JAMA

Grulee, Clifford G.

doi: 10.1001/jama.1953.03690170001001pmid: 13069219

It is startling that the diagnosis of a disease on which so much professional effort and interest has been focused is suspected far more frequently than it is definitely made. A final diagnosis, even in the presence of typical clinical features, must depend on demonstration of the virus, either by animal inoculation or tissue culture techniques, as well as on changes in antibody titers between the acute and convalescent phases. Nevertheless, the diagnosis of poliomyelitis can be presumed with some confidence on purely clinical grounds as can the diagnosis of other viral diseases, such as measles or mumps, which is also most difficult to substantiate. In epidemics the suggestive spinal fluid findings and the typical spotty lower motor neuron type of paralysis may often justify an unequivocal clinical diagnosis. At times of high poliomyelitis incidence, however, the diagnosis of any vague febrile illness offers difficulties comparable to those of uncomplicated

Schnabel, Truman G.

doi: 10.1001/jama.1953.03690170004002pmid: 13069220

The American Board of Internal Medicine was founded by the cooperation of the Section on the Practice of Medicine of the American Medical Association and the American College of Physicians in 1936. It has continued to function under their sponsorship and by authorization of the Advisory Board for Medical Specialties since that year. For many years before, an increasing number of physicians had limited their practice to special fields of endeavor after special study and application to practice. There was the physician, however, who was reputed to