《刘士豪论文选集》李乃适主编|(epub+azw3+mobi+pdf)电子书下载

图书名称：《刘士豪论文选集》

【作　者】李乃适主编

【页 数】 473

【出版社】 北京：中国协和医科大学出版社 , 2020.12

【ISBN号】978-7-5679-1658-6

【价 格】165.00

【分 类】肾疾病-文集-内分泌病-文集

【参考文献】 李乃适主编. 刘士豪论文选集. 北京：中国协和医科大学出版社, 2020.12.

图书封面：

图书目录：

《刘士豪论文选集》内容提要：

本书共分八编，主要内容包括:风华正茂;赴美求学;胰瘤研辨;骨病深耕;名世之作;英伦进阶;贫血探秘;一代宗师及附录等。

《刘士豪论文选集》内容试读

第一编风华正茂

第一编收录了刘士豪教授担任实习医师、住院医师和总住院医师期间的论文。1924年10月，刘士豪尚未毕业时即发表了第1篇学术论文《The influenceof cod--liver oil on the calcium and phosphorus metabolism in tetany》,探讨了鱼肝油对2例搐搦症患者钙磷代谢的影响。这是他学术生涯的开端，也是他研究钙磷代谢的开端。这篇论文特地致谢了G.A.Harrop教授。Harrop教授是当时北京协和医院的内科客座教授，也是张孝骞教授赴美进修时的导师；由此也可初步了解刘士豪的学术师承。本编第2篇论文《The partition of serum calcium intodiffusible and non-diffusible portions(透析血清钙质之研究)》发表于当年创刊的我国著名学术期刊《中国生理学杂志》，探讨了发挥生理作用的血清钙到底是“非渗透性钙”还是“渗透性钙”，以翔实的数据为这一关键问题提供了重要证据。第3篇《Plasma acid-base equilibrium in malaria》和第4篇《Studieson plasma lipoids..l.Fatty acids of blood plasma in diabetes and nephrosis》同样发表于《中国生理学杂志》。《Plasma acid-base equilibrium in malaria》研究了疟疾的酸碱平衡问题，得出了阴性结果，但结论同样非常重要，以客观数据否定了原先的错误结论。《Studies on plasma lipoids.1.Fatty acids of blood plasma in

diabetes and nephrosis》探讨糖尿病和肾病患者的血清脂肪酸水平，是林树模与刘士豪合作所著，也是生物化学方法在内分泌学的应用。实际上刘士豪在这一时期发表了15篇学术论文，涉及内分泌代谢的诸多方面，因篇幅所限不得不忍痛割爱，可参看附录一。

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第一编风华正茂

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VoL.XXXVIII.

OCTOBER,1924.

NO.Io

THE INFLUENCE OF COD-LIVER OIL ON THECALCIUM AND PHOSPHORUS METABOLISM IN

TETANY.*

LIU SHIH-HAO,M.D.,Peking.

The close association between rickets and infantile tetany is aclinical observation of long standing.The relationship has beenfurther verified by chemical studies which have indicated adisturbance in the balance between calcium and phosphorus in bothconditions.In infantile tetany'there is a diminution of the calciumcontent of the blood,the inorganic phosphorus remaining normal orslightly above normal in the majority of the cases.It has beenshown that the calcium content of the blood rises with thedisappearance of the symptoms of tetany.In rickets2,however,the blood calcium is usually normal or nearly so,while thephosphorus is reduced 4o per cent to 6o per cent or even more.

When a cure results from the use of cod liver oil,ultra-violetradiation,exposure to sunlight,or the use of proper dietary regime,the phosphorus of the serum rises to normal limits,and there isa deposition of tricalcium phosphate in the bone.When rickets iscomplicated by tetany,certain cases may show only a lowconcentration of calcium,while still others may present a diminu-tion of both calcium and phosphorus.

According to the available evidence,it seems that the defectivecalcification in rickets*may be accounted for by the fact that thebone-forming elements,calcium and phosphorus,are present in theblood in such low concentrations that the precipitation of tricalciumphosphate is impossible.Similarly it is believed that thesymptoms of tetany are attributable to the low calcium con-centration in the blood and tissues,because numerous researches

*From the Departmeut of Medicine,Peking Union Medical College,

Peking.

士家论文选集

794

The China Medical Journal.

have demonstrated the important relation of calcium salts toirritability of the central nervous system.Their withdrawal,asby applying oxalate to the cortex,leaves the latter in a state ofhyperirritability,which can be made to disappear by supplying asolution of calcium salts.Furthermore,the addition of calciumto a solution of sodium salts allays the stimulating effect of thelatter on the isolated frog muscle.

It is believed s that calcium salts in blood exist in three forms,namely,(a)as highly dissociable compounds with protein;(b)asundissociated crystalloid molecules;and (c)as free ions.Pre-sumably,calcium salts exert their physiological effect only to suchextent as physico-chemical conditions permit their presence ascalcium ions.Any condition that decreases the dissociation ofcalcium in the blood would tend to produce symptoms of tetanyeven though the total calcium in the blood were normal.Whenthe concentration of the ionized calcium is lowered,hyperirritabilityof the neuro-muscular system results.Rona and Takahashi haveshown that increase in the bicarbonate content of the blooddiminishes the ionized calcium,whereas increase in the hydrogenion concentration permits a larger concentration of calcium ions.

