No abstract

As a cause of accidental and suicidal death carbon monoxide ranks second to automobile fatalities. It is estimated that there occur annually in the United States about fifty thousand deaths from asphyxiation, at least half of which are due to this gas. In New York City reports show that for every seven automobile deaths there are five carbon monoxide deaths. Unfortunately, there are few reliable statistics available on the incidence of acute carbon monoxide asphyxiation, and there are none whatever regarding the remote effect of the gas. The most valuable data have been collected and published by the Ohio State Board of Health, which has been emphasizing the importance of the subject from the standpoint of public health for a number of years. The records for 1936 showed a progressive increase of the hazard in both the domestic and the industrial life of the community.Of a total of 518 gassings, there were 288 from defective domestic appliances, with sixty-two fatalities. Of the victims twenty-three were overcome by bathroom heaters with four deaths, twenty-six by hot water heaters with six deaths, and fifty-five by coal or coke stoves and furnaces with five deaths. The worst menace was the gas stove for heating rooms, which was respon¬ sible for twenty deaths. Even the beauty shop is not free from hazard, as eight persons were overcome from imperfect heating devices.Despite the well known fact that carbon monoxide is a powerful death-dealing agent in acute asphyxiation, knowledge is lacking concerning the delayed result or after-effects of acute asphyxiation or the insidious effect of the gas in producing chronic ailments in those exposed intermittently over long periods. Years ago a statement to the effect that if carbon monoxide does not kill it will do no harm became axiomatic. Unfortunately, absurd as this statement seems, apparently no effort has been made to prove or disprove its correctness. In conse¬ quence, victims who have survived asphyxiation and become physically incapacitated have failed to get com¬ pensation for disability, nor did the family receive any award in case of death.It is difficult to estimate the incidence of the so-called chronic forms or secondary syndromes of asphyxiation resulting from carbon monoxide. Until further clinical investigations are made and more careful statistics com¬ piled, it can only be a matter of conjecture.A personal study and analysis of 150 selected patients suffering either from anoxemia due to slow asphyxiation or from the residual effects of severe acute asphyxiation yielded important facts relating to the subject.Geographically, the cases were distributed as follows :West Virginia ninety-six, Maryland forty-two, Pennsyl¬ vania five, Ohio four, Kentucky, New Jersey and Okla¬ homa one each.In our series one out of eleven patients admitted from West Virginia for diagnosis was a victim of slow gas asphyxiation, whereas from all other states com¬ bined there was approximately only one out of every 150 patients.There were ninety-one males and fifty-nine females. I...

Progress in clinical endocrinology depends largely upon the successful application of knowledge derived through extensive experimental animal research. It is generally assumed that there is a parallelism between the results obtained in man and those obtained in animals. There are instances, however, in which this corollary does not apply, and the reactions in man occur in an antagonistic or paradoxical manner as compared to those occurring in animals. The case which we herewith report, of pituitary dwarflsm with diabetes mellitus, is an example. There have been only a few such cases recorded in the literature. Sexton and Neuhoff (1) recently reported a somewhat similar case. We are presenting our case in the hope that it may stimulate further research and investigation, and ultimately solve this unexplained clinical phenomenon.Clinically, Goetsch, Cushing and Jacobson (2) early pointed out the presence of decreased sugar tolerance in cases of hyperpituitarism. Cushing (3) demonstrated that hypophysectomy creates adipose dwarfs with increased carbohydrate tolerance. Experimentally, Houssay (4) opened the field for further speculation with his hypophysectomized-pancreatectomized dogs. He found that hypophysectomy in dogs causes an increased sensitivity to insulin (5); that hypophysectomy ameliorates diabetes produced by ablation of the pancreas (6); and that in hypophysectomized dogs, injection of anterior lobe substance causes hyperglycemia ( 7 ) . Evans ( 8 ) produced glycosuria and hyperglycemia in normal dogs by injections of anterior pituitary extract.The nature of these observation led to the concept of a diabetogenic principle of the anterior pituitary in order to explain the reactions enumerated above. The diabetogenic substance, as well as the growth factor, is believed to reside in the eosinophilic cells of the anterior lobe. Despite these observations, the experimental evidence does not seem to be conclusive, since it fails to explain satisfactorily the co-existence of pituitary dwarfism (anterior lobe deficiency) and diabetes mellitus (decreased sugar tolerance), the two outstanding clinical manifestations in our case. CASE REPORTThe patient, referred by Dr. Wilson of Piedmont, West Virginia, is a boy 1 7ŷ ears of age, who has been under our observation for stunted growth and diabetes during the past 2y 2 years. There was no history of dwarfism or diabetes in the family. His parents were both 62 inches tall. Four brothers ranged in height from 67 to 71 inches, and 2 sisters each measured 63 inches. The patient was considered of average size at birth, developed normally and grew fat until the age of 4 years, when he suffered from an attack of rheumatic fever. At the age of 5 he contracted 115 The Endocrine Society. Downloaded from press.endocrine.org by [${individualUser.displayName}] on 28 March 2016. at 07:25 For personal use only. No other uses without permission. . All rights reserved.