The chromaffin cells of the adrenal medulla are a part of the scattered " chromaffin tissue system."The tumours of these cells, the pheochromocytomata or adrenal paragangliomata are nearly always benign, but usually produce paroxysmal hypertension ending fatally if the tumour is not removed.There are reports of 152 cases of pheochromocytoma. The only extra-adrenal paragangliomata that have produced the hypertensive picture are those arising in the retroperitoneal tissues between the kidneys: of 13 such cases, 9 had the cardiovascular syndrome typical of the adrenal cases, and they form part of one clinical problem and are considered with the adrenal cases here. Of these 165 cases, 90 have been described since 1929, and 36 operations have been reported.Paragangliomata arising from the intrathoracic sympathetic chain, from below the bifurcation of the aorta, from the coccygeal body, from the carotid body, and in the wall of the intestine are described, but very few of these are true tumours of the chromaffin tissue system (Da Costa, 1939-40;Christie, 1933) and none has given the cardiovascular picture. In 1886 Frankel reported an autopsy finding of bilateral adrenal tumours and cardiac hypertrophy in a girl of 18 who for three years had had attacks of palpitation, headaches, and vomiting. The first full clinical description was by Labbe, Tinel, and Doumer (1922) who observed the paroxysmal hypertension in the attacks. The first case in which the correct diagnosis was made and followed by operation and cure was that of Pincoffs and Shipley (1929).The final important step was by Beer, King, and Prinzmetal (1937) who showed that during the crises the blood contained large amounts of adrenaline.Incidence and pathological anatomy. The incidence of pheochromocytoma in men and women is equal. Cases with the cardiovascular syndrome occur at all ages; mostly between 20 and 50 years. The association with generalized neurofibromatosis is recorded in nine cases.The common lesion is a benign adenoma of one adrenal body. Sixteen bilateral tumours are recorded: of these, 8 showed a cardiovascular syndrome and 6 were malignant. Malignant pheochrome tumours are rare (15 cases), but may show a hypertensive picture. In about one case in ten the tumour is extra-adrenal, lying between the adrenal and the midline.
is a brave boy,' proclaimed George Hector,* when he brought Samuel Johnson into the world. From this moment and throughout most of his childhood, young Sam was harassed by a variety of afflictions that troubled his daily existence, but did not prevent him from eventually becoming one of England's outstanding literary figures. Samuel Johnson's adult illnesses and the history of his childhood have been described by many writers, but no separate work is available on his childhood medical history. The purpose of this paper is to describe Johnson's childhood medical disorders and their consequences. The principal source of information on this period in Johnson's life is from an autobiographical sketch, An account of the life of Dr. Samuel Johnson from his birth to his eleventh year, written by himself. Johnson apparently called this his 'Annals' and his two principal biographers, Boswell and Hawkins, did not know of its existence. This was written when he was 55 years old and was 'among the mass of papers which were ordered to be committed to the flames a few days before his death.'** Johnson's 'Annals' gives a record of his early affections, but it contains a rather questionable medical implication that has been perpetuated as fact. This is that Johnson developed tuberculosis during the first few weeks of his life. We propose to point out that this is unlikely and to show that it is much more probable that he developed tuberculosis later, when he was about two years old. * George Hector (b. circa 1678), whom Johnson called 'a man midwife of great reputation', was a surgeon in Lichfield. Hector had a large practice as a parish doctor, attending various ills, setting broken bones, treating scrofulous tumors, etc.'7 His home was less than one hundred yards away from the Johnsons. He was an uncle of Johnson's schoolfellow and lifelong friend, Edmund Hector, a Birmingham surgeon. It was unusual in the early eighteenth century for childbirth to be assisted by a 'man' midwife. His mother's age and difficult labour probably prompted Hector's attendance during the birth. In previous times ladies-in-waiting or midwives were usually present during labour and birth. Obstetrics as an accepted speciality for physicians did not begin until the late eighteenth century with the publication of Smellie's Midwifery (1752) and William Hunter's the Gravid Uterus (1774). ** This manuscript diary was preserved from the flames by Johnson's Negro servant Francis Barber, and subsequently purchased from Barber's widow by Richard Wright, a surgeon in Lichfield.
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