For this reason symptoms of tetany appear as a result of the ad-ministration of alkalies,'gastric operations,'or hyperpnoea,wherea definite increase of bicarbonate or a decrease of hydrogen ionconcentration has been demonstrated.Recently Gamble and Rosshave found following the administration of caleium chloride,ammonium chloride,and hydrochloric acid,to infants with tetany,that the plasma bicarbonate is decreased,and the hydrogen ion con-centration of the plasma is increased,while the tetanoid symptomsdisappear.The first two factors inerease the ionization of calciumso that enough ions are present to allow normal irritability of thenerves.

In addition to the bicarbonate content and the hydrogen ionconcentration,another factor that influences the ionization ofcalcium is its total concentration in the plasma.Of the totalcalcium about one-third is bound by protein and may be left outof consideration,because,as shown by Salversen and Linder,thelowered calcium in tetany is not due to a primary decrease in theprotein-bound calcium,but is caused by a decrease in the diffusiblefraction.This fraction comprises the free calcium ions and the

4

风华正茂

Influence of Cod-liver Oil on Metabolism in Tetany.795undissociated crystalloid molecules of calcium salts.Using theformula of Rona and Takahashis the calcium ion concentration isfound to be about 3.mg.per Ioo c.c.of blood,a valueexperimentally confirmed by Brinkman and Van Dam.The resmaining third is said to be present as undissociated calciumcarbonale in supersaturated solution.These two fractions arepresent in a constant ratio as expressed in the following equation':

(Ca++)(C0,-)

=K

(CaCO,】

In order to maintain this constant,any decrease in the diffusiblecalcium would involve the undissociated molecules as well.Whenthe calcium ions are sufficiently decreased,tetany occurs.In themajority of cases of tetany,where there is no increase of plasmabicarbonate nor decrease of hydrogen ion concentration,one mayconclude that the low total calcium in the blood is responsible forthe diffusible calcium concentration,the immediate cause of tetany.

But the question arises:"What causes the low total calciumin the blood of infants with tetany?"In rickets the lowphosphorus content of the blood,which mainly accounts for thefailure of calcification of the bones,has been shown to be due todefective absorption of this element through the gastrointestinaltract by the metabolism experiments of Schabad and Schloss.

Normally,7o per cent or more of the phosphorus excreted bybreast fed infants appears in the urine,and with children on cow'smilk about 6o per cent is thus excreted.In rickets the conditionsare quite reversed:much the larger part may be eliminatedthrough the bowei.When recovery takes place following theadministration of cod liver oil a return to normal occurs;thephosphorus may be quite unchanged in amount but that in thefeces is greatly reduced.Retention occurs at the expense of thefecal phosphorus.Recent work by Orr,Holt,Wilkins,and Boone12has further shown that ultra-violet radiation,like cod liver oil,causes large amounts of calcium and phosphorus to be retained inthe body,and the increased calcium and phosphorus are found inthe urine after the radiation,indicating an increased absorptiontrom the intestines.They conclude that the defective absorptionfrom the intestine found in active rickets is the cause of the

*Referred to under Reference 10.Original article is not available.

20☑

刘士豪论文选集

796

The China Medical Journal.

low concentrations of calcium and phosphorus found in the serumand is the ultimate cause of the defective calcification of thebones of the rachitic infants.The condition of affairs in tetany,however,remains obscure,although this latter disease has beenextensively treated with cod liver oil,and ultra-violet radiation'.

It has been the purpose of this study to determine,in the first place,whether or not the low serum calcium in tetany is due to thedefective absorption of this substance through the intestine;andin the second place,whether or not the efficacy of cod liver oil inthe treatment of tetany lies in its ability to promote the absorptionof calcium from the intestinal canal.

METHODS OF INVESTIGATION.

The subjects were two girls,each of whom showed onadmission to the hospital marked carpopedal spasm,Chvostek'ssign,Trousseau's sign,and the typical electrical reactionscharacteristic of tetany.They came from an orphanage in Pekingcontaining about fifty girls and seventy boys,varying from Ioto 18 years in age.About ten of the girls complained of stiffnessof the fingers during the winter months,and showed on examina-tion varying degrees of the facial phenomenon.In all of thecases this was the first symptom complained of,although severallater had difliculty in walking.None of the boys were affectedsimilarly.Investigation into the living conditions showed thatthe girls stayed indoors practically all the time in the coldermonths,studying two hours and working on embroidery eight hoursdaily.The boys were employed in rug weaving,so thattheir hands were employed approximately to the same extent.

They had better facilities for getting out into the open air andrunning about in the sunlight,which were denied the girls.

The diet in the orphanage is practically constant throughoutthe year.It consists of the following foodstuffs:for breakfast,millet gruel,corn bread,salted turnip;for lunch,wheatbread,vegetable;For supper,corn bread,vegetable.Aportion of meat is served once a month,and the vegetablesare varied according to the season.Bean sprouts are obtainablein January and February;onions and beau curd in Februaryand March;spinach in April;egg-plant and gourds,May to

July;pearl melons in August and September;and cabbage,

October to January.During the period of study the patients were

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