EDITORIAL

stressed, because it is an insidious disease andfrequently overlooked clinically, is chronic in-terstitial nephritis (pyelonephritis) which,when sufficietitly severe, brings about theexcretory failure of kidneys previously the seatof only arterial and arteriolar sclerosis anddetermines the development of the malignantphase. The other complicating renal diseaseswhich may have the same effect are glomerulo-sclerosis and various types of glomerulone-phritis, which, when superimposed upon renalarterial and arteriolar sclerosis, of even moder-ate degree, may precipitate the change fromthe benign to the malignant phase. Interstitialnephritis (pyelonephritis), however, does thisfar more frequently; and some of the histologicfeatures of the kidneys, such as the focalglomerulitis and the proliferative endarterialfibrosis and elastosis of vessels larger than

arterioles, frequently regarded as specific formalignant nephrosclerosis, are really character-istics of the chronic pyelonephritis that helpsto bring about the accelerated hypertension.Less commonly, the malignant phase occurs asa result of the development of arteriolar sclero-sis or periarteritis nodosa in an individual witha previously existent chronic bilateral pye-lonephritis and its accompanying glomerularand vascular disease.The importance of the part played by inter-

stitial nephritis as one of the possible causes ofmalignant hypertension cannot be stressed toogreatly because it promises possible treatment,and even prevention, of the most commonpathologic condition responsible for bringingabout the change from the benign to the malig-nant phase of essential hypertension.

HARRY GOLDBLATT

9As the student, fresh from the schools, and proud of his supposed superiority in the refinements

of diagnosis, advances into the stern realities of practice, he will be taught greater modesty and amore wholesome caution: he will find, especially in chronic disease, that important changes mayexist without corresponding physical signs,-that as disease advances, its original special evidencesmay disappear, that the signs of a recent and trivial affection at one portion of the heart mayaltogether obscure or prevent those of a disease longer in standing and much more important, thatfunctional alteration may not only cause the signs of organic lesion to vary infinitely, but even towholly disappear,-that the signs on which he has formed his opinion to-day may be wanting to-morrow, and lastly that to settle the simple question between the existence of functional and thatof organic disease will occasionally baffle the powers of even the most enlightened and experiencedphyNsician.-WILLIAM STOKES. The Diseases of the Heart and the Aorta. Dublin, 1854.

699

RHEUMATIC HEART DISEASE IN THIRD-FIFTH DECADES OF LIFE

que le dimensiones cardiac representa un factorplus importante ab le puncto de vista delsuperviventia.

REFERENCES1 WILSON, M. G., AND LUBSCHEZ, R.: Longevity

in rheumatic fever. J.A.M.A. 138: 794, 1948.2 BLAND, E. F., AND JONES, T. D.: Rheumatic

fever and rheumatic heart disease. Circulation4: 836, 1951.

3BERKSON, J.: The construction of life tables andthe use of the method for calculating survivalafter operation. Proc. Staff Meet., Mayo Clin.9: 380, 1934.

4 REED, L. J., AND MERRELL, M.: A short methodfor constructing an abridged life table. Am. J.Hyg. 30: 33, 1939.

'GLOVER, R. P.: The present status of intracardiacsurgery for mitral and aortic stenosis. Trans.& Stud. Coll. Physicians Phildaelphia 21: 97,1954.

6 SOLOFF, L. A., AND ZATUCHNI, J.: An evaluationof present day surgery for mitral stenosis. Bull.New York Aead. Med. 31: 815, 1955.

7BAILEY, C. P., AND BOLTON, H. E.: Criteria forand results of surgery for mitral stenosis, PartII. New York State J. Med. 56: 825, 1956.

8 ELLIS, L. B., AND HARKEN, D. E.: Clinical re-sults of first five-hundred patients with mitralstenosis undergoing mitral valvuloplasty. Circu-lation 11: 637, 1955.

9 NEW YORK HEART AssoCIATION, INC.: Nomen-

clature and Criteria for Diagnosis of Diseasesof the Heart and Blood Vessels. New York,Peter F. Mallon, Inc., 1953.

10 WILSON, M. G.: Clinical radioscopie studies ofthe heart in children. Am. J. Dis. Child. 47:750, 1934.

-: Rheumatic Fever. New York, The Common-wealth Fund, 1940.

12 -, EPSTEIN, N. , HELPER, H. N., AND HAIN, K.:Evaluation of routine serial fluoroseopic ex-aminations of the heart in the postero-an-terior and oblique views at specific degrees ofrotation. Circulation 8: 879, 1953.

13 MERRELL, M., AND SHULMAN, L. E.: Determina-tion of prognosis in chronic disease, illustratedby systemic lupus erythematosus. J. Chron.Dis. 1:12, 1955.

14 U. S. DEPARTMENT OF COMMERCE, Bureau ofCensus: Vital Statistics of the United States,1940-part 1, p. 13, 1953. U. S. DEPARTMENTOF HEALTH, EDUCATION AND WELFARE: VitalStatistics-Special Reports; Abridged LifeTables, United States. 42: 240, 1955.

1 BOLT, W., AND LEW, E. A.: Prognostic value oflife insurance mortality investigations. J.A.M.A.160: 736, 1956.

16 MAGIDA, M. G., AND STREITFELD, F. H.: Thenatural history of rheumatic heart disease inthe third, fourth and fifth decades of life. II.Prognosis with special reference to morbidity.Circulation 16: 713, 1957.

