Medicine. 371

ABSTRACTS FROM CURRENT MEDICAL

LITERATURE.

MEDICINE.

The Biological Problem of Permanent "Solitary" Hyper- tension. By Pierre Noel Deschamps (La Presse Medicate, 16th February, 1929).?There exists, in addition to hypertension of renal and suprarenal origin, a class of idiopathic or solitary hypertension the causation of which is obscure.

The author has studied the different paths of possible causation without,

however, solving the problem. The first consideration in discussing idiopathic hypertension is the hypothesis

of some lesion to the central nervous system. The precise localization of the tension regulating mechanism has not yet been determined.

Again, irritation of the autonomic system leads to increased hypertonus which is permanent. This can be demonstrated in mediastinal and o?sophageal tumours involving the vagus.

The existence of endocrine upsets in idiopathic hypertension is a logical

hypothesis. This is indicated in the synergic balance struck by the various hormones and their interaction with the vago-sympathetic mechanism. The

author for some time was doubtful of the importance of this endocrine action. It is not necessary to recapitulate the number of works dealing with supra-

renal hyperactivity. Clinical works have demonstrated a relationship uniting certain paroxysmal hypertensions to the "adenomas" or paraganglionic cells of

the suprarenal. One cannot by any means hold this as a demonstration in the

actual state of our knowledge that the same pathogenesis applies to permanent

solitary hypertension. A number of authors have endeavoured to ascribe glandular synergism in

addition to interaction between the thyroid, hypophysis, and ovaries. The

role of the ovary would be of interest to specify precisely. Its probable

importance appears proved by the frequency of hypertension complicating genital lesions?thus the hypertension in the menopause, after hysterectomy, and

maladies attending fibroids. Here, however, it must be admitted that

hypotheses are often unproved. The endocrine territory of solitary hypertension has recently widened?the

new hypotheses are of great interest as a possible line of inquiry. Besides the

internal secretion glands proper, certain complex glandular structures, such as

the pancreas and the liver, play a role, perhaps, in the variations of the cycle of

arterial pressure. One can well visualize the role of the pancreas. There is

frequently demonstrated with hypertension a concomitant hyperglycemia

(spontaneous or provoked), and even glycosuria. Besides, the antagonism between insulin and adrenalin is known. When the pancreas secretes less

insulin there is an increase of adrenalin in the blood due to lack of equalization

by the pancreatic hormone. This is a seductive hypothesis, and certain authors

have actually affirmed a hypotensive action due to insulin.

372 Abstracts from Current Medical Literature.

More important still is the work on the liver in variations in arterial

pressure. Harrower, in 1914, envisaged this hypothesis. Roger, in 1912, showed the effect of liver extract on hypertension. This question has been more

fully taken up in the United States recently. Ralph-Major, MacDonald and Levin have prepared liver extracts which have received the name

" anabolin," and which appear to possess the property of decided hypotensive action.

Anabolin has no effect on normal tension, but on hypertension only (this substance was either obtained experimentally or from histamin or guanidin). The American authors think that solitary hypertension is linked to some hepatic insufficiency, modifications of the ureal or uric acid metabolism, or a diminution of the antitoxic power of the liver allowing in the organism the retention of toxic products with hypertensive action.

Whatever be the boldness of this conception, there is in it a new way of

envisaging the pathogenesis of hypertension which is, perhaps, only an

intoxication by certain unknown products brought to life in some trouble of

elementary function.?J. Gibson Graham, Jr.