JAMA

BRICKNER, RICHARD M.

doi: 10.1001/jama.1936.02770250001001pmid: N/A

In recent years the pathogenesis of multiple sclerosis has been investigated intensively, especially in this country. The results of these observations, made in scattered places, have never been brought together. My purpose in this communication is to summarize them and to make what comparisons appear to be possible. In the 1870's, after the disease had been made well known by Charcot, much was said concerning possible causes. Out of this discussion some views emerged, which are still of great interest. Among the most ingenious of the hypotheses was one of Pierre Marie's, which deserves rescue from the fortgetfulness that has encompassed it.1 Marie observed a patient who, three years following an attack of typhoid, developed multiple sclerosis; he suggested that sclérose en plaque might be a tertiary stage of typhoid in the same sense in which tabes dorsalis is recognized as a manifestation of the tertiary stage of syphilis.

BLODGETT, WILLIAM E.; FAIRCHILD, ROBERT D.

doi: 10.1001/jama.1936.02770250005002pmid: N/A

It is our purpose in this paper to present a new conception of the treatment of the acute fracture of the patella. The ideas herein set forth have been used in a sufficient number of instances in a large charity service and in the private practice of one of us (W. E. B.) to warrant our bringing them to the attention of those treating this type of injury. That the treatment of fractures of the patella is still open for discussion is attested by the number of procedures recently devised for dealing with the condition. It is noteworthy that all the newer methods aim at a more rapid restoration of the patient to economic usefulness.1 Following the lead of Gallie and LeMesurier,2 procedures using fascial transplants have been described by Allen,3 Haggart,4 and Leavitt.5 They all involve the preparation of another operative field to obtain

HERBST, ROBERT H.; MILLER, EDWIN M.

doi: 10.1001/jama.1936.02770250009003pmid: N/A

The number of cases of vesico-intestinal fistulas reported in the literature is considerable, most of the cases being due to diverticulitis and a malignant condition. A fair number are caused by the rupture of an appendicele or pelvic abscess into the bladder with a resultant fistula. Trauma, serious bowel infections, tuberculosis, actinomycosis, syphilis and bilharziasis play a small rôle in the etiology. Fistulas between the bowel and the bladder caused by foreign bodies in the bowel are quite unusual. REVIEW OF THE LITERATURE In a review of the literature it has been difficult to cull out these cases, owing to the fact that the cause of the fistula is frequently not stated; also in many of them it has been impossible to determine whether the foreign body that produced the fistula was introduced into the bladder or whether it was ingested. There are quite a number of reports of cases

ABBOTT, WALTER D.

doi: 10.1001/jama.1936.02770250013004pmid: N/A

The diagnosis of compression of the lumbosacral roots of the spinal cord following injury is sometimes quite difficult. The usual classic sequence of root pain, loss of motion and sensation, vesical or rectal incontinence and absent reflexes does not prevail in each case. The symptoms of root pain which is accentuated by lying on the back or on exertion should lead to a suspicion of compression of the cord. Hypertrophy of the ligamentum flavum in the lumbar region has been described on only three occasions. The case reported by Elsberg,1 cited the instance of a woman, aged 39, who was thrown from a car ten months prior to her operation. She suffered from stiffness of the back, with pain over the distribution of the fourth lumbar root on the left side. Roentgenograms revealed an old fracture and thickening of the arches of the fourth and fifth lumbar vertebrae. On

HITCH, J. M.; SCHWARTZ, W. F.

doi: 10.1001/jama.1936.02770250014005pmid: N/A

The pharmacologic actions of the nitrophenols1 have been known since 1885, when it was found that these compounds possess the property of elevating the metabolic rate in animals. However, the effect of this chemical group on human beings was not generally recognized until the late war. At this time Perkins'2 investigations on munitions workers in France focused attention on its many toxic reactions. The therapeutic possibilities of these chemicals apparently were not utilized until 1933, when Cutting, Mehrtens and Tainter3 introduced dinitrophenol as a treatment for some forms of obesity. They were fully aware of the many potential dangers of this drug and in their original series of cases encountered only mild and transient reactions, perhaps because of the conservative dosage and stringent observation. From the available reports of toxic manifestations to Jan. 1, 1936, it appears that the early reactions, except in the occasional hypersensitive individual,

