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In defence of ancient bloodletting.

The ancients used bloodletting extensively in infectious and other diseases. When recent work on iron and bacterial infection is taken into account, it is possible to argue that bloodletting, which reduced plasma iron and transferrin saturation, might have been of value in increasing resistance to infection by bacteria or plasmodia. Galen's bloodletting methods are summarized, and their probable effect on plasma iron is considered. The ancient physicans who had no specific remedies for infection whatsoever, may well have been justified in making responsible use of bloodletting, both for the treatment and for the prophylaxis of infectious disease.

Blood Donors

Of bloodletting.

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Bloodletting

Improvement in pulmonary function with diuretic therapy in the hypervolemic and polycythemic patient with chronic obstructive pulmonary disease.

Central hemodynamics and gas exchange were studied in six patients with chronic obstructive pulmonary disease (mean age, 60 years). Patients were selected for the study if the volume of blood was 1 L larger than the predicted normal value, if there was no history of infection, and if no drug assumed to influence pulmonary circulation had been given during the last four weeks. Measurements were first performed in the hypervolemic state. This was followed by a venesection of 0.5 L, and the measurements were repeated 15 minutes later (immediate effects of dehydration). After two weeks to two months of intensive diuretic therapy, new measurements were performed (long-term effects of dehydration). With hypervolemia, there was pulmonary hypertension, increased pulmonary vascular resistance, and normal cardiac output. The arterial oxygen tension (PaO2) was markedly reduced. The arterial carbon dioxide tension (PaCO2) was increased in two patients, and dead-space ventilation (VD/VT) increased in all. The sole immediate effect of venesection was a small increase in heart rate and a reduction in PaCO2. The long-term effects were a maintained low blood volume (on the average, 0.7 L less than before bloodletting) and lowered hematocrit reading (8 percent less than before bloodletting), a reduced and in some patients normalized pulmonary arterial pressure, a reduced pulmonary vascular resistance, and an unchanged cardiac output. The PaO2 improved, while PaCO2 did not change; neither did VD/VT. The changes correlated partly with the diminution in blood volume and partly with the reduction in hematocrit reading.

Aged

[Treatment of chronic respiratory insufficiency of pulmonary origin. Clinical considerations].

The key-points of the physiopathological treatment of chronic pneumogenous respiratory insufficiency are: correction of distribution defects, suitable local adjustment of the ventilation: perfusion ratio, and correction of obstacles to alveolocapillary diffusion. Many drugs can be used to obtain these results; bronchodilators, vasoactive drugs, cortisones, cardiokinetics, antibiotics, analeptics. Reference is also made to oxygen therapy, depletion management (bloodletting and-or diuretics, and their possible mechanisms. Lastly, attention is given to disturbances, in acid-base equilibrium in chronic respiratory insufficiency and their correction.

Adrenal Cortex Hormones

Measurement of cardiac output by impedance cardiography under various conditions.

The suitability of impedance cardiography as a method to follow changes in cardiac output (CO) was investigated by comparing it with thermodilution and by measurements in conditions with predictable effects on CO. The correlation between absolute CO values obtained by impedance and thermodilution techniques was moderate (r = 0.61), but the percentage changes showed a good correlation (r = 0.84). Head-up tilting decreased CO by 25% in 5 normal subjects. Bloodletting in three subjects caused a 20% decrease, reinfusion in one subject a 16% increase. Occlusion of artificial large flow arteriovenous shunts in 6 dialysis patients caused a 12% decrease in CO, whereas the effect was less with moderate and absent with small flow shunts. Ultrafiltration caused a 28% decrease in two dialysis patients. In 20 hypertensive patients CO dropped 25% after salt depletion; propranolol administered intravenously gave a 15% decrease (n = 13), diazoxide intravenously a 30% increase (n = 6). It is concluded that, provided conditions are strictly defined, impedance cardiography is a reproducible method and suitable for the measurement of intrapatient changes in cardiac output.

Adult

[Functional morphology of the hypothalamo-neurohypophyseal system and juxtaglomerular apparatus in acute vascular insufficiency].

The functional morphology of the hypothalamic neurohypophyseal system (HNHS) and juxtaglomerular apparatus (JGA) were studied in 50 male cate. A rising secretory activity in HNHS and JGA, accompanied by accumulation of hormone-containing granules, was seen in acute vascular insufficiency caused both by the injection of a ganglion-blocking agent and by bloodletting. This factor is qualified by the authors as a specific sign of hypotonic stress, consisting in incomplete use of HNHS and JGA adaptive capacity in acute pressor hormone deficit.

Acute Disease

Charles Dickens and the ear, nose, and throat.

Charles Dickens is known as a novelist, humorist, humanist, and a social reformist. One of his many abilities was an astute power of observation, and some of his writings included descriptions considered as original medical knowledge. Among the hundreds of characters portrayed by Dickens, many had depictions or diseases of interest to the otolaryngologist. Dickens described deaf children and was interested in the methods used in their teaching. He had a keen interest in children and their welfare and described his visits to the Childrens Hospital in London and to Parkins Institute at Boston. He described both temporary and permanent deafness following exposure to loud noise. Dickens was a medical critic and most of his writings on the subject were humorous, though mixed at times with a spicy element of satire.

Adolescent

Correction of platelet dysfunction and bleeding in cyanotic congenital heart disease by simple red cell volume reduction.

Red cell volume reduction corrected the platelet aggregation abnormality and bleeding tendency in four boys, aged 5 to 16 years, with severe cyanotic congenital heart disease and polycythemia. Red cell volume was reduced by replacing 15 to 20 ml/kg body weight of the patient's blood with plasma in 50 ml increments over a 1 to 2 hour period. Within 3 days, platelet aggregation was restored essentially to normal, and previous bleeding symptoms disappeared. Platelet aggregation remained normal during 3 weeks of follow-up study and hematocrit values remained at palliative levels. The procedure was safe and simple, and it had beneficial effects not only on bleeding but also on other symptoms related to polycythemia. These preliminary observations suggest that red cell volume reduction may be useful preoperatively in patients with cyanotic heart disease and defects in platelet function to lessen the risk of serious bleeding during the early postoperative period. Palliation in severely cyanotic children whose condition is inoperable is another possible indication for this procedure.

Adolescent