17 WILSON, M. G., AND LIM, W. N.: Natural courseof active rheumatic carditis and evaluation ofhormone therapy. J A.M.A. 160: 1457, 1956.

The Foxglove when given in very large and quickly-repeated doses, occasions sickness, vomiting,purging, giddiness, confused vision, objects appearing green or yellow; increased secretion of urinewith frequent motions to part with it, and sometimes inability to retain it; slow pulse, even as slowas 35 in a minute, cold sweats, convulsions, syncope, death.-WILLIAM WITHERING. An Accountof the Foxglove, and Some of Its Medical Uses. Birmingham, 1785.

712

RHEUMATIC HEART DISEASE IN THIRD-FIFTH D)ECAI)ES OF LIFE

49 annos esseva functionalmente in le classifi-cation I. Le majoritate del patientes constenosis e insufficientia mitral sin o con asso-ciate morbo aortic sed con marcate grados deallargamento cardiac esseva functionalmentein le classificationes II, III, o IV.

Le residue insulto cardiac experientiatedurante le 2 prime decennios del vita special-mente le grado del allargamento cardiac esapparentemente le major factor de influentiasuper le morbiditate e mortalitate durante letertie, quarte, e quinte decennios.

REFERENCES

' WILSON, MXl. G., AND LIM, W. N.: The naturalhistory of rheumatic heart disease in the third,fourth and fifth decades of life. I. Prognosis with

special reference to survivorship. Circulation16: 700, 1957.

2 HARKEN, D. E., ELLIS, L. B., DEXTER, L., FAR-RAND, R. E., AND DICKSON, J. F. III: The re-sponsibility of the physician in the selection olpatients with mitral stenosis for surgical treat-ment. Circulation 5: 349, 1954.

SOLOFF, L. A., AND ZATUCHNI, J.: Some difficultiesin evaluating functional results after mitral com-missurotomy. J.A.2M.A. 154: 673, 1954.

4NEW YORK HEART ASSOCIATION, INC.: Nomen-clature and Criteria for Diagnosis of Diseasesof the Heart and Blood Vessels. New York,Peter F. MIallon, Inc., 1953.

WILSON, A. G.: Rheumatic Fever. New York,The Commonwealth Fund, 1940.

6SMITH, H. L.: The relation of the weight of theheart to the weight of the body and of theweight of the heart to age. Am. Heart J. 4: 79,1928.

p-t

FORTHCOMING ARTICLESSprague, H. B.: Emotional Stress and the Etiology of Coronary Artery Disease.Gifford, R. W., Hines, E. A., and Craig, W. M.: Sympathectomy for Raynaud's Phenome-non: Follow-up Study of 70 Women with Raynaud's Disease and 54 Women with SecondaryRaynaud's Phenomenon.

Lowy, A. D. and Barach, J. H.: Predictive Value of Lipoprotein and Cholesterol Determinations inDiabetic Patients Who Developed Cardiovascular Complications.

Katz, L. N.: Rehabilitation of the Cardiac Patient.Riseman, J. E. F., Altman, G. E., and Koretsky, S.: Nitroglycerin and Other Nitrites in the Treat-ment of Angina Pectoris: Comparison of Six Preparations and Four Routes of Administration.

722

RILE1Y AND) STEINER

necessari pro demonstrar que le reduction delcholesterol del sero oceurrente in coincidentiacon le ingestion de sitosterol es plus grandeque le fluctuationes del nivellos de cholesterolseral que occurre in pitienites con atherosclero-sis coronari.

RlEFl'EJRE',NCES

POLLACK, 0. .J.: Reduction of blood cholesterol inman. Circulation 7: 702, 1953.

2 BEST, AI. 1I., DUNCAN, C. H., VAN LOON, EJ. .

AND WATHEN, ,J. D).: Lowering of serum cho-lesterol by the alministration of a plant sterol.Circulatioll 10: 201, 1954.

3-, , , AND : The effects of sitosterol onserum lipids. Am. J. .Med. 19: 61, 1955.

4 JOYNIER, C. R., ANI) Kuo, P. T.: The serum chio-lesterol level an(1 lipoprotein pattern followingthe administration of plant sterols. Abstracted,Circulation 10: 589, 1954.

5FARQUHAR, J. ., SMITH, R. E., ANI) DEMPSEYA. E.: The effect of beta sitosterol on the serumlipids of young men with arteriosclerotic heartdisease. Circulation 14: 77, 1956.

6 BARBEYR, . M\., ANI) GRANT, A. P.: The serum

cholesterol and other lipids after administrationof sitosterol. Brit. HearthJ. 17: 296, 1955.

7WILKINSON, C. F., JR., BOYLE ,E., JACKSON, R.S., AND BENJAMIN, AM. R.: The effect of varyingthe intake of dietary fat and the ingestion ofsitosterol on the lipid fractions of humanserum. Metabolism 4: 302, 1955.

8 BOYLE, E., WILKINSON, C. F., JR., JACKSON, R.S., AND BENJAMIN, M. R.: Lipoprotein studiesof humans subjected to controlled dietaryregimens with subtraction an(l addition of fats,sitosterol, and dihydrocholesterol. Abstracted,Circulation 8: 443, 1953.

5 SCHOENHEIMER, R., AND) SPERRY, W. AM.: A micro-method for determination of free and combinedcholesterol. J. Biol. Chem. 106: 745, 1934.

