[Six papers on the posterior pituitary hormone and the parasympathetic nervous system] / by Harvey Cushing.

  • Harvey Williams Cushing
Date:
[1931?]
Catalogue details

Licence: Public Domain Mark

Credit: [Six papers on the posterior pituitary hormone and the parasympathetic nervous system] / by Harvey Cushing. Source: Wellcome Collection.

    9/54 page 167
    11.20.—Temperature falling rapidly. Now 98.5°. Flush persists. Perspiration still excessive. Nauseated but no cramps. 11.30.—Rectal temperature 97.7°. Condition otherwise unchanged. 11.38.—Gradual slowing of pulse to 60 and of respiration to 12. Blood-pressure fallen to pre-injection level of 130. Rectal temperature 96.8°. 11.50.—Rectal temperature 96°. Flush fading. Perspiration much diminished. 12.00 Noon.—Rectal temperature 95.3°. Flush barely perceptible. Skin drying. Still nauseated. 12.10 P.M.—Rectal temperature 94.8°, Pulse 60. 12.20.—Rectal temperature 94.2°. Vomited 75 c.cm. of bile-stained mucous fluid. 12.30.—Rectal temperature continues at 94.2°, its lowest point, a drop of 5.6° F. in 1 hour 40 minutes. Erythrocytes 4,800,000. Blood sugar 0.114. 12.41.—Basal metabolic rate —31. Rectal temperature has started to rise, 94.4°. Beginning to feel cold though he has been well covered and room temperature at this time is 77°F. 2.30.—Weight 83.9 kgm. Loss of 1.9 kgm. 2.45.— Vomiting again, 150 c. cm. of yellow mucous fluid. Unable to void voluntarily. Bladder feels empty. 3.00 et seqg.—Returned to ward. Rectal temperature (taken by thermometer) did not regain pre-injection level until 6 P.M. and continued to rise to a maximum of 101 °F. at2A.M. Voided400c.cm.at6 A.M. Morning rectal temperature 99.8°F. 8.30 A.M. basal metabolic rate —1, a rise of 30 points from low injection level of day before. To summarize: The injection in this case gave a marked reaction, its more striking features being the vaso-dilatation and sweating (sparing the skin over the bone flap); the drop of 5.6°F. in body temperature in the course of an hour and a half with coincidental lowering of the basal metabolic rate from —13 to —31. Vomiting was less pronounced and more tardy in appearance than usual but the patient stated that he never vomits easily. The customary salivation and lachrymation were not noted. There was no temporary increase in erythrocytes as has been observed in some other tests though the loss of fluid from sweating would have led one to expect there might be, regardless of any effect in con- traction of the spleen. Similar injections with variable amounts of the extract (one cubic centimeter of surgical pituitrin being the customary dose) have been made up to the present time on 38 occasions in 24 subjects. The majority of the patients who have submitted to the tests were convalescing from operations for pituitary adenoma of one sort or another, the larger number of them with adenomas of chromophobe variety associated with moderate signs of pituitary insufficiency (hypopituitarism). As this clinical state is usually accompanied by more or less pallor and by an extreme dryness of the skin, the flushing and sudorific response have been the more striking. Because the operations on these patients had been conducted for the purpose of restoring vision due to pressure against the chiasm of a large adenoma, this fact implies that the posterior lobe was in all probability thrown out of function by the expanding intrasellar lesion, which might
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