JAMA

UPHAM, J. H. J.

doi: 10.1001/jama.1937.02780240001001pmid: N/A

As I look back on forty years of medical practice I realize that I have lived in a period of medical progress greater and more rapid than any that has ever previously occurred in the world's history. Johns Hopkins Hospital, where for two years I was assistant resident, had opened its doors just five years before I came there. At that time it was considered the last word in hospital construction. Under the leadership of that remarkable quartet composed of Kelly, Halstead, Welch and Osler it stood at the peak of medical science and medical practice in our country. Howard Kelly, with his marvelous dexterity and operative skill, inventive genius, exploring the bladder and catheterizing the ureters, the only man in the country able to do so at that time, was easily the leading gynecologist of the United States if not the world. Thomas Halstead with his great contributions to

HEYD, CHARLES GORDON

doi: 10.1001/jama.1937.02780240003002pmid: N/A

In every age and in every cultural order, the doctor has existed and maintained himself in spite of war, catastrophes and revolution. He lived and practiced his art during the decline and fall or even the complete annihilation of previously existing states of civilization. From remote times the doctor has enjoyed complete professional freedom and has thereby assumed great social responsibility. Through the centuries, fundamental discoveries made by practicing physicians have changed the whole current of life. Vaccination against smallpox, the discovery of the bacterial causes of disease, the development of the stethoscope, the cystoscope and other instruments of precision and the x-rays, the discovery of the specific effects of certain medicaments, such as vitamin therapy in deficiency diseases, liver therapy in anemias, and insulin in diabetes, have all given to many human beings increased years of greater usefulness. These discoveries were made by physicians without any monetary remuneration or

BLAND, P. BROOKE; RAKOFF, A. E.

doi: 10.1001/jama.1937.02780240005003pmid: N/A

Until it has been definitely proved whether or not trichomonads from one source may survive and multiply in other organs, the possibility of auto-infestation remains an important factor in the prevention and treatment of trichomonad infestations, especially the common clinical entity trichomonas vaginitis. The probability of autotransmission depends, however, on the incidence of the organisms in the suspected foci, while the percentage of multiple infestations may be considered as an indication of the extent to which it has occurred. Although the incidence of Trichomonas has been reported by a number of workers, we are not aware of studies of the incidence of trichomonads from these three sources in any one group of individuals. In the present investigation such a study was undertaken among a group of 200 women. All the available laboratory methods of diagnosis, including examination of the fresh specimen by wet smear and stained preparations as well as

MASON, HOWARD H.; SLY, GRACE E.

doi: 10.1001/jama.1937.02780240008004pmid: N/A

Since the introduction of insulin, cases have appeared from time to time that showed most of the symptoms and signs of diabetes mellitus but did not respond to insulin. The physiologic explanation behind most of these conditions is still obscure. For this reason we are reporting the following case, which was insulin resistant but did respond to a change in the type of monosaccharide derived from the food: H. W., a white boy, aged 25 months, was admitted to Babies Hospital July 11, 1935, for malnutrition and glycosuria. The family history was irrelevant. The patient had had repeated respiratory infections with otitis media and one attack of bronchopneumonia. He was small at birth and gained very slowly in spite of adequate amounts of food and vitamins. The weights were: at birth 4 pounds 14 ounces (2,213 Gm.); at one year 12 pounds (5,443 Gm.); at eighteen months 13 1/2 pounds

KIRSNER, J. B.

doi: 10.1001/jama.1937.02780240012005pmid: N/A

Subcutaneous emphysema following trauma is a familiar clinical entity and is frequently seen after puncture of the lung by a fragment of bone in a fracture of a rib, in a bullet or stab wound, or around the point of insertion of the needle in artificial pneumothorax. A similar clinical picture has been described after esophagoscopy,1 tonsillectomy,2 extraction of a tooth,3 parturition,4 and as a complication of a foreign body in the bronchus.5 Many articles have reported this interesting complication following pneumonia (Rush, Adkinson and Hardwick,6 Lucke and Meyer,7 Sergent, Launay, Poumeau-Delille and Robert,8 Harris,9 Jones10 and Borsarelli,11 among others). Its occurrence after rupture of a viscus12 and in glass blowers13 indicates the wide variety of etiologic factors. Apparently subcutaneous emphysema following bronchial asthma is a rather rare complication. The only case that I have been able