10 ABELL, L. L., LEVY, B. B., BRODIE, B. B., AND)KENDALL, F. E.: A simplified method for theestimation of total cholesterol in serum anddemonstration of its specificity. J. Biol. Chem.195: 357, 1952.

11 FISKE, C. H., AND SUBBAROW, Y.: Colorimetricdetermination of phosphorus. ,J. Biol. Chem.66: 375, 1925.

12 STEINER, A., AND DOMANSKI, B. A.: Serum cho-lesterol level in coronary arteriosclerosis. Arch.Int. _Med. 71: 397, 1943.

I!,Albert, S. N., Spencer, W. A., Boling, J. S., and Thistlethwaite, J. R.: Hypothermia in the Manage-ment of the Poor-Risk Patient Undergoing Major Surgery. J.A.IMA. 163: 1435 (April 20),1957.Observations in 76 patients of various ages are described briefly. Hypothermia of 28 to 32 C.

was achieved in each by using a water-cooled mattress and infusing trimethaphan camphorsul-fonate (Arfonad). Less anesthesia was required and surgery was better tolerated by the cooledindividual. Intra- an(l postoperative adrenal cortical response was less as indicated by a smallerrise in the plasma level of 17 hydroxycorticosteroids, greater urinary sodium loss and greaterdiuresis of a water load. Ventricular irritability increased and premature contractions appearedin over one half of the patients; trimethaphan administration suppressed this disturbance. Hypo-thermia is advocated as a protective adjunct in the major surgical management of the poor-riskperson.

ROGERS

729

McCORD, VAN ELK, AND BLOUNT

which there is pulmonary stenosis or pulmonaryatresia. J.A.I.A. 128: 189, 1945.

T.ussI, H. B., AND BAUERSFIELD, S. R.: Fol-low-up studies on the first 1000 patients operatedon for for pulmonary stenosis or atresia (resultsup to March, 1952). Ann. Int. M\ed. 38: 1, 1953.

6-: Congenital MIalformation of the Heart. NewYork, The Commonwealth Fund, 1947.

7 ALLANBY, K. D., BRINTON, WV. D., CAMPBELL,AI., AND GARDNER, F.: Pulmonary atresia andthe collateral circulation to the lungs. Guy'sHosp. Rep. 99: 110, 1950.

8 CAMPBELL, M., AND GARDNER, F.: Radiologicalfeatures of enlarged bronchial arteries. Brit.Heart J. 12: 183, 1950.

9 BING, R. J., VANDAM, L. D., AND GRAY, F. D.,Jr.: Physiological studies in congenital heartdisease. II. Results of pie-operative studies inpatients with tetralogy of Fallot. Bull. JohnsHopkins Hosp. 80: 121, 1947.

10 HOLLING, H. E., AND ZAK, G. A.: Cardiac catheter-ization in the diagnosis of congenital heartdisease. Brit. Heart J. 12: 153, 1950.

GOETZSCHE, H.: Congenital Heart Disease. Copen-hagen, H. P. Hansens Bostrykheri, 1952, p. 136.

12 KJELLBERG, S. R., -MANNHEIMER, E., RUDHE, U.,AND JONSSON, B.: Diagnosis of CongenitalHeart Disease. Chicago, The Year Book Pub-lishers, Inc., 1955.

13 BROCK, R. C., AND CAMPBELL, MI.: Infundibular

resection or dilatation for infundibular stenosisBrit. Heart J. 12: 403, 1950.

14 MCCORD, M. C., AND BLOUNT, S. G., JR.: CoI11-plications following infundibular resection inFallot's tetralogy. Circulation 11: 753, 1955.

15 BROCK, R. C.: The results of direct operations onpulmonary stenosis in Fallot's tetralogy. Ab-stracts of papers, Second World Congress ofCardiology, 1954, p. 145.

16 ROWE, R. 0., VLAD, P., AND KIETH, J. 0.: Atypicaltetralogy of Fallot: A noneyanotie form withincreased lung vascularity. Circulation 12: 230,1955.

17 BROADBENT, J. C., WOOD, E. H., AND BURCHELL,H. B.: Left to right intra-cardiac shunts in thepresence of pulmonary stenosis. Proc. StaffMeet., 1\ayo Clin. 28: 101, 1953.

18 SELL, C. G. R., FOWLER, R. L., SAILORS, E.,HYMAN, A. L., LEVY, L., AND ORDWAY, N. K.:Physiological studies in cases of "tetralogy ofFallot" with little or no overriding of the aorta.Abstracts of papers, Second World Congress ofCardiology, 1954, p. 380.

BLOUNT, S. G., JR., MUELLER, H., AND MCCORD,M. C.: Ventricular septal defect: Clinical andhemodynamic patterns. Am. J. Med. 18: 871,1955.

20 EISENMENGER, V.: Ursprung der Aorta aus beidenVentrikeln beim Defect des Septum Ventricu-lorum. XVien. Klin. Wchnschr. 11: 25, 1898.

9tMedical EponymsBy ROBERT W. BUCK, M.D.

Fick Principle. Professor Adolf Fick (1829-1901) of AWhrzburg discussed "The Measurementof the Amount of Blood in the Ventricles" (Ueber die Messung des Blutquantums in den Herz-ventrikeln) on July 9, 1870 before the Physicomedical Society of Wiirzburg. An abstract of hisdiscussion appears in the Verhandlungen der Physikal.-medicin. Gesellschaft in Wiurzburg. 2 (neueFolge): Sitzungsberichte fur 1870, pp. xvi-xvii, W0tirzburg, 1872.

