PROCEEDINGS OF THE TWENTY-NINTH ANNUAL MEETING OP THE AMERICAN SOCIETY FOR CLINICAL INVESTIGATION HELD IN ATLANTIC CITY, N. J., MAY 3, 1937 READ BEFORE THE SCIENTIFIC SESSION The Etiological Relationship of the Eosinophile to the titer of serum antibodies, are not resistant to infection Gordon Test for Hodgkin's Disease. By JOSEPH C. with vaccinia. TURNER (by invitation) and HENRY JACKSON, JR., Boston, Mass. Estimation of Thyrotropic Hormone in Human Urine In 1932 Gordon reported that broth suspensions of and Blood in Health and Disease by the Micrometric lymphadenomatous (Hodgkin's) tissues upon inocula- Analysis of the Response of the Guinea Pig Thyroid. tion into the brains of rabbits or guinea pigs produce a By PAUL STARR and (by invitation) RULON W. RAW- characteristic paralysis (Gordon test). Subsequent in- SON, Chicago, Ill. vestigation has established that approximately 75 per cent of cases of Hodgkin's disease exhibit this phenomenon. A method of approximating the amount of thyrotropic Friedemann (1933) discovered that a paralysis in the hormone present in a solution by the micrometric analysis same animals, indistinguishable from that of Gordon, is of the response of the guinea pig thyroid has been de- produced with extracts of normal human bone marrow, scribed. A frequency curve of the heights of the acinar spleen, or leukocytes. cells measured with an ocular micrometer was plotted The nature and significance of the paralysis-producing and subjected to statistical analysis. Increasing doses of agents of Gordon and of Friedemann remain obscure. a known thyrotropic preparation (Parke, Davis and Com- Their identity has not been proved. pany) gave a series of curves shifting increasingly to We have performed the Gordon test in ten cases of the right. Hodgkin's disease. The test was positive in six and in The urine itself, or the acetone precipitate from small these six only could eosinophiles be found. Moreover, amounts, or the isoelectric precipitate from large amounts, the potency of the material used varied directly with the injected into the animal, produces characteristic shift of number of eosinophiles present. such a curve. In the case of a normal person with a In order to test the significance of this observation, normal metabolic rate and no evidence of thyroid in- suspensions were made of the bloods of normal and dis- activity, there is slight shift to the right. Patients with eased individuals, some of whom had a high degree of moderately low metabolic rates, "relative hypothyroid- eosinophilia. Animal inoculations showed that a paraly- ism," have more of this material in the urine. This sug- sis-producing factor was present in titers which paralleled gests that the procedure may be used to detect the need precisely the number of eosinophiles in suspension. Sus- for thyroid hormone when general metabolic measure- pensions containing few, or no, eosinophiles gave nega- ments are inconclusive. Following total thyroidectomy tive results. the urine contains excessive amounts. It appears that the Gordon test is positive in Hodgkin's In hyperthyroidism there is less thyrotropic hormone disease only because of the presence of eosinophiles. It present than in the normal urine. This is true whether is tentatively proposed that the paralysis-producing agent or not exophthalmos is present. This raises the possi- present in the tissues of certain cases of Hodgkin's dis- bility of the use of the procedure as a diagnostic aid in ease and that present in normal leukocytes are both de- hyperthyroidism. Patients with various types of pitui- rived specifically from the eosinophile and are therefore tary tumors and goiters have different amounts of the identical. material in the urine. The possibility that lack of response to the hyper- Studies of a Stable Antigen of Vaccine Virus. By thyroid urine is due to excess iodine present has been ROBERT F. PARKER (introduced by J. T. Wearn), covered by the addition of amounts of iodine of like Cleveland, Ohio. order to specimens giving marked stimulation. The pos- The isolation of a serologically active heat stable sub- sibility that the response is not specifically due to thyro- stance from tissues infected with vaccine virus has al- tropic hormone has been met by heating the specimen, ready been reported, and the chemical characteristics of since the pituitary thyrotropic hormone is heat labile. the substance have been described. On inoculation into Furthermore, the hyperthyroid urine containing similar rabbits, it elicits the formation of antibodies, demon- amounts of foreign material fails to give a response. strated by precipitation and complement fixation tests. Blood serum from these groups of patients may be The serum agglutinates heated and unheated elementary classified in the same way. bodies of vaccinia but apparently neutralizes only very Conclusion. The method affords a convenient and spe- small amounts of vaccine virus. Rabbits subjected to re- cific means of assaying the appearance of thyrotropic peated inoculation with the substance and having a high hormone in clinical material. 