ROCK, JOHN; BARTLETT, MARSHALL K.

doi: 10.1001/jama.1937.02780240014006pmid: 12255649

Interest in the factors of female fertility has led us to a study of the endometrium, for among the cyclic changes in this tissue is written the story of the patient's menstruation, and from this we have traditionally sought insight into her ovarian behavior. Long before modern endocrinology a close association was recognized between uterine flow and fertility. Of late we have enjoyed the demonstration of causal relationship between the hormones of the follicles and of the corpus luteum on the one hand and of changes in the endometrium on the other. Work done in both the clinic and the laboratory shows that estrogen is the specific hormone of the growing and ripe follicle and that it causes proliferation of the endometrium. This is a true growth of the mucosa evidenced by many mitoses in the glandular epithelium, an increase in the number and complexity of the glands and an

CASE, JAMES T.

doi: 10.1001/jama.1937.02780240020007pmid: N/A

Twenty-nine years ago I gave my first opaque enema under fluoroscopic screen control. The publications of Pfahler and a few references from foreign literature constituted the stimulus for the undertaking. Bismuth subnitrate was the opaque salt, suspended in buttermilk. The chief aim of the study was to determine the position of the transverse colon and of the right and left colic flexures. To emphasize the contrast presented by the elaborate roentgen study of the colon as practiced now, with indications for its use covering a very wide range of pathologic possibilities, I was asked to offer a review of the evolution of the technic of x-ray examination of the colon, followed by an evaluation of the different methods. Routine practice in intestinal x-ray examinations includes the opaque meal, with appropriate screen or film observations of the opaque residues as they move along the large bowel (fig. 1), followed by the

Fidler, Herbert K.

doi: 10.1001/jama.1937.92780240001008pmid: N/A

The importance of differentiating between the lesion found in first infection tuberculosis and that resulting from reinfection was recognized first by Ghon1 in 1912. Since then it has been customary to think of the primary tuberculous lesion, found most frequently in childhood, as confined chiefly to the lung, because most of his cases were of this type. This is probably true; but if the site of initial entrance of the tubercle bacillus is through the skin the resulting lesion differs from the well recognized types of adult skin tuberculosis (verruca necrogenica, lupus vulgaris and tuberculosis colliquativa) in a manner similar to that in which the childhood pulmonary lesion differs from the adult pulmonary lesion. This concept is not new, as Ghon in his original communication reported one case of primary skin tuberculosis as well as several cases in which the site of entry had been the tonsil or bowel.

Conwell, H. Earle; Alldredge, Rufus Henry

doi: 10.1001/jama.1937.92780240002008apmid: N/A

A complete dislocation, simple or compound, at the tibiotalar joint without a fracture is extremely rare.1 A lesion of this type when it does occur is usually compound. The ligaments about the ankle are usually stronger than the malleoli, and for this reason a fracture of one or both of the malleoli usually accompanies such an injury, since the bone in most instances breaks before the ligaments will rupture. Böhler2 states that a lateral dislocation of the ankle without a fracture of one or both of the malleoli is possible only when the joint between the tibia and the fibula is broken. In the case reported here a separation did not occur at the tibiofibular joint, as shown by roentgenograms and by open inspection of the joint. Complete dislocations of the ankle joint are classified as follows, according to their order of frequency: (a) posterior, (b) anterior, (c) external lateral

Burch, John E.

doi: 10.1001/jama.1937.92780240003008bpmid: N/A

During the course of my intern service at Charity Hospital, New Orleans, I came in contact with numerous infections and disorders of the phalanges, both in the surgical wards and in the outpatient dispensaries. I found that, in treating these conditions, immobilization for a short period with the use of a simple finger splint in addition to the usual hypertonic wet dressings shortened the duration and intensity of symptoms and hastened the healing process. I have done extensive reading among the numerous articles dealing with finger splints, and so far I find that the splint generally used in such conditions is the ordinary tongue depressor. After using this splint several times on miscellaneous infections about the finger tip, I noticed certain disadvantages: 1. The splint was hard and, if applied tightly, became painful to the patient after several hours. 2. It will not conform to a rounded surface, as it