JAMA

FOORD, ALVIN G.

doi: 10.1001/jama.1948.02900140001001pmid: 18890444

The problem of embolism and peripheral venous thrombosis has always been a major one in the treatment of heart disease and particularly of coronary heart disease. This is due to the prevalence of mural thrombi in the chambers of the heart, which may serve as a source of emboli, and to the occurrence of peripheral venous thrombi, especially in the legs. Several articles on the subject have appeared in the literature of the last few years, a splendid summary of which is given by Hellerstein and Martin,1 who also give their own observations in 160 cases of myocardial infarction occurring in a total of 2,000 autopsies at the University Hospitals in Cleveland. In 45 per cent of the cases in their series there were emboli or thrombi in other parts of the body, a total of one hundred and eleven peripheral thromboembolic lesions being found. In 12 per cent

PETERMAN, M.G.

doi: 10.1001/jama.1948.02900140004002pmid: 18890445

Recent publicity to the laity by well meaning persons concerning the advances in the diagnosis and treatment of epilepsy has evoked some unfortunate reactions. Parents in desperate search of the "miracle treatment" have been given false hopes and dissatisfaction with usually adequate treatment or the best treatment available. The family physician who treats most of the cases of epilepsy and usually sees them first has properly resented the challenge to his familiarity with the recent developments in the study of the disease. Advertisements of "83 per cent improvement" in epilepsy and of "the hopeful disorder" offer false encouragement and lead to cruel disillusionment even though they quote learned authorities. For these reasons I have considered it timely to restate known facts concerning the cause of epilepsy and to review the advances in diagnosis and treatment with the newer drugs. Our first duty to our patients and to the public is

VOGEL, VICTOR H.; ISBELL, HARRIS; CHAPMAN, KENNETH W.

doi: 10.1001/jama.1948.02900140011003pmid: 18890446

When the Harrison Narcotic Act was passed in 1914 there were perhaps 150,000 to 200,000 narcotic addicts, mostly women, in the United States.1 Now, according to a recent estimate by Mr. H. J. Anslinger, Commissioner of Narcotics,2 there is about 1 addict per 3,000 of population, or a total of approximately 48,000, mostly men. This reduction in addiction has been largely due to the vigorous enforcement of the Harrison Narcotic Act and to federal facilities for the treatment of addicts. Compared with the problems arising from the abuse of drugs such as the barbiturates and alcohol, narcotic addiction is not a great public health hazard. However, to the person and his family, narcotic addiction is a tragedy which often brings about complete ruin. Without the preventive influence of legal control and the treatment of identified addicts, narcotic addiction would spread somewhat like the infectious diseases which are public

DeWEESE, MARION S.

doi: 10.1001/jama.1948.02900140018004pmid: 18890447

The treatment of malignant melanoblastomas presents a discouraging and difficult problem. The mortality rate is notoriously high and the results of treatment uniformly poor. The physician who seeks to increase his knowledge of the melanotic tumors is confronted by a large volume of interesting but confusing literature. We have learned a great deal about these tumors through clinical experience. An enormous amount of investigation has also been carried out in regard to the related developmental, cytologic, genetic, endocrinologic, chemical and physical aspects of pigment cell activity. So urgent was the need for correlating this basic knowledge that a conference was recently held to discuss all the various aspects of the "Biology of Normal and Atypical Pigment Cell Growth."1 This historic meeting, in which many of the pioneers and leaders of current thought in this field participated, stands as a milestone in efforts to understand and combat these complex lesions.

