Sodium succinate and leucocytosis

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Content SODIUM ’ SUCCINATE AND
LEUCOCyT0SIS
A Thesis
Presented to the Department of Physiology
College of Physicians and Surgeons
University of Southern California
In partial fulfillment
of the
Requirements for the
Degree of Master of Arts
By
Ernest E. Kessler
April 30,1917
UMI Number: EP67689
All rights reserved
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The writer wishes to express his appre
ciation to the Los Angeles County Hos
pital authorities for the opportunity
afforded and to Drs. C. C. Browning and
F* S. Hammett for their kind assistànce
and suggestions.
SODIUM SUCCINATE AND LEUCOCYTOSIS.
INTRODUCTION.
Pfeiffer's phenomena regarding the action of leucocytes
when micro-organisms are introduced into the peritoneal cavity
gave the necessary stimulus for the inauguration of intensely
active work along the line of phagocytosis and immunity. Since
then, workers of such note as Metchnikoff, Von Behring, Ehrlich
and Salimbeni have attempted to solve this question,
i
Salimbeni , working in the laboratory of Metchnikoff, car
ried out a series of experiments on phagocytic reaction in
acquired immunity and came to the following conclusions: Oedema
at the point of innoculation begins immediately after the in
jection of the micro-organism into the test animal. After 20
to24 hours phagocytosis, which at first was insignificant, was
complete. The macrophags,present in large numbers, envelop
the bacteria, but the bacteria overcome the macrophage and they
are destroyed. The microphags now attack the invaders and are
successful in overcoming them.
With the above factors in mind, Metchnikoff suggested that:
**We may even attempt to Increase phagocytosis in surgical ope
rations, especially in those on the peritoneal cavity, by there
setting up an artificial aseptic inflammation by means of various
substances, which attract a large number of leucocytes. In la
boratory practice, this method is in daily use for the purpose
of increasing the resistance of an animal against intraperito-
neai injections of various micro-organisms, and Dunham, has
^Ann. de I'Inst. Pasteur, Paris, 1898,t.Xll pl92.
suggested the extension of the same method to human medicine.
Following this line of thought, Loewy and Richter^, M.Hahn^,
and Jakob , carried on a series of experiments proving that ar
tificial leucocytosis influences the course of an infectious
disease, with special reference to pneumonia. Kikodse^, Sad
ler^, V.Jâksch®,îschistowitsch^ and Turk^^ all state that leu
cocytosis is absent in especially severe or in fatal cases.
It seems, then, that if the leucocyte content of the blood
could be raised to combat the invading organism, the patient
would be benefited.
Bacterial toxins, proteins, organ extracts, poisons, inor
ganic chemicals, etc. have been used to induce leucocytosis.
Bauer^^,reports that oil of turpentine produces leucocytosis
in great many infections, but not in Enteric Fever. Pilocar-
pin, as well as colloidal metals have been found to increase
the leucocytes but the former is too depressing to the system.
Sodium cinnamate increases the white cells more than double.
2
Immunity in Infectious Diseases pp. 568-9.
Deutsche Med. Wochens. 1895 No.15.
^Hahn M. Arch. f. Hygiene 1895 Vol.XXX.
®Jacob - XV Kongress innere f. Medizin, 1897, Zeitsahh. f.
Klin. Wochenschr. 1904.
^Kikodse- Zentralbl. f. Allgem. Pathologie u patholog. Ana-
r j tomie. 1891 #3.
'Sadler-Portschritte d. Medizin ïHHS XîîX.XXra:.1892.
^Jaksch R.V.- Zentralbl. f. Klin Medizin 1893 Vol.X^lll
9
Tschistowitsch(abstract)Zentralbl f.d. Med.Wissensch 1894
No.39 and Annales Institut Pasteur 1892.
10rpuj.k-Klinische TJntersuchungen uber das Verbal ten des Blutes
beiakuten Infectious-krankheiten, Vienna & Leipzig 1898
^^Bauer- Virchow's Archiv. Vol.CLVl
Nuclein has been found to have a powerful leucocyte increasing
action. Dr. Hahn says that the count is doubled; Von Mager
12
reports an average increase of 75^. Sadler in 1892 has found
that digitalis causes a hyperleucocytosls in favorable cases
of pneumonia. This was confirmed by Thislowitsch and Schle-
singer^^. Just recently Fralich^^ has made use of dlgalln both
orally and intravenously as an aid to surgery.
