JUNE 26, I926] INICOTINE IN POST-ENCEPHALITIC PARKINSONISM. M J 1079The chemical character of the base may be an important factor; lard and wool-fat are both esters and both absorb well, the absorption increasing on continued rubbing, so that probably part at least of the absorption takes place through the sebaceous glands. Possibly the difference between them in the absdrption of medicament may be due to the glyceryl esters of the lard, which may assist the secretions of the glands t-o form oleates or other easily absorbed compounds; the oleate, as shown above, is itself easily absorbed. The cholesteryl esters of the wool-fat may not form similar compounds. It has been generally assumed that the wool-fat would be the better base for absorbent ointments because it approximates more nearly to the natural fats of the skin; though this may be an important-factor in the absorption of the wool-fat itself, it evidently does not aid the absorption of the mercurial zuedicament.Paraffin composed of hydrocarbons and comparatively inert chemically is not likely to form compounds with the sebaceous secretions; it has not much power of penetrating the skin, and possibly that which is absorbed may be taken up by the epidermal layers; the fact that absorption does not increase with increased rubbing seems to point to this possibility.One factor undoubtedly influencing the amount of absorption by the skin is the temperature; it was always found that rubbings done in very cold weather gave less absorption than usual. This may be partly due to the increased vascularity of the skin at the higher temperature, and partly to the higher temperature making the ointment softer and more easily rubbed into the skin. That the latter is not the only explanation is shown by the fact that rubbings taken on an exceptionally hot day in July, 1923, gave figures slightly below the average-namely, 10 per cent. for a lard and 5.5 per cent. for a paraffin base. Possibly the moist condition of the skin from perspiration on that day had an adverse influence on absorption.An attempt was made to compare the amount of absorptioni through the skin of the palm, which contains no sebaceous glands but many sweat glands, with the amount absorbed through an equal area-on the arm. The rubbings weire carried out on the palm and the arm on the same day, aind tlhe same mercurial ointment with a lard base was used.The total absorption through the palm was 4.3 per cent., and through the arm 7.3 per cent.; the amount of mercury absorbed in the palm was 0.8, and through the arm 1.8; the lessenedl absorption through the palm may bo due either to the greater thickness of the epidermis or to the absence of sebaceous glands, or more probably to both of these factors. CONCLUSIONS. 1. Under the conditions of these experiments it wasfound that when rubbed into the skin all mercurials were absorbed to some extent from all the bases tested.2. That in all cases tho greatest absorption took place froiii the lard basis, and that the amount of absorption with tho lard basis increa...
ASSISTAST S U H O X O S I N TIW GEXERAI, IXFIRMAKY, I.EEDS.TIIIS study has been undertaken in order to obtain further information about the inhibitory influence, if any, of the sympathetic nerves on gastric acidity.Evidence in favour of the depressive influcnces reaching the stomach by the splaiichriic nerves will be deduced from :-I . Uitzicul 00seri!ations : (1) Gastric analyses in cases of hyperthyroidism ; (2) Thc effect of thyroid feeding on gastric secretion ; (3) Changes produced by adrenalin and nicotine administration ; (4) Depressive action of emotions on acid secrction.11. E: iperittieiitul Obsewatioris : Observations on HC1 secretion after bilateral section of the splanclinic nerves in the dog.
THIS case is noteworthy on account of its unusual clinical features during life and the anatomical abnormality found post mortem--namely, a very large diverticulum of the small intestine..HIs!roRY.-An infant, 5 months old, was admitted under the care of Dr. Vining for severe attacks of melmia. A first attack, sudden in onset, occurred two days after birth, a second hEmorrhage took place two months afterwards. and a third just before admission. W-hen admitted, the child appeared very blanched, and the blood-count showed a very severe type of secondary ansmia. Repeated small injections of blood taken from the father were given intramuscularly and improved the child's condition, and the patient was duly discharged from the hospital. The infant was, however, re-admitted two and a half months later for another severe attack of melena. This time a diagnosis of polypus of the intestine was suggested, and a laparotomy was performed which revealed free fluid in the abdomen and enlarged mesentcric glands. The condition was taken to be tuberculous, and the abdomen was closed. The child died a few days after the operation.POST-MORTEM ExAnIrNATIoN.-on opening the abdomen the peritoneal cavity was found to contain a few ounces of clear, straw-coloured fluid. The lower part of the ileum had a double-barrelled appearance which a t first was thought to be due to matting together of two coils of intestine, as 'seen in tuberculous peritonitis. On closer inspection, however, one of the two coils proved to be a very large diverticulum arising from the ileum two feet above the ileocaecal valve. The diverticulum showed all the layers of the small intestine, and communicated with the main channcl of the gut by a large opening about an inch in diameter, lying on the antiniesenteric border of the ileum. A t the junction of the diverticulum with the ileum were two chronic ulcers which probably had been the cause of bleeding during life.The diverticulum crossed over the ileum to become attached to its mesenteric border and thus accompanied the gut upwards for 334 in., terminating blindly. A well-marked stitch-work, very typical of physiological adhesions, bound the diverticulum to the gut, and blood-vessels, branches of the ileocolic artery, were seen coursing across the ileum to supply it. No communication between the two channels, other than the one described, was detected even after the water t e s t ; nor did the ileum present any breach of its
In nine insulin-dependent diabetics postprandial glucose control under closed loop insulin infusion by an artificial endocrine pancreas was compared with that obtained under open loop infusion employing identical infusion profiles which were advanced 20 min by time in the case of open loop infusion. The earlier increase of insulin infusion rates in the latter case resulted in lower postprandial glucose concentrations during the first 90 min after meal intake. Incremental areas under the blood glucose curves during this time were significantly lower when insulin infusion rates rose earlier (4.5 X 10(3) +/- 0.5 X 10(3) vs 2.1 X 10(3) +/- 0.6 X 10(3) mg/dl X min; p less than 0.02). Insulin was administered at maximum rates 45-50 min after the start of the meal during closed loop infusion (196 +/- 38 mU/min) and 25-30 min after the meal during open loop infusion (192 +/- 35 mU/min). Correspondingly, mean free insulin concentrations which are available from six patients rose to 135 +/- 47 (40 min) or 141 +/- 50 muU/ml (20 min). Glucagon levels did not differ between both parts of the study. It is concluded that increases of postprandial insulin infusion rates occurring earlier than increases of blood glucose levels are important for optimizing glucose profiles and possibly reflect physiologic conditions.
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