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Notes: Summary The “hair-standing-on-end” appearance or the “brushlike” symptom on the skull occurs in a number of severe blood diseases and is due to the action of the hyperplastic and hypertrophic red marrow filling up the bones in these disorders. No special metabolic or hereditary features of the osseous tissue can be made responsible for the alterations: the changes of the bones are brought forth by the direct effect of the erythroid cells on the bony substance without the interference of osteoclasts and osteoblasts. It is the pressure exerted by the growing and multiplying red cells, whose immature precursors require a largely increased space, that constitutes the main factor causing the alterations. The characteristic changes observed in the X-ray pictures as well as in the autoptic preparations are resulting from the adjustment of the bones and the osseous substance to the forces of pressure and originating from the overgrowing marrow. They cause a widening of the bones and arrange the structure of the spongious substance according to their direction and distribution. That can be recognized by the characteristic pattern of the cancellous substance. An other important factor for the development of the “brush-like” alterations are the shape and the anatomical conditions of the cranial bones. As the marrow constitutes a kind of semiliquid matter and is surrounded from all sides by a solid osseous layer, the forces of pressure arising in the marrow must be directed, according to physical laws, perpendicularly to the enveloping bone. Also the forces of stress evolved in the marrow will act in the same direction. Thus the direction and the distribution of the forces of pressure and stress depend largely on the morphological feature of the bones. Thus, due to the peculiar shape and anatomical conditions of the cranial bones, these forces are distributed in a special manner and owing to the strong bending of the bones, they are acting in a radial direction. They are diverging outwards and converging inwards respectively. That is demonstrated by the structure of the spongious substance showing a vertical striation and a radial arrangement of the spiculae composing the “brush” on the skull. The “brush-like” symptom, therefore, represents the arrangement of the spongious substance in the cranial bones according to the particular distribution of the forces of pressure and stress in the bones caused by the overgrowing marrow and, as the anatomical structure of the cranial bones is very different from all other bones, the “brush-like” symptom is only to be found on the skull. In consequence of the divergency or convergency respectively of the forces developed in the bones secondary effects are produced resulting in a tension in the outer parts of the cranial bones, moreover, and in a compression in the inner parts. Due to it the tabula externa and the neighbouring layers of the osseous substance are loosened and rarefied and the tabula interna and the adjacent strata are condensed and thickened. As a result of it, a different resistance in the interior of the bones is developed facilitating the expansion of the marrow and the enlargement of the spongious substance into the exterior direction. Against it, the growth of the marrow and the enlargement of the bony tissue into the interior direction are rendered difficult. By diverting the growth and expansion in an unilateral way the provision of new space for the marrow on the exterior surface of the cranial bones is strongly favoured, whereas the invasion in the cerebral cavity is prevented. The “brush-like” symptom, therefore, is the result of the close association between function, structure and anatomical conditions. The organism, by making use of their connection, is meeting with the increased demands put on him in severe blood disorders and provides new and organized space for the badly needed blood forming tissue without doing harm to the body and its functions. Thus the organism sets an impressive example of an autonomous way of self-help in a difficult situation by functional and structural adaptation.

Notes: Summary Histamine concentrations in plasma, whole blood and various tissues of human subjects, monkeys, pigs and dogs were determined by fluorometric methods before, during and after surgical operations. Following intraabdominal surgery in 6 of 22 patients elevated plasma histamine levels were found several hours after the end of operation. Some of the causes of histamine release in surgery were found to be premedication by atropine, intravenously administered anaesthetics, infusion of plasma substitutes and manipulation on the gut. Acute blood losses were without effect on the plasma histamine levels. Clinical symptoms and pathophysiological reactions, such as tachycardia, hypotension, increased gastric secretion and anaphylactoid reactions could be related to the release of histamine in some circumstances.