Dr. C. C. Browning of Los Angeles, has been utilizing So
dium Succinate in treating his tubercular patients and noted
that in some instances the drug caused a leucocytosis. In
order to investigate the leucocytic action of this compound
a series of experiments were carried out at the Laboratory of
the College of Physicians and Surgeons of the University of
Southern California and the Los Angeles County Hospital.
MSTHOa.
The subjects selected were divided into two groups; group
1 constituting normal cases- Those with no known illness, and
group 2, tubercular patients from the Los Angeles County Hos
pital. The second group was carefully chosen so as to repre
sent patients in the various stages of the disease.
12
Sadler- Fortschritte der Medizin 1892.
13
Thislowitsch- Annales de l'Institut Pasteur Vol.V.
14
Schiesinger - Zeitschrift fur Hygiene Bd.35.
15^’
Fralich W. G. - Medical Times N. Y. 1916 XLIV 249-51.
The time for making the tests was arranged so that the pos
sibility of error arising from physiological leucocytosis was
minimized. The regulation of the time and amount of diet
was strictly carried out in the case of the normals, but this
could not be attempted with the members of group 2.
the method of procedure with both of the groups were similar
and will here be described. Previously to the use of the So
dium Succinate, blood was drawn from the subject on two or
more occasions and five white blood cell counts were made each
time. The average of all these counts constituted the normal
for that individual* Within two or three days, the first dose
of the drug was given in the form of .Ic.c. of a 1% solution
subcutaneously. Four to six hours later. The first test count
was made, which was determined from the average of five sepa
rate counts from the same dilution. The subsequent test counts
were made a day or two apart, until the count had reverted to
normal to such an extent that the increase due to one injec
tion was confirmed. Then, a second dose of drug was adminis
tered and the same procedure as above followed.
In order to eliminate the possibility of unfavorable reac
tion the patients were watched for possible symptoms of rise
of temperature, feeling of light headedness, restlessness,
nausea etc. The doses of the drug were given not less than
five days apart-
RESULTS.
The first group was composed of four subjects,- all students
at the College of Physicians and Surgeons. The amonht of the
noonday diet was restricted to a minimum. The results are found
in a tabulated form below:
TABLE I — NORMALS
Subj Normal Count Count after *lcc 88 Count after *2cc 88
Date W.B.C. Date W.B.C. Date W.B.C.
A 2-2-17
2-5-17
4PM
4PM
6550
6800
2-6-17
2-8-17
2-9-17
2-14-17
2-21-17
4PM
4PM
4PM
4PM
4PM
9600
9160
9200
9200
7200
2-28—17
3-2— 17
3—9——17
3-14-17
3-16-17
4PM
4PM
4PM
4PM
4PM
9550
10800
7750
8500
7200
B 11-27-16
11-29-16
4PM
4PM
8000
7800
12-12-16
12-14-16
12—18-16
4PM
4PM
4PM
11#0
10732
8300
1-13-17
1-5— 17
4PM
4PM
15150
11200
C 3-1-17
3-6-17
3-7-17
4PM
4PM
4 PM
7320
7300
7000
3—14——17
3-16— 17
3-23-17
4PM
4 PM
4PM
1ÔÔÔ0
9200
7750
5-28-17
3-30-17
4PM
4PM
8650
3600
D §-12-16
g-.14«14
230**
230”
852Ô
8480
§-1^416
9—20—16
9-22-16
350PM
225PM
220PM
1Ô86Ô
11120
9850
0-25-16
9—28—16
10—4—16
È25PM
240PM
240PM
11400
10400
8700
(Second injection of *2cc Sodium Succinaî
10—18—16
&0—20—16
10-30—16
11—3——16
225PM
220PM
215PM
220PM
11050
12240
11800
8320
Prom the above table it will be seen that in these normal
subjects there was an increase of leucocytes ranging from
thirty to seventy percent*
In the- second group we find subjects complaining not only
of tubercular infections but also of concurrent Involvement,
A, B, and H, givin a history of specific infections, and B
and B,complaining of a previous pulmonary involvement* We
know that the majority of the advanced cases of tuberculosis
are accompanied by concurreht secondary diseases, and, there
fore, it is not surprising to find that a large percentage of
these subjects show a high normal white blood-cell count*
Cases with a normal cell count showed an increase of* 58^ and
20% respectively. Considering the members of Group II se
parately, we note that;
Case A - showed no change in the leucocyte count* The ge
neral physical condition of the patient was some
what Improved and the temperature lowered.
