesmall, unendowed research group or the individualinvestigator.

"... thebllistocardiographprovides a good empiricmeasure of cardiac output. Agreement with the directFick method is essentially the same as that of othermethods ... The ease of single or serial determinationswith this technic contrasts markedly with most othermethods."2The natural frequency of the loaded bed is above 14cycles per second. When a human load is used, thedamping produced by the body tissues is sufficientto eliminate after-vibration.

Further descriptive details and specifi-cations are available. Please write to:

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xxxix


Two significant books on Diagnostics...and what reviewers say of themr

DIFFERENTIAL DIAGNOSIS OF INTERNAL DIS-EASES: Clinical Analysis and Synthesis ofSymptomsand Signs . Julius Bauer, M.D.

Circulation: "It is clearly the work of a master clinician who has matured and whoknows, as does every seasoned clinician, that the successful rehabilitation of ailingpatients often requires more of the art than the science of medicine .... The bookis well written, well printed and is a veritable storehouse of information in the fieldof differential diagnosis [and as such] will make a valuable addition to the internist'slibrary. "

Ann. Internal Med.: "This book can be highly praised. The author has combinedwith his individual approach to each subject in turn an extraordinary display ofknowledge .... healthy attitudes pervade the well written text, which is amplyillustrated with numerous case reports. [It] is an education to read and will remainan invaluable work of reference."876 pages

56 illustrations Pennsylvania Med. J.: .... learned and comprehensive ... recommended."bibliographies

index Southern Med. & Surg.: "This review copy will be kept by the reviewer as his very$12.00 own, and appealed to daily."

FUNDAMENTALS OF CLINICAL FLUOROSCOPYWith Essentials of Roentgen Interpretation(Third printing) . Charles B. Storch, M.D.

Circulation: "A lucid style supplemented by outstanding illustrations, many ofwhich are original and ingenious teaching aids of the author, make this text ... re-quired reading for anyone preparing for the performance of fluoroscopic examina-tions."

Ann. Internal Med.: .... highly recommended ... will prove valuable readingfor medical students, interns and residents . . . specialists and the general practi-tioner."y

Bull. Johns Hopkins Hosp.: .... well illustrated and easy to read ... definitelya welcome aid to . . . those wishing to study the elements of fluoroscopic examin-ations."Ohio State J. Med.: .... a practical and comprehensive manual-fully illustrated-

210 pages on [fluoroscopy's] basic diagnostic aspects. The only book of its kind that we know217 illustrations of and certainly one for which many physicians have been looking."bibliographies Am. J. Digest. Dis.: ". . . merits the attention of everyone doing diagnostic x-ray

index work, but it will prove particularly valuable-even indispensable-to the internist$6.75 or general practitioner who attempts to do his own radiological investigations."

1S 381 Fourth AvenueNew York 16, N. Y.

M- I-

xI


another important advantage of Thiomerin: |}/ h44- 0 X

Suitability for Home Administration

references:1. Journal-Lancet 70:298, 1950.2. Rocky Mountain M. J. 48:99,

1951.3. Am. J. M. Sc. 218:298, 1949.4. J. M. Soc. New Jersey 48:12, 51.5 Am. J. M. Sc. 219:139, 1950.6. U. S. Armed Forces M. J. 1:332,

1950.7. Circulation 1:502, 1950.8. Cincinnati M. J. 31:137, 1950.9. Southern M. J. 44:44, 1951.

10. M. Times 79:83, 1951.11. J. A. M. A. 146:250, 1951.12. Circulation 1:508, 1950.

The self-injection of the thionated mercurial diuretic, Thiomerin,has now become a well-established procedure for patients who havecongestive heart failure, just as the self-injection of insulin has longbeen a well-established procedure for patients who have diabetes.Numerous authorities'-1 recommend Thiomerin for home admin-

istration because it is as well tolerated and predictable in effectwhen given subcutaneously, as when given intramuscularly andintravenously. The technique of injecting Thiomerin Sodium maybe quickly mastered.

Consequently, more and more physicians are finding that it isoften desirable to instruct the patient or a member of his family inthe use of Thiomerin so that injections between visits can be made onschedule-according to the dosage plan that best suits each patient.A supply of printed instructions for patients will be sent to the

physician on request.

THIOMERIN®SODIUM

MERCAPTOMERIN SODIUM WYETH

Council-Accepted Mercurial Diuretic for Subcutaneous, Intramuscularor Intravenous Injection

J4gie4 INCORPORATED, PHILADELPHIA 2, PA.

xli


for VramUW tetnse.. .

A powerful hypotensive agent, Solution IntravenousVeriloid, on slow infusion by vein, is capable of drop-ping the blood pressure in a matter of minutes in themajority of patients.Thus it presents a lifesaving emergency measure in the

conditions in which a continuing state of extreme hyper-tension might lead to serious complications. Hence it hasrightly been termed "A Must in Every Emergency Bag."

In hypertensive states accompanying cerebral vas-cular disease, in malignant hypertension, and in hyper-tensive crisis (encephalopathy) arterial tension can bereduced-under full control of the physician-to a pointcompatible with the patient's condition. The only con-traindications are pheochromocytoma and coarctationof the aorta; in patients receiving quinidine therapy thedrug should be given with caution.