"The amount of oxygen taken from the air by an animal during a given time is measured aswell as the amount of carbon dioxide given off. During the experimental period, a sample of arterialand one of venous blood is also taken. The oxygen content and carbon dioxide content is measuredin both. The difference between the two oxygen measurements reveals how much oxygen eachcubic centimeter of blood has taken up in its passage through the lungs, and thus we know the totalamount of oxygen taken up during a definite period of time. Consequently the number of cubiccentimeters of blood which passed through the lungs during this time may be reckoned, or if w edivide by the number of heart beats during this period of time, we may determine how manycubic centimeters of blood were put out with each cardiac svstole."

749

LIEWIS, I)EITZ, WALLACE, AND BROWN

tempore del catheterisationi cardiac debe provarse de adjuta definite in le diagnose de congenitemorbo cardiac.

ACKNO-L ED)GMENT

The authors wish to acknowledge the graciousassistance of the American Lava Corporation, theUnited States Stoneware Company, the HeilandI)ivision of the Miinneapolis-Honeywell RegulatorCompany, and the Kay Electric Company. We alsowish to thank Rear Adlmiral S. B. Spangler, USN,Commander, U. S. Naval Air Development andMaterial Center for his support and encouragementand Dr. Samuel Bellet, Director, Division of Car-diology, Philadelphia General Hospital, for hisadvice and valuable criticisms in the preparation ofthe manuscript.

REFE'RENCES1 WALLACE, J. D., BROWN, .J. R., JR., LEwIs, D. H.,

AND DEITZ, G. W.: Acoustic mapping withinthe heart. J. Acoustical Soc. America 29: 9, 1957.

2 AWALLACE, J. D.: U. S. Patent 2,724,171, "Activa-tion of Ferroelectries," November 22, 1955.

3MAIcKusICK, V. A., TALBOT, S. A., AND WEBB, G.N.: Spectral phonocardiography; problems andprospects in the application of the Bell soundspectrograph to phonocardiography. Bull. JohnsHopkins Hosp. 94: 187, 1954.

4 VAN SLYKE, D. D., AND NEILL, J. AM.: Determina-tion of gases in blood an(l other solutions byvacuum extraction an(l manometric meas-urement. J. Biol. Chem. 61: 523, 1924.

5SCHOLANDER, P. F.: Analyzer for accurate estima-tion of respiratory gases in one-half cubic centi-meter samples. J. Biol. Chem. 167: 235, 1947.

6 McKuSICK, V. A., REGAN, W. P., SANTOS, G. W.,AND WEBB, G. N.: The splitting of heart sounds.Am. J. Mled. 19: 849, 1955.

7YAMAKAWA, K., SHIONOYA, Y., KITAMURA, K.,NAGAI, T., YAMAMOTO, T., AND OHTA, S.: Intra-cardiac phonocardiography. Am. Heart .1. 47:424, 1954.

8 WALLACE, J. D., CooP, J. J., REPICI, D. J., ANDSTEIN, J. H.: Ribbon condenser hydrophones.J. Underwater Acoustics 6: 306, 1956.

9FISHER, D. L.: The use of pressure recordingsobtained at transthoracic left heart catheteriza-tion in the diagnosis of valvular heart disease.J. Thoracic Surg. 30: 379, 1955.

it,De Bakey, M. E., Cooley, D. A., and Creech, 0., Jr.: Aneurysm of the Aorta Treated by Resection.J.AM.A. 163: 1439 (April 20), 1957.This report summarizes a 5-year experience in which 313 aortic aneurysms were resected. Surgical

technics involved simple excision in the case of saccular aneurysms, and additional grafting infusiform lesions. When the arch of the aorta is cross-clamped during the resection, a temporaryshunt around the occluded segment or hypothermia is employed to protect particularly the centralnervous system from ischemic effects. The frequent involvement of one or more major abdominalaortic branches by the aneurysm no longer prevents successful resection, and therefore diagnosticaortography is seldom needed. In dissecting aneurysms the false passage usually is led back intothe aortic lumen proximally and distally it is obliterated; less commonly the dissecting area istotally excised. The over-all operative mortality rates have been 31 per cent for 83 thoracic aneu-rysms, 33 peir cent for 27 ruptured abdominal aneurysms, and 8 per cent for 203 nonrupturedabdominal ones. Factors increasing these mortality rates have been technical inexperience, patientsover 60 years of age, and the presence of hypertension or heart disease. Follow-up studies of patientssurviving abdominal operation for periods up to 31] years have shown in general excellent reliefof symptoms, good circulatory maintenance, and a significant increase in survival rates.

ROGERS

775

BRUCE AND JOHN

2STEAD, E. A., WARREN, J. M., _MERRILL, A. J.,AND BRANNON, E. J.: The car(liac output inmale subjects as measured by the technique ofright atrial catheterization. Norimal values withobservations on the effects of anxiety and tilt-ing. J. Clin. Invest. 24: 326, 1944.

31\ CAIICHMEL, J., AND SHARPEY-SCHAFER, E. P.:Cardiac output in man by a direct Fick method.Effects of posture, venous pressure change,atropine and adrenaline. Brit. Heart J. 6:33, 1944.