Case B - Ambulatory- Condition fair* He had been running
a subnormal temperature. Temperature was raised.
Patient left hospital in fair physical condition.
Leucocyte count increased 30#*
CAse C • Bed case. Severe active tubercular condition*
Patient gave no evidence of change in condition
after injection of Sodium Succinate. Cell count
increased 25#*
Case D - Semi-ambulatory. Patient was in the terminal
stages of the disease* Very aenemic, weak. Tem
perature subnormal, but was increased for a few
days befère death* Cell count increased 38#*
Case E - Ambulatory# Patient in fair condition. After
first and only injection of Sodium Succinate, a
40# increase of leucocytes was observed* Patient
left the hospital.
Case F - Bed case* The temperature of the patient showed
no change. Pulse and respiration stationary. No
increase of cell count*
Case G - Ambulatory. Patient in fairly well advanced stage
of the disease* Temperature curve very irregular;
condition changeable. Patient showed a 20# in
crease of leucocytes.
Case H - Ambulatory. Good condition. Luetic history of
three separate infections given. No marked change
in cell count.
Case I - Bed case. Active tubercular condition. Cell
count increased 20#.
For complete report of findings in above cases refer to
Table II attached.
DISCUSSION.
Summing tip the findings in th cases of Group II, then,
we see that six cases showed an increase of white blood cells
ranging from twenty to forty percent. Three cases showed no
change in the leucocyte count. Comparing these findings with
those of Group I, we must account for the wide discrepency in
the percentage of increase found in the two groups.
In Group I all the subjects were healthy young fellows rea
dily responding to stimuli such As is experienced from the in
troduction of any drug into the system. We know that more
drug is needed in pathological than normal cases to accomplish
the desired result, and as the same quantity was used in both
cases, we would expect to get a greater increase of leucocytes
in the normal cases.
If, however, there is an increase of even twenty per cent
of leucocytes in the majority of cases, and if no untoward
effects result from the use of the drug- and none were noted -
Sodium Succinate is a valuable adjunct of the body in its baty
8
tie to overcome the invading hosts.
These experiments have a direct hearing upon the work of
Thunherg^® who states that Succinic Acid possibly plays a role
in the oxidation in the body, as he has found that it influen
ces oxidation of muscle in quite a special manner* As Sodium
Succinate causes an increase of leucocytes , the oxidase, which
Mathews in his book on Physiological Chemistry contends is pre
blood
sent in all white cells of the body, is increased, and increased
oxidation will take place in the body*
SUMMARY.
Below is given a condensed summary of the findings in these
experiments.
No. showing inc.
GROUPS No.Subj of leucocytes. % of Inc.
I Normal cases 4 4 20— 40#
II Tuberculars 9 6 30— 70#
CONCLUSION.
In conclusion- Sodium Succinate administered in small doses
hypodermically will cause a hyperleucocytosis.
^^Thunberg-MuKcle Respiration. Skan Archiv. f. physiol;
25,1911, p.37.
BIBLIOGRAPHY.
Bauer, Virchow*s Archiv.. Vol.CLVl.
Frailch, W.G., Medical Times, N.Y., 1916, XLIV 249-51*
Hahn, M*, Arch, f. Hygiene. 1895, Vol.XXX.
Jakob, XV Kongress innere f* Medizin, 1897, Zeitsch. f. Klin*
Wochenschr., 1904.
Jaksch, R.V., Xentralbl* £. Klin. Medizin. 1893, Vol. XXIII.
Kikodse, Zentralbl* f. Allgem. Pathologie u. patholog. Anatomie.
1È91, No.3.
Mathews, A.P., Physiological Chemistry, second edition, Wm. Wood
& Co., N.Y., 1916.
Metchnikoff, Immunity in Infectious Diseases. Putnam & Sons,
N.Y., 1910.
Richter, Deutsche Med. Wochens.. 1895, No. 15.
Sadler, Fortschritte d* Medizin. 1892.
Salimbeni, Ann, de 1*Inst. Pasteur. Paris, 1898, t.XII p 192.
Schlesinger, Zeitschrift fur Hygiene, Bd. 35*
Thislowitsch, Annales de 1*Institut Pasteur. Vol. V.