Solution Intravenous Veriloid makes available for the

Solutio venousfirst time a purified fraction of Veratrum viride, a prod-

Veriloid, 0.4 m of Veri- uct of Riker Laboratories research, generically desig-loid standard r ference nated alkavervir, which can be administered by vein.powder per cc., sup- Complete instructions for its use accompany each am-plied in 5 cc. am les.

pule. Physicians are invited to send for detailed lit-erature.

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keep cardiacs at constant weight

In congestive failure, Tablets MERCUHYDRIN with AscorbicAcid provide a simple, effective and safe method ofmaintaining optimum weight levels by the oral route.Alone or supplemented by injection, Tablets MERCUHYDRINwith Ascorbic Acid simplify management and help thecardiac adjust to the requirements of long-term therapy.

CONTINUOUS DAILY ADMINISTRATION

The key to optimal clinical results in oral diuretic therapy is continuoustherapy -Tablets MERCUHYDRIN with Ascorbic Acid, one or two tablets daily,morning or evening, preferably after meals. To secure the greatest efficacyand all the advantages of Tablets MERCUHYDRIN with Ascorbic Acid,prescribe an initial three-week supply. . . 25 to 50 tablets.

Any patient receiving a diuretic should ingest daily a glass of orange juice,a banana, or other supplementary source of potassium.

a BORATORIES, INC., MILWAUKEE 1, WISCONSIN M-24

Circulation MAY. 9SN2.5 %WO,, ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~VOL. V NO.

9CONTENTS

SPONTANEOUS ATHEROSCLEROSIS IN THE RABBIT......i......Jo8eph H. Bragdon 641MECHANISM OF IODIDE ACTION ON CHOLESTEROL METABOLISM

Helen B. Brown and Irvine H. Page 647CHANGES IN EXCRETION OF INTESTINAL CHOLESTEROL AND STEROL DIGITONIDES

IN HYPER- AND HYPOTHYROIDISMMeyer Friedman, Sanford 0. Byers and Ray Hj.Asenman 657

INTRA-ARTERIAL HISTAMINE IN THE TREATMENT OF OCCLUSIVE PERIPHERAL AR-TERIAL DISEASE

John A. Dixon, W. J. Merle Scott and Matwin A. Epstein 661ENDARTERIECTOMY, OR SURGICAL RESTORATION OF THE LUMEN OF AN OBSTRUCTED

ARTERY IN ARTERIOSCLEROSIS OBLITERANS. A PRELIMINARY REPORTA. Neaftz Ngifez, B. Milang and J. Rodriguez Inligo 670

CFSREBROVASCULAR THROMBOSIS IN PATIENTS WITH BUERGER'S DISEASEHeinz I. Lippmann 680

THE SYNDROME OF SHORT P-R INTERVAL, NORMAL QRS COMPLEX AND PAROXYSMALRAPID HEART ACTION

Bernard Lown, WiUiam F. Ganong and Samuel A. Levine 693INDICATIONS FOR BISHYDROXYCOUMARIN (DICUMAROL) IN ACUTE MYOCARDIAL IN-

FARCTION ........ Henry I. Russek, Burton L. Zohman,Alexander A. Doerner, Allen S. Russek and LaVere G. White 707

FRONTAL AND SAGITTAL ELECTROCARDIOGRAMS OF NORMAL AND HYPERTENSIVESUBJECTS DURING AN EXPERIMENTALLY PRODUCED PHASE OF LOWERED BLOODPRESSURE. Joseph Brumlik and Charles E. Kossmann 712

CONGENITAL ANEURYSMAL DEFECT OF THE MEMBRANOUS PORTION OF THE VEN-TRICULAR SEPTUM ASSOCIATED WITH HEART BLOCK, VENTRICULAR FLUT-TER, ADAMS-STOKES SYNDROME AND DEATH

Richard J. Clark and Paul D. White 725ARTERIAL HYPERTENSION IN DOGS. I. METHODS

Henry A. Schroeder and Melvin L. Goldman 730THE EFFECT ON BLOOD PRESSURE IN THE RIGHT HEART, PULMONARY ARTERY AND

SYSTEMIC ARTERY OF CARDIAC STANDSTILL PRODUCED BY CAROTID SINUSSTIMULATION

Charles V. Dowling, Warren W. Smith, Adolph R. Berger and Roy E. Albert 742CATION EXCHANGE RESIN IN THE TREATMENT OF CONGESTIVE HEART FAILURE.

I. ELECTROLYTE EXCHANGES DURING INITIAL PERIODS OF RESIN THERAPYJ. R. Elkinton, R. D. Squires and W. C. Klingensmith, Jr. 747

TISSUE CATIONS AND WATER IN ARTERIAL HYPERTENSIONLouis Tobian, Jr. and John T. Binion 754

HEART FAILURE AND PULMONARY EDEMA PRODUCED BY CERTAIN NEUROLOGICSTIMULI

Robert Paine, John R. Smith, Harvey R. Butcher and Frank A. Howard 759DEATH IN POTASSIUM DEFICIENCY. REPORT OF A CASE INCLUDING MORPHOLOGIC

FINDINGS ......... .................................John D. Keye, Jr. -766CLINICAL PROGRESS: THE SPECIFIC TREATMENT OF SYPHILITIC AORTITIS

R. H. Kampmeier and Hugh J. Morgan 771ABSTRACTS............................................................... 779BOOK RVIEWS ..798AMERICAN HEART ASSOCIATION.. 800

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