4 HICKAM, J. B., AND CARGILL, W. H.: Effect ofexercise in cardiac output and pulmonary arte-rial pressure in normal persons and in patientswith cardiovascular disease and pulmonary em-physema. J. Clin. Invest. 27: 10, 1948.

' DEXTER, L., WHITTENBERGER, J. L., HAYNES,F. W., GOODALE, W. T., GORLIN, R., ANDSAWYER, C. G.: Effect of exercise on circulatorydynamics of normal individuals. J. Appl. Phys-iol. 3: 439, 1951.

6SLONIM, N. B., RAVIN, A., BALCHUM, 0. J., ANDDRESSLER, S. H.: The effect of mild exercise inthe supine position on the pulmonary arterialpressure of five normal human subjects. J. Clin.Invest. 33: 1022, 1954.

BADER, R. A., BADER, M. E., ROSE, D. J., AND

BRAUNWALD, E.: Hemodlvnamics at iest and(luring exercise in normal pregnancy as studiedby cardiac catheterization. J. Clin. Invest. 34:1924, 1955.

8 CONSOLAZIo, F. F., JOHNSON, R. E., AND -MAREK,E.: MXetabolic Methods. Clinical Procedures inthe Study of MIetabolic Functions. St. Louis,C. V. MIosby Co., 1951, p. 333.

GOLDBERG, H., AND DOWNING, D. F.: The physi-ological and clinical changes following closure ofatrial septal defects by atrio-septopexv. Am.Heart J. 49: 862, 1955.

10 WIEDERHIELM, C. A.: Direct recording amplifierfor oxygen saturation and dilution curves. Cir-culation Research 4: 450, 1956.

11 DONALD, K. W., BISHOP, J. 1I., CUMMING, G.,AND WADE, 0. L.: The effect of nursing positionson the cardiac output in man. Clin. Sc. 12:199, 1953.

12 SWAN, H. J., MARSHALL, H. W., AND WOOD, E. H.:The effect of exercise on the pulmonary bloodflow in patients with left to right shunts. Sci-entific Session, Central Society for Clinical Re-search, November, 1956.

13DONALD, K. W., BISHOP, J. M., CUMMING, G.,AND WADE, 0. L.: The effect of exercise on thecardiac output and circulatory dynamics of nor-mal subjects. Clin. Sc. 14: 37, 1955.

(pgaGitlin, D., Craig, J. M., and Janeway, C. A.: Studies on the Nature of Fibrinoid in the Collagen

Diseases. Am. J. Path. 33: 55 (Jan.-Feb.), 1957.Human tissues obtained at necropsy from patients with rheumatoid arthritis, disseminated

lupus erythematosus, dermatomyositis, glomerulonephritis, periarteritis nodosa, and tissuesobtained at operation from patients with appendicitis and placentas obtained at delivery as wellas biopsied rheumatic nodules and muscle from patients with dermatomyositis, were studied todetect the presence of fibrinoid. Thin sections of the tissue were stained with rabbit antihumanfibrin antisera labeled with fluorescein. Other sections of these tissues were stained with conven-tional stains to detect fibrinogen and fibrin in the tissue. The fluorescent antibody method forstaining to detect fibrin was much more sensitive than conventional stains. Fibrin deposited asfibrinoid was not restricted to collagen diseases, but was found in other inflammatory conditionsas well. Further, the interaction of fibrin with dyes was dependent upon the medium in whichthe conversion of fibrinogen to fibrin occurred. This reaction is enhanced by albumin. It is con-sidered that interstitial albumin is increased locally by the inflammatory processes, and this maybe one of the parameters for the production of the dye-positive form of fibrin.

HARVEY

783

SPECIAL ARTICLE

REFERENCESCRUMP, L., YOUDEN, W. J., Cox, G. M., LECLERG;

E. L., ASTRACHAN, M., AND TERRY, M.: Specialprograms for teaching experimental statistics toscientists. Proc. Annual Meet. Am. Stat. Assoc.,New York, 1955. Unpublished.

2 "STUDENT" [GoSSET, W. S.]: The probable errorof a mean. Biometrika 6: 1, 1908.

Committee on Lipoproteins and Atherosclerosis ofthe National Advisory Heart Council: Evalua-tion of serum lipoprotein and cholesterol meas-urements as predictors of clinical complicationsof atherosclerosis. Circulation 14: 691, 1956.

4 FISHER, R. A.: Statistical Methods for ResearchWorkers. Edinburgh, Oliver and Boyd, 1925.

5-: The Design of Experiments. Edinburgh, Oliverand Boyd, 1935.

6 HERRERA, L.: Bias in the allocation of treatmentsby random numbers. Science 122: 828, 1955.

MAINLAND, D.: Elementary Medical Statistics:The Principles of Quantitative Medicine.Philadelphia, Saunders, 1952.

8 : The modern method of clinical trial. InMethods in Medical Research. J. M. Steele, Ed.Chicago, The Year Book Publishers, Inc., 1954,vol. 6, p. 152.

9 MEDICAL RESEARCH COUNCIL: Streptomycintreatment of pulmonary tuberculosis. Brit. NI.J. 2: 769, 1948.

10 MAINLAND, D., HERRERA, L., AND SUTCLIFFE, 1\I.I.: Statistical Tables for Use with BinomialSamples-Contingency Tests, Confidence Limitsand Sample Size Estimates. Department of

Medical Statistics, New York UniversityCollege of Medicine, 1956. (Obtainable from theDepartment.)