Tschistowitsch, (abstract) Zentralbl f. d. Med. Wissensch#
1894, No. 39. ■ “
Annales 1*Institut Pasteur. 1892.
Thunberg, Uascle Respiration..Skan. Archiv. Physiol.. 25
1911, p 37.
Turk, Klinische Untersuchungen uber das Verhalten des Blutes
a
beijcuten infectiousf e krankheiten. Vienna & Leipzig, 1898.
SubjeoH Normal leucocyte Count Leucocyte Count After
•Icc of 1# Na Succinate
Leucocyte Count After
•2cc of 1# Na Succinate
Leucocyte Count After
•2cc of 1# Na Succinate
A
< ;
;
i Date : Temp| pulse WBC
’ ...----- 1 n - -
: i 1 !
J Date Temp Pulsej wBC Date Temp Pulse
r -
WBC
- 1 .....T " - T - ...
I Date Temp PuLm e WBC
; 7 -19-16
.
1
lOO'^ ! 88 15400 j i 7-24-161 9 8 .6M 80 I 13942
! ; 7-26-161 96.8 j 74 | 14132
; : ; i 1
7-31-16
8— 2-16
8— 8— 16
8-11-16
980
98
98.8
97.6
86
90
90
86
14960
1684a#
15750^
13120
i ! r !
! : ! ■
B ' 7-16-16
I I
96.8 1 80 11200 ! 7-21-16! 96.6 90 15460
' 7-26-161 97.6 ! 82 ! 11950
8 -7 -1 6 98.2 80 13750
0 ! | 7-17-16
1
l i
' 1 " I I I
9 7.5 1 102 ' 20200 7-21-16} 98.5 94 j 24600
' 7-26-16; 99 106 1 25480
1 • ; 7-28-161 100 97 ■ 21480
8— 1— 16
8 -3 -1 6
8 -8-1 6
101
100.6
100.6
114
112
110
35460
18760
17640
i
1
1
I 1
j 1
3 ) i 7-17 -16 1 9 7 .S 70 ^ 6460 7-21-16i 96.4 ’ 66
1 ' ' 7-26-16: 98 74
6800
g' 8260
!
1 .
“ T ... ! ■ ■ ' ■
i
i !
B
.. ! ' .. ' ■ " i " J " - * ■ ' " ' j. j
7 -1 ^ 1 6 j 1 )10190 ’ ^
14080
1
1
! ;
i
P Î ; 7-17-16 1 98.6 ! 96 I 10150 | ! 7-24-16} 98.6 j 98
' ! ! 1 ^ ■
9860 7-28-16
7-31-16
8— 2— 16
8 -1 1 -1 6
99.5
99.6
99.7
99.4
80
100
94
94
8640
9300
9200g
8800g
I
. ... _ , ,
! :
I
j
1 !
S ’ 7-17-16
1 7-19-16
1'
100.7
1 00 .8
108 1 14000 7 -2 4 -1 6 i 99.6 1 0 4 | 18400
98 I 14800 8 -8 -1 6 | 1 00.5 96 %16280
8 -11-161100.0 I 92 : 12760
- - J - - - ... ........ - - . -
7-26-16
8 -2-1 6
100
100.4
104
108
16800
14040
__
!
!
. 1 ............... 1 ..................
E 7-17-16 97.4
7 -19 -1 6 1 97.1
' !
78 ! 11680
80 I 12460
7-24-16; 97 70 : 12800
! 7-26-161 98.6 98 012560
7-21-16! ' 12880
1 . i • |-
r
i
i i
I jj 7 -3 1 -1 6 98.9 74 1 6280
i
■ ■ ■ — .4 -------„---- - 1
8 -2 -1 6 ! 98 ' 80: 8480
u ------------------------ 1------------------ J________________ U -------- -— ^
8— 8— 16 97.9 74 7280
i
8 -11-16
...........................
98.1. 74 7900
i
X - A second injection of the dose
designated at the head of the
column was given.
Unless otherwise stated, the counts
were made after one injection of the
designated dose.
A CONTRIBUTION TO THE STUDY
OP
EMOTIONAL GLUCOSURIA
A Thesis
Presented to the Department of Physiology
College of Physicians and Surgeons
University of Southern California
In partial fulfillment
of the
Requirements for the
Degree of Master of Arts
By
Ernest E. Kessler
April 30, 1917
The writer wishes to express his ap
preciation for the many valuable sug
gestions and assistance which had
afforded by Dr. Frederick S. Hammett*
A CONTRIBUTION TO THE STUDY OP EMOTIONAL GLUCOSÜRIA.