CANNON, A. BENSON; ROBERTSON, JOYCELIN

doi: 10.1001/jama.1936.02770250017006pmid: N/A

After a quarter century of experience with the arsphenamines, there are still schisms in the ranks of experts over many vital phases of their use in the treatment of syphilis. It is not surprising, then, that the status of bismuth—in use as an antisyphilitic only a little over a decade—should not have achieved the fixity of the Decalogue. The physician who declines to depend on the drug salesman for his choice, and who attempts instead to sift the testimony of experienced users of bismuth, will find these divided, like Caesar's Gaul, in partes tres: one, led by the French, who see in bismuth a sort of miracle drug, destined to replace the arsphenamines because equally efficacious but less toxic; a second, who believe that bismuth cannot replace the arsphenamines but that as an adjuvant it has certain advantages over mercury, for which it may be substituted either entirely or in

FOSHAY, LEE; MAYER, O. B.

doi: 10.1001/jama.1936.02770250025007pmid: N/A

W. H. H., a white man, aged 49, a master mechanic, dressed a rabbit that had been killed by his son, Jan. 12, 1935. Previously his health had been excellent and his weight had averaged 175 pounds (79.4 Kg.). January 15 he had a severe chill for two hours, followed by high fever and marked loss of strength. The next day he could scarcely speak above a whisper. January 18 a sore appeared on the right third digit near the nail root. The entire arm became painful, and tender swellings developed at the elbow and in the axilla. The temperature was 104 F. and remained so for the next three days. After January 21 he was out of bed, sitting around his home, with moderate fever, little malaise, profound weakness, drenching sweats, and pain limited to the right hand and arm. January 24 he walked to the office and gave

doi: 10.1001/jama.1936.02770250028009pmid: N/A

THE THERAPY OF THE COOK COUNTY HOSPITAL Edited by BERNARD FANTUS, M.D. CHICAGO Note.— In their elaboration, these articles are submitted to the members of the attending staff of the Cook County Hospital by the director of therapeutics, Dr. Bernard Fantus. The views expressed by various members are incorporated in the final draft for publication. The articles will be continued from time to time in these columns. When completed, the series will be published in book form.—Ed. THE THERAPY OF ITCHING (PRURITUS) In Collaboration with Dr. Theodore Cornbleet The first principle in the treatment of itching is that scratching must be prevented, for scratching starts and maintains a vicious circle. It damages the skin, and the healing of the damage accompanied by itching again incites scratching. The scratching also inseminates and disseminates infection, which in turn makes the itching worse. Merely telling a patient not to scratch does no

Lewin, Philip; Taub, Samuel J.

doi: 10.1001/jama.1936.92770250001008pmid: N/A

Bilateral chronic synovitis or intermittent hydrarthrosis appears in attacks of such striking periodicity that an allergic basis for these attacks is strongly suggested. In 1924 Miller and Lewin1 were the first to suggest that idiopathic hydrarthrosis is a sensitization disease, basing their evidence on the satisfactory response of this condition to injections of peptone intravenously. Judging from the sparse literature since this observation, very little attention has been given to this group of cases, with the exception of Rowe,2 who reported a case of intermittent hydrarthrosis that proved to be due to food sensitization. Skin tests were mostly negative in this case and the causative foods were determined by means of his elimination diets. We report a case of intermittent hydrarthrosis of the knee due to ingestion of English walnuts. By allergic synovitis we mean a swelling, hyperemia and overactivity of the synovial membrane manifested by swelling, limitation

doi: 10.1001/jama.1936.02770250032010pmid: N/A