11 : Use of case records in the study of therapy andother features in chronic disease. I. Planningthe survey. Ann. Rheumat. Dis. 14: 337, 1955.

12 DOLL, R., AND HILL, A. B.: Smoking and carci-noma of the lung. Brit. M. J. 2: 739, 1950. Astudy of the aetiology of carcinoma of the lung.Ibid. 2: 1271, 1952.

13 HAMMOND, E. C., AND HORN, D.: The relationshipbetween human smoking habits and death rates.J.A.M.A. 155: 1316, 1954.

14 BERKSON, J.: Limitations of the application offourfold table analysis to hospital data. Bio-metrics Bull. 2: 47, 1946.

-: The statistical study of association betweensmoking and lung cancer. Proc. Staff. 1Ieet.,Mayo Clin. 30: 319, 1955.

16 WILSON, E. B., JR.: An Introduction to ScientificInvestigation. New York, McGraw-Hill, 1952.

17 MAINLAND, D.: The risk of fallacious conclusionsfrom autopsy data on the incidence of diseases,with applications to heart disease. Am. Heart.J. 45: 644, 1953.

18 -, AND HERRERA, L.: Clinical surveys. InMethods in Medical Research. J. M. Steele, Ed.Chicago, The Year Book Publishers, Inc., 1954,vol. 6, p. 159.

19 -: An experimental statistician looks at anthro-pometry. Ann. New York Acad. Sc. 63: 474,1955.

20 -: A study of age differences in the x-ray densityof the adult human calcaneus variation andsources of bias. J. Gerontol. 12: 53, 1957.

IT,Armitage, A. K., Burn, J. H., and Gunning, A. J.: Ventricular Fibrillation and Ion Transport.

Circulation Research 5: 98 (Jan.) 1957.Ventricular fibrillation has been studied by driving the ventricles of the isolated rabbit heart

electrically and observing whether fibrillation persisted after stimulation was stopped. When theheart was perfused with a solution containing only 25 per cent of the normal content of potassiumions, it soon passed into fibrillation which could be arrested by the addition of potassium ions oradenosine triphosphate, but prolonged by dinitrophenol. The results support the theory thatfibrillation depends on disturbances of the metabolic processes concerned with ion movements.It is proposed that fibrillation is due to passage of potassium ions out of the cell, which is reversedby perfusing with additional potassium ions.

AVIADO

790

INTERFERENCE DISSOCIATION

BER-MAN, R.: Reverse Wenckebach periods: Twocases of an unstable form of partial auriculo-ventricular block. Am. Heart .1. 50: 211, 1955.

MYE'RS, G. B.: The Interpretation of the Uni-polar Electrocardiogram. St. Louis, C. V. _MosbyCo., 1956.

3 LANG1;NDORF, R.: Concealed A-V conduction:The effect of blocked impulses on the formationa(ln conduction of subsequent impulses. Am.Heart J. 35: 542, 1948.

CUTTS, F. B.: Reciprocal rhythm in a patient withcongenital heart disease. Am. Heart ,J. 14: 717,1937.

3 KATZ, L. N., AND KAPLAN, L. G.: Unusual formsof rhythms involving the A-V node. Am. HeartJ. 16: 694, 1938.

40 ZUIDI MA, P. J.: Dissociation with double inter-ference. Am. Heart J. 48: 475, 1954.

41 GENTILE, C.: Disociacion con doble interferencia.Rev. argent. dc car(liol. 106: 212, 1951.

42 LANGINDORF, R.: Differential diagnosis of ven-tricular paroxysmal tachycardia. Exper. M\led.& Surg. 8: 228, 1952.

PICK, A., AND \VINr.RNIrZ M.: Mechanismsof intermittent ventriculat bigeminy. Circula-tion 11: 422, 1955.

44 PoICK, A., LANGEINDORF, R., AND KATZ, L. N.:Depression of cardiac pacemakerls by prema-ture impulses. Am. Heart J. 41: 49, 1951.

4 I)ECHERD, G., AND RUSKIN, A.: Studies of theproperties of the A-V node: 1. Reciprocalrhythm. Texas Rep. Biol. & Me(l. 1: 299, 1943.

4 PENTON, G. B., MILLER, H., AND L1EVINE, S. A.:Some clinical features of complete heart block.Circulation 13: 801, 1956.

41 ROSENBAUM, 2M. B., AND LEPETSCHKIN, E.: Theeffect of ventricular systole on auricular rhythmin auriculoventricular block. Circulation 11:240, 1955.

" 1)REssLER, WV., AND ROIS;LER, H.: Prematurebeats in atrioventr i(cular rhythm. Am. HeartJ. 51: 261, 1956.

49 CUTTS, F. B.: The transitions between normialsinus rhythm, ventricular escape, A-V nodalrhythm and A-V dissociation. Am. Heart .1.13: 451, 1937.