INTRODUCTION.
In 1911, Gannon, Shohl, and Wright^ demonstrated that
a glucosuria was produced in animals as the result of emo
tional excitement which takes the form of pain, fear or
rage. These results have since been confirmed by the work
of Scott^, Roily and Opperraann^, Jacobson^ and others*
That emotional excitement in man also tends to a gluco
suria- at times permanent, at times transitory- is evidenc
ed from the clinical reports of Kleen^, Naunyn®, and others.
Such pathologic conditions as mania or mental disturban
ces are also often accompanied by the presence of sugar in
the urine, as reported by Schultze.*^ He considers that
the evidence supports the view that the amount of sugar
eliminated is somehow connected with the degree of depres
sion, and is also increased with the fear-psychosis- Rai-
mann®and also Mita^ have added to this fund of clinical evi-
^Cannon, Shohl and Wright: Cited from Cannon: Bodily Changes
in Pain, Pear, Hunger and Rage, 1915,p.70.
^Scott; Am. Jour. Physiol., 1914,34, 283.
^Rolly and Oppermann: Biochem. Ztschr. 1913, XLIX, 201.
^Jacobson: Biochem. Ztschr. 1913, LI, 449.
%leen: On Diabetes Mellitus and Glycosuria, Philadelphia,
1900, pp.22,37.
^Naunyn: Der Diabetes Mellitus, Vienna, 1898, pp.72,73.
gchultze: Verhandl. d. Ges. deutsch. Naturforsch. und
Aerzte 1908, II, 358.
0
Raimann: Zrsbhr. f. Nervenh. 1902, XXIII, Abt. Ill, 14, 19*
^Mita: Monatschr. f. Psyschiat. u. Neurol., 1912, XXXII,159.
2
dence the fact that melancholia is very often accompanied by
glucosoria. The most detailed study was made by Folin and
Denis^O on the inmates of an institution for the insane. They
found that 12# of the 192 subjects under investigation had glu
cosuria. In addition, Arndtstudied several cases of deli
rium induced by alcohol and noted the development of glueocu
ria with the progress of the mental incoordination.
It is, accodingly, obvious that disturbance of psychic en
tity is often accompanied by the presence of sugar in the ur
ine, and the so-called "sugar-center” of Bernard is thus inti
mately connected with the higher centers of thought and imagi
nation.
The question now is; does ordinary disturbance of mental
equilibrium, such as is aroused in every person by various
external circumstances, tend toward the production of a glu
cosuria?
There is ample evidence that relatively normal causes of
emotional excitement may lead to an excretion of sugar in
the urine. Smillie^^ , working with medical students under
going written examination, found that four out of nine deve
loped a glucosuria as the result of a hard examination, while
but one of the nine did this after an easy examination. Fiske
and CannonlS found glucosuria development in twelve out of
^^Folin; Denis, and Smillie: Jour. Biol. Chem*, 1914,XVII,619.
^^Arndt: Ztscfer. f. Nervenh., 1897, X, 436.
^^Smillie: Compare Footnote 1, p75.
Jîske and Cannon: Compare Footnote 1, p.75.
5
twenty-five members of a football squad after an important
contest, five of whom were substitutes, not participants. The
urine of the only spectator examined contained sugar. Folin,
Denis and SmillielO, investigating the effects of examinations
of students, found that six out of thirty-three medical stu
dents, or 18#, developed glucosuria as the result of the exa
mination and that six out of thirty-six women students, or 17#,
showed a similar facility for excreting sugar as the result of
mental strain.
In order to confirm the earlier results and to extend the
study of this phase of altered metabolism a series of experi
ments were carried out by the writer under the supervision of
Dr. P.S. Hammett.
METHOD.
Four groups of individuals were chosen for the experiments,
each of these groups having a different cause for emotional
disturbances.
From the standpoint of exciting stimulus, these four groups
may be divided into two classes. In the first class the arous
ing stimulus was a foot-ball-game. For the second class, a
written examination was used as an emotional excitant.
In the first class there were three groups, consisting of
(1) Players; (2) Substitutes; (3) Spectators. The second class
consisted oof but one group, i.e. those taking the examination.