657 658 PROCEEDINGS OF THE TWENTY-NINTH ANNUAL MEETING Influence of the Thyroid Gland on Intestinal Absorption without serious trophic disturbance of a permanent na- of Dextrose, Galactose, and Xylose. By T. L. AL- ture. Arteriograms in such cases often show direct THAUSEN, with the technical assistance of M. STOCK- anastomosis by means of smaller arteries between the HOLM, San Francisco, Calif. segments of the artery above and below the area of oc- Normal rats, rats treated with thyroxin, and thyroid- clusion. In such cases the roentgenograms show that the ectomized rats were given measured amounts of sugar by artery below the obturated portion is still functioning, stomach tube. The amount of sugar absorbed in one the blood having been shunted around the occluded por- hour was calculated from the unabsorbed residue in the tion. Arteriograms and drawings of the extremities of digestive tract. In hyperthyroidism, intestinal absorp- patients illustrating this mechanism of readjustment of tion of dextrose and of galactose was markedly increased. the circulation are shown. Various types of anastomoses In hypothyroidism, intestinal absorption of dextrose was are demonstrated. reduced considerably. The Effects on the Cardiovascular System of Fluids Ad- Depletion of carbohydrates, raised basal metabolism, mnittistered Intravenously. By MARK D. ALTSCHULE increased velocity of the blood flow, intestinal hyper- and DOROTHY R. GILLIGAN (introduced by Herrman L. peristalsis, and rate of gastric discharge appear to play Blumgart), Boston, Mass. no part in the observed changes of intestinal absorption. Therefore, a specific action of thyroid hormone on the The effect on the cardiovascular system of the injec- intestinal mucosa is suggested as a possible explanation. tion of fluids intravenously, such as is employed routinely Increased phosphorylation appears to be the chief in postoperative treatment, has been studied in a large mechanism by which thyroxin increases absorption of group of patients with no evidence of heart disease. The dextrose because phlorizin which inhibits this mechanism fluids employed were physiological saline solution or 5 greatly decreases the absorption of dextrose in experi- per cent glucose in distilled water, or 5 per cent glucose mental hyperthyroidism. But simple diffusion also seems in physiological saline; the volumes injected varied from to play a part since absorption of xylose is likewise in- 500 to 1500 cc. and the rates of injection from 6 to 80 cc. creased by thyroxin. per minute. Clinically, altered intestinal absorption may be an im- Immediately after the injection of fluids intravenously, portant factor in producing abnormally high dextrose the minute volume output of the heart and the blood vol- tolerance curves often seen in patients with hyperthyroid- ume were increased, and the velocity of blood flow was ism and unusually low curves observed in patients with accelerated. When the more rapid rates of injection myxedema. The same mechanism may play a major were employed or the larger volumes of fluid adminis- part in the impairment of "tolerance" to galactose ob- tered, significant and even marked increases in venous served in hyperthyroidism in man. pressure were observed; a return to the control level of venous pressure was again observed within approxi- Pressor Effects of Renal Extracts of Nornad Dogs and mately twenty minutes after the end of injection in these of Dogs with Experimental Renal Hypertension. By patients with no evidence of heart disease. Slight in- T. R. HARRISON, ALFRED BLALOCK and (by invitation) creases in pulse rate and in systolic blood pressure and M. F. MASON and J. R. WILLIAMS, JR., Nashville, pulse pressure were observed in approximately 40 per Tenn. cent of our studies. Electrocardiographic studies re- vealed in some instances appreciable increases in the Hypertension has been produced in dogs by the method height of the P and variable changes in the T-waves. of Goldblatt (partial occlusion of the renal arteries). The magnitude and duration of the above effects were Saline extracts of the kidneys of such animals have been influenced by the composition of the fluid injected. injected into rats and the changes in blood pressure com- These studies have demonstrated that the administra- pared with those produced by extracts of the kidneys of tion of fluids intravenously under conditions frequently normal dogs. The former extracts were found to have employed routinely subject the heart to increased work, greater pressor effects. which amounts to about 50 per cent above basal levels. In a second series of experiments preparations from The implications of these findings in the management of the two kidneys of a dog rendered hypertensive by the patients with cardiovascular disease is clear. application of a clamp to one renal artery were studied. Here again the extract of the ischemic kidney caused a The Estimation of the Subcutaneous Tissue Pressure by greater rise in blood pressure than did that of the normal a Direct Method.