Prothrombin Deficiency in Pulmonary Tuberculosis

Abstract

accompanying surgical manipulations. Criticism of available solutions is well taken. Alcohol is far from an ideal solution.We certainly need something to replace alcohol. We should make every effort to find it. The series of cases Dr. McCuskey mentioned in which lumbar sympathetic block was used to treat phlebitis is extremely interesting. This is one of the most dramatic and successful practices in the field of therapeutic nerve blocking. We have recently analyzed similar cases in Bellevue. Fifty-four patients have been treated. Seven were unsatisfactory and would not submit to a second injection; 4 were improved after only two blocks and 43 had satisfactory results. Most patients treated here have had early acute involvement. However, the block is certainly indicated in chronic cases. One case is that of a phlebitis for five months following hysterectomy which responded to one injection. I agree that interrupting the lumbar sympathetic pathway at any one point is sufficient. However, we still inject the first, second and third ganglions with procaine and lately we have been put¬ ting alcohol in the second. The matter of diagnosis has been stressed throughout the discussion and I think should be empha¬ sized. The cases of Dr. McCuskey and the first case of Dr. Sword point definitely to the advantages in treating diseases other than those with associated pain particularly if vasospasm is present. We do not use brachial plexus block in the differen¬ tial diagnosis of Raynaud's disease. It is simpler to do an ulnar block, and the results are satisfactory. I will not attempt to discuss the indications and limitations of subdural alcohol.When we employ such therapy, which is not often, the injection is made with the patient in the head down-feet down position, inclined forward, so that the apex of the angle formed is at the position of the principal nerve segment that we think may be involved.Since 1937, when A. J. Quick demonstrated the relation of a low prothrombin level in the blood to a hemorrhagic tendency, there has been application of the Quick prothrombin test in the investigation of the bleeding tendency in many clinical entities. It has been established that a definite prothrombin deficiency is associated with the bleeding observed in obstructive and catarrhal jaundice.1 A prothrombin deficiency has been observed in hemorrhagic disease of the newborn and in other clinical conditions, as has been well summarized by Snell and Butt.2In a certain number of cases pulmonary tuberculosis is complicated with hemorrhage. This symptom of hemoptysis is most harassing and alarming to the patient. The incidence has been reported as ranging from 20 to 80 per cent. A. R. Masten 3 found that 33.8 per cent of 1,000 patients admitted to a sanatorium because of pulmonary tuberculosis had hemoptysis before discharge or death. To determine whether there occurred any disturbance in the mechanism of coagu¬ lation, an investigation of the prothrombin concentration was made on the blood of patients with active and chronic pulmonary...