A consideration of the cause of excitation of the members of
^^Folin; Denis, and Smillie: Jour. Biol. Chem., 1914, XVII,619.
the three groups comprising the first class shows a primary
united interest in the game, and secondary group stimuli. For
the players, men actually engaged in the contest, the emotion
al stimulus was caused by the eager desire to win coupled with
anxiety as to the outcome of their efforts. With the substi
tutes the important stimulus was caused by the personal desire
to become a contestant, while the anxiety as to the outcome of
the game was of secondary importance. As far as the spectators
were concerned, there was no stimulus due to participation in
the game nor was there emotional excitement caused by desire to
participate therein, hence the stimulus arose from the general
mental disturbance due to anxiety as to the outcome of the con
test and the interest in the game as such. Hence the cause of
reaction of this third group can properly be compared with itat
of the group in the second class, whose stimulus was one of
mental effort combined with anxiety as to whether or not the
result of the examination would satisfy the instructor.
Now if a fair proportion of each of these four groups de
veloped a glucosuria, it can reasonable be supposed that the
reaction was due to the emotion aroused by the acute Interest
involved. If this glucosuria is the result of mental dis
turbance of some sort, it should disappear shortly after ces
sation of stimulus.
It was impossible to study this phase of glucosuria pro
duced by emotion with those subjects having as their primary
stimulus the foor-ball game, but with the group of men under
going the severe written examination, this study was made and
is reported in this paper.
The urines of all the subjects were examined for reducing
sugar before the tests were made and founf to be sugar free.
Fehling's solutions were used to detect the presence of sugar.
The reaction was qualitative.
RESULTS.
The group of men actually playing in the game comprised se
venteen subjects. Of the urines collected immediately after
the game, nine showed the presence of reducing sugar, demonstra
ting that fifty-three per cent of these men had developed a glu
cosuria as the result of the emotional strain incident upon the
contest.
The second group, composed of men acting as substitutes and
not participating in the game, contained seven subjects, six of
whom developed a glucosuria during the progress of the game.
Eighty-five per cent, then, of this group responded to the sti
mulus .
DISCUSSION.
Now a comparison of the relative results of these two groups
seems to demand an explanation. There must be some cause why
a higher percentage of substitutes should show a glueesuria
than was found with the actual participants in the game. Two
logical causes can be assigned to this difference* The first
can be easily recognized as due to the fact that the regular
players are less susceptible to the exciting stimulus because
they are about to perform habitual acts governed by previous
training. The second cause could well lie in the supposition
that opportunity was offered to the group of players whereby
through muscular effort the excess carbohydrate produced by
the emotional stimulus could be utilized and thus not appear
in the urine. Whether or not this occurred, depended upon the
intensity of the stimulus and the production of available car
6
bohydrates. It is obvious that the substitutes were offered no
such opportunity for utilization of the extra energy producing
material thus liberated.
In connection with the fact later to be reported, that
this glucosuria is transitory and rapidly disappears, it may
also be suggested that the actual excitation period for the
players commenced some time earlier than the stimulus for the
substitutes, and, as the result of this difference, some of
the players had had opportunity to dispose of the carbohydrate
by muscular exercise.
Continuing the results of the first class, it was found
that six out of the thirteen spectators or forty-six per cent
had developed a glucosuria during the first half of the game,
after which the second and final sample was taken. These last
results taken in connection with those just to follow show the
effect of pure emotion without the primary stimulus of pain,
fear, or rage. (That is, as far as could be ascertained.)
The second class of subjects were first year medical stu
dents subjected to a severe written examination. The urines
were tested for sugar before the examination. Immediately
after, and four hours after.
None of the urines showed the presence of reducing sugar
before the experiment. Of the twenty-seven urines collected
immediately after the examination eleven, or forty-one per
cent, showed the presence of sugar. Of these eleven positive
reactions but one showed a continued presence of sugar four
hours after, demonstrating that in this series ninety per cent
of the glucosurias were of relatively short duration and un
doubtedly due to emotional excitement.
SUMMARY.
The following table is a condensed summary of the results
reported in this paper.
CLASS A-------------STIMULUS— FÜÜT-BALL GAME.
GROUP No.SUBJECTS % DEVELOPING GLUCOSURIA.
1 Players 17 53#
2 Subs. 7 85#
3 Spectators 13 46#
CLASS B------------ STIMÜLUS--SEVERE WRITTEN EXAMINATION.