Edwards, J. E.: Correlations in Coronary Arterial Disease. Bull. New York Ac. _Med. 33: 199(M\arch), 1957.The material in this report came from patients (lying in the hospital or at home under the care

of physicians associated with the clinic or from autopsies done at the request of the coroner's(office. Studies included cutting cross sections of epicardial vessels at regular intervals of 3 to 5 mm.and making transverse slices of the ventricles with microscopic examination of muscle from portionsof the ventricles supplied by all branches of the coronary arteries. Significant coronary lesionswere found in these patients, the highest incidence being in the age range from 50 to 59 years,where 75 per cent of the individuals had lesions. A correlation is made with the clinical circum-stances of coronary artery disease. The author points out that in those patients with coronary

arteryl disease and acute mynocardial infarctions clinically, the mechanism of d(ath is difficult toestablish. Of 133 patients studied, 57 or 43 per cent (lied with evidence of myocardial failure.Thirty-one or 23 per cent of the patients died with repeated attacks of chest pain and withoutevidence of myocardlial failure. This was diagnosed as (oronary failure and there was no pathologihgevidence of new infaretion. Twentv or 15 per cent of the patients died of rupture of the heart.The rupture of the heart resulted first from a dissection in the endocardium with bleeding intothe myo(ar(lium, and a final (lissection of the hematoma through the epicardium into the peni-car(lial space. In the 133 patients, only 8 who (lied had associate(l thromboembolic complications.In 250 patients with coronary artery (lisease in whom acute infaretion ha(l o((urre(l in the past,64 or 26 per cent (lied suddenly without evidence of repeated mvocar(lial infarction. The authorstresses that patients with coronary artery (lisease, including patients with healedc myocardi.alinfarction mnay die on the plresunel( basis of acute mvcocarcdial ischemia vithout infarction.

HARVEY

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AMERICAN HEART ASSOCIATION, INC.44 East 23rd Street, NEW YORK 10, N. Y.

Telephone Gramercy 7-9170

ASSOCIATION AWARDS PRESENTEDTO PHYSICIANS AND LAYMEN

Among the honors conferred on physicians,scientists and laymen in recent months by theAmerican Heart Association for outstandingservice in advancing the Heart program and forachievement in cardiovascular research werethe following:

GOLD HEART AWARDS

Recipients of the Gold Heart Awards, high-est award of the Heart Association for out-standing contributions to cardiovascular medi-cine and to the Heart organization, were IrvingS. Wright, M\.D., Past President of the Ameri-cani Heart Association; Irving B. Hexter,Cleveland publisher; and television star RalphEdwards.

Dr. Wright, Professor of Clinical Medicineat Cornell University Medical College, has longbeen an outstanding leader in both the nationalAssociation and the New York Heart Associa-tion. A member of the Board of Directors ofboth groups, he is also Chairman of the na-tional Association's Publications Committeeand serves on the Editorial Board of Circula-tion.

Mr. Hexter, President of the Industrial Pub-lishing Company, Cleveland, is a Vice Presidentand Board member of the Association. He hasbeen Secretary of the national Association,Chairman of the Board of the Ohio State HeartAssociation and Chairman of the Board ofTrustees of the Cleveland Area Heart Society.A special Gold Heart Award was presented

to Ralph Edwards to commemorate the tenthanniversary of his "'Walking Man" radio con-

test which raised the funds required to launchthe Association as a voluntary health agency.

LASKER AWARD

Isaac Starr, M.D., former Dean of the Uni-versity of Pennsylvania School of Medicine,received the Albert Lasker Award of the Ameri-can Heart Association for distinguished achieve-

ment in the field of cardiovascular research andparticularly for his influence in helping todevelop today's vastly changed concepts ofcongestive heart failure. Tribute was paid toDr. Starr for his numerous achievements as aphysiologist, pharmacologist, clinician, researchscientist, teacher and, above all, as an inde-pendent thinker. He is Hartzell Research Pro-fessor of Therapeutics at the University ofPennsylvania School of Medicine and serves onthe Editorial Board of Circulation. The award,consisting of a statuette of the JVinged Victoryof Samothrace and an honorarium of $2,500, isgiven annually by the Albert and MIary LaskerFoundation through the American HeartAssociation.

SPECIAL CITATIONS TONOBEL PRIZE LAUREATES

Special citations also were presented to threeNobel Prize winners, Andre Cournand, M.D.and Dickinson Richards, M.D. of New Yorkand, in absentia, Werner Forssmann, M4.D.,Germany, for catheterization of the heart andresearch carried out by means of catheteriza-tion.

All of the above awards Awere presented at theAnnual Meeting and Scientific Sessions of theAmerican Heart Association in Chicago,October 25-29.

BLAKESLEE AWARD WINNERS

Five winners of the 1957 Howard W. Blakes-lee Awards of the Heart Association for out-standing reporting in the field of heart andcirculatory diseases were honored at a specialluncheon in New York on October 5. New ad-vances in heart surgery wAere featured by fourout of the five winners in the categories of na-tional news syndicates, local newspapers,national magazines and television.

Recipients of the Blakeslee Awards, each ofwhich includes an honorarium of $500, are asfollows:

Circulation, Volume XVI, Yovember 1957851

AMERICAN HEART ASSOCIATION

Leonar(l Engel, free lance writer, for a serieson cardiac surgery published by the NorthAmerican Newspaper Alliance.

W'alter Bazar, Newv York Journal American,for a series on heart research and advances intreatment7, including surgery, entitled, "NewvHope for Your Heart."Don Duinham, Cleveland Press, for his spot

news report on the first "stopped heart"operation, performed at the Cleveland Clinic.

Stev(en .11. Spencer, for his article in theSaturday Evening I'ost, "They Repair Dam-aged Hearts," a comprehensive review of ad-vances in heart surgery.

"Robert Montgomer!y Presents," for theNBC-TV presentation, "The Long Way

Home,"ya one-hour dramatization about a man

who suffered a heart attack and his subse-(uent recovery.

WO( ItLD CON(GR ESS OF CA4RDIOLOGYABST IRCTrS DUE BE FORE FEBRUARY

The American Heart Association will receiveabstracts from those persons in the UnitedStates who wish to present papers at the ThirdWorld Congress of Cardiology to be held inBrussels, Belgium, September 14-21, 1938.Summaries of the papers, consisting of 200typewritten words in English and a translationin 1'reach, Spanish or German, must be in theHeart Association's national office, 44 E. 23rdSt., prior to February 1, 1958. Participants whoreside in a country outside the United Stateswhich has no National Society of Cardiologyshould address abstracts and translations to theSecretary of the Congress, Dr. F. Van Dooren,80 lRue MIercelis, Brussels, Belgium.

Registration for attendance at the ThirdWorld Congress of Cardiology is open tomemhbers of the various national societies andasso(iations engaged in the study and controlof cardiovascular disease as well as to physi-ciatns and scientists residing in countries whereno national society of cardiology has been

established. Ameiicaii physicians who attendedthe Second World Congress in Washington(1394) ws1ill receive a pamphlet on the ThirdCongress and application forms. Further in-formation on the forthcoming Congress may

be obtained from the American Heart Associa-tion or fromi Secretary Van I)ooren in Brussels.

HEART ASSOC1ATIOl\ ISSUESVARICOSE VEINXS BOOKLET

A new illustrated booklet, entitled, "N a-cose Veins," has been published hy the Associa-tion. Intended primarily for distribution byphysicians to patients with this condition andtheir families, the booklet emphasizes that thephysician should be consulted early whenever,varicose veins are suspected. If the physi(inniis seen in time, it points out, he c(an often wardoff serious damage resulting from this (onidi-tion.

Single copies of the booklet are availablefree of charge from the American Heart Associ-ation and local Heart Associations.

BRAZIL CARDI()Lo(;Y' CONGRESSELECTS NEW DIRE.CTORS

The 1960 Iinter-American Meeting of theBrazilian Congress of Cardiology will be heldinlRio de .Janeiro, it was atiiniouniced at the14th Brazilian Congress of Cardiology held last.July 7-13. The Society elected the followingnew officers for the 1937-38 term: 1vresident A.de Carvalho Azevedo, Vl).;Vice President,lProf. Rubens Niaciel; Glenjeral Secretary,Robinson Roubach, -I.Ml).; Treasurer, GT.Strunck, \1.I).; Sub-Seeretary, Adao G.Mattos, M.D.

GRANTS AVAILABLE To STUDY ASI4ANFLU I1E ART EFFECTS

The National Advisory Heart Council hasrecommended that the Natioi ial Heart Instituteencourage research on the effects of Asian II-flueaza upoIn the (ardiovas(clar system. Na-tional Heart Institute research giants are avail-able on a competitive basis to investigatorswishing to study the (ardiovals( lar-renial ef-fects of influenza.

Research grant applicatioiis will be processe(las rapidly as possible. Applicatiois may be ob-taimed by writing to Hermani I. Schmid, .1r.,MI.)., National Heart Inlstituite, Bethesda 14,M~d.

MEETINGS CAIXLNDARNovember 22-23: Council for High Blood Pressure

Research of the American Heart Association,Cleveland. Mrs. Jerry H. Bruner, 1689 East115th Street, Cleveland 6, Ohio.

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AMERICAN HEART ASSOCIATION

December 3-6: American Medical Association,Philadelphia. George F. Lull, 535 DearbornStreet, Chicago 10, Ill.

December 6-7: American Federation for ClinicalResearch, Eastern Section, New Haven, Conn.Franklin H. Epstein, M1.D., Department ofInternal 1Iedicine, Yale University School ofMedicine, 333 Cedar Street, New Haven 11,Conn.

December 10-12: Southern Surgical Association,White Sulphur Springs, W. Va. Mdr. George G.Finney, 2947 St. Paul Street, Baltimore 18,MId.

January 24, 1958: American Federation for ClinicalResearch, Southern Section, New Orleans.Kenneth R. Crispell, M.D., Department ofInternal 1\edicine, University Hospital, Char-lottesville, Va.

January 29-30: American Federation for ClinicalResearch, Western Section, Carmel, California.M~onte IA. Giee, 1\L.D., University of OregonMedical School, Portland, Ore.

March 9-14: International College of Surgeons, 11th

Biennial Congress, Los Angeles, Karl A. Mey er,M.D., 1516 Lake Shore Drive, Chicago 10, Ill.

iIarch 20-22: Chicago Heart Association, Confer-ence on Pulmonary Circulation, Palmer House,Chicago. Wright Adams, 1I.D., Department ofMedicine, University of Chicago, Chicago 37,Ill.

ABROADJanuary 7-10, 1958: Third International Syimiposiuiim

on Radioactive Isotopes in Clinical Applicationand Research, Bad Gastein, Austria. The SecondMedical Clinic, Vienna University, Vienna,Austria.

January 21-February 14: International Union ofBiochemistry, General Assembly, Vienna, Aus-tria. Prof. R. H. J. Thompson, Department ofChemical Pathology, Guy's Hospital \IMedicalSchool, London, S.E. 1, England.

September 14-21, 1958: Third World Congress ofCardiology, Brussels. Dr. F. Van Doorein, 80Rue -Mercelis, Brussels, Belgium.

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