MASSELL, BENEDICT F.; DOW, JAMES W.; JONES, T. DUCKETT

doi: 10.1001/jama.1948.02900140022005pmid: 18890448

In a previously reported study conducted from November 1945 to June 1946 on the wards of the House of the Good Samaritan penicillin was administered intramuscularly to all patients with rheumatic fever' found to have throat cultures which were positive for the hemolytic streptococcus.1 This study, which was made with a view to reducing the spread of hemolytic streptococci from one patient to another, was partially successful in that of a total of 20 cases, hemolytic streptococci were eliminated permanently from the throat cultures in 17. Furthermore, only one of the three strains which could not be completely eradicated belonged to serologic group A. The studies which are the basis of the present report were a continuation and extension of the previous studies and were carried out from July 1946 through June 1947. Our objectives were as follows: (1) to determine whether orally as well as intramuscularly administered penicillin

FRIEDELL, MORRIS T.; DRUCKER, EDGAR F.; PICKETT, WILLIAM J.

doi: 10.1001/jama.1948.02900140028006pmid: 18890449

A better understanding of the role of the sympathetic nervous system, antisympathetic drugs, antibiotics and refrigeration has converted the emergency amputation to an elective procedure. The surgeon, confronted with a gangrenous extremity, now has several aids that he may use to save the patient's life and to conserve tissue formerly sacrificed. Increasing interest in the conservative management of certain sequelae of vascular disease is evidenced by such recent reports as those of Wirtschafter and Widmann.1 This report contains our experience with the use of histidine and ascorbic acid in the conservative treatment of one type of peripheral vascular disease as first suggested by Wirtschafter and Widmann. Holtz2 advanced the theory that histamine was formed in vitro and in vivo by the action of ascorbic acid with histidine. Block and Pinösch3 found that there was an increase of histamine in the lungs of guinea pigs following administration of

MENAKER, GERALD J.; PARKER, MORRIS L.

doi: 10.1001/jama.1948.62900140001007pmid: 18890450

In surgical treatment of the biliary tract the surgeon is often faced with three major problems: first, anatomic anomalies which occur rather frequently in this system, affecting particularly the cystic duct; second, distortion of the external biliary passages by inflammatory processes and adhesions, causing poor visualization of the ducts, and, finally, the absence or atresia of the extrahepatic biliary ducts, which is most difficult and presents the most distressing problem of all. Immediate cholangiography and dissection are the only aids which the surgeon possesses in the operating room. Dissection may be unsuccessful and dangerous, while cholangiography requires special equipment, is time consuming and is often of little assistance because of the difficulty in application and lack of information as to the third dimension. We believe that we have found a method which obviates these difficulties and have established a procedure which may be an invaluable adjunct in this type of

FERSHTAND, JOHN B.; BEAVERS, G. HERBERT

doi: 10.1001/jama.1948.62900140002007apmid: 18890451

Complete heart block is one of the least frequent observations in all patients with cardiovascular disease. Since its commonest cause is arteriosclerosis most patients with this condition are beyond the childbearing period. The combination of complete heart block and pregnancy is, therefore, rather rare. Diddle1 reviewed the literature to 1941 and could find only 21 authenticated cases. To these he added his own. Since then there have been reports by Yepez,2 Quentin,3 Mitchell and his co-workers4 and Barton and LaDue,5 making, with this presentation, a total of 27 patients in whom pregnancy has been complicated by this serious disturbance of cardiac rhythm. This is the first such case observed in this hospital in 15,708 deliveries over a ten year period. REPORT OF A CASE The patient, Mrs. E. F. H., a 34 year old white woman, was first seen by us on March 16, 1946,

doi: 10.1001/jama.1948.02900140033008pmid: N/A

doi: 10.1001/jama.1948.02900140034009pmid: N/A

Elsewhere in this issue is an announcement of the appointment of the director of the survey of medical education which is being conducted by the Committee to Survey Medical Education under the joint sponsorship of the Council on Medical Education and Hospitals of the American Medical Association and the Association of American Medical Colleges. The survey will begin Jan. 1, 1949, and will extend over a period of three years. At its completion, a detailed report of the Committee's findings and recommendations will be published. One of the important forces that have raised medical education in this country to its present high level has been the capacity of the medical profession and medical educators to indulge in self criticism and to exercise self regulation. It may be expected that the present survey will follow the tradition of previous surveys by emphasizing the deficiencies rather than the accomplishments of our present