GROUP No.SUBJECTS- #DEVELOPING GLUCOSURIA.
Medical
Students 27 41#
In addition ninety per cent of the subjects developing glu
cosuria as the result of the examination had recovered four
hours after the inception of the stimulus.
CONCLUSIONS.
The results herein reported led to the conclusion that wide
ly varying causes may lead to an emotional disturbance, giving
rise to the presence of reducind sugar in the urine and that
this condition of altered metabolism is rapidly readjusted so
that the glucosuria is of very brief duration.
TABLE No.1---PLAYERS
Player Length played Fehlings Reaction.
in min. Before game After game.
A 15 neg neg
B 5 neg neg
C 4 neg pos
D 40 neg pos
E 10
neg neg
F 60 neg pos
G 30 neg neg
H 25 neg pos
I ' 60 neg pos
J 60 neg neg
K 60 neg pos
L 60 neg pos
M 60 neg pos
N 60 neg neg
0 60 neg pos
P 50 neg neg
Q
34 neg neg
Percentage Poe.---53#
Positive--------9
Total No.-----17
Note; Urine collected. First Sample--Day preceding game 4-5P.M
Second 8ample-Day of the game 4-5P.M
TABLE No.II*.
.SUBSTITUTES.
Player Before Game After Game.
A neg pos
B neg pos
C neg
pos
D neg
pos
E neg
pos
P neg
neg
_ Q neg
pos
Positive-
Percentage Pos.— -86.71#
Total No.**—'#*7
Note; Urine collected same as players.
10
TABLE No.Ill SPECTATORS.
Spectator Before Game After Game.
A
neg neg
B neg pos
C neg pos
D neg pos
E neg neg
P neg neg
G neg neg
H neg pos
I neg pos
J neg neg
kq neg pos
L neg
neg
M neg neg
Positive— ---6
Total No*— -13
Percent Pos*46
Note; Urine from spectators with exception of D,E and M-—
collected a day before and after the game---was ob
tained immediately before the game and between halves:
40 min* elapsing between the time of collection of the
first and second samples*
11
TABLE No.IV. ■MEDICAL STUDENTS.
Student
Before Exam. After E]Lamination
Sample No.l Sample No.2
A neg
neg neg
B
«eg
pos neg
C
neg
PCS neg
D
neg
neg neg
E
neg
pos neg
F
neg
neg neg
G
neg
neg neg
H
neg
pos neg
I
neg
pos neg
J
neg
pos pos
K
neg
pos neg
L
neg
neg neg
M
neg
neg neg
neg
neg neg
0
neg
neg neg
P
neg
neg neg
Q
neg
pos neg
R
neg
neg neg
S
neg
neg
neg
T
neg
pos neg
U
neg
pos neg
V
neg
neg neg
W
neg
neg neg
X
neg
neg neg
y
neg
neg
neg
z
neg
neg neg
12
TABLE No. IV— «-CONTINUED.
Positive — 11
Percentage Pos.— 41^.
Total No. -27
Note; Urine No.2 "After Examination" was collected 2
to 4 hours after sample No.l "After Examination"
was obtained.
13
BIBLIOGRAPHY.
Arndt, Ztschr. f. Nervenh., 1897, X, 436.
Cannon, Shohl and Wright,-Cited from Cannon- Bodily Changes in
Pain, Fear, Hunger and Rage. Appleton Co., New York,
3L ^ ^ ^ mt I HIM’ nmmi ■■■— ^ "
Folin, Denis and Smillie, Jour. Biol. Chem., 1914, XVII, 519.
Jacobson, Biochem. Ztschr., 1913, LI, 449.
Kleen, On Diabetes Mellitus and Glycosuria, Philadelphia,1900.
Mita, Monastchr. f. Psychiat. u. Neurol., 1912, XXXII, 159.
Naunyn, Der Diabetes Mellitus, Vienna, 1898.
Ralmann, Ztschr. f. Nervenh., 1902, XXIII, Abt. Ill, 14, 19.
Roily and Oppermann, Biochem. Ztschr., 1913, Vol. LXIX, 201.
Schultze, Verhandl. d. Ges. deutsch. Naturforsch. und Aerate
1908, II, 358.
Scott, Am. Jour. Physiol., 1914, XXXIV, 283.

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Creator Kessler, Ernest Edward (author)

Core Title Sodium succinate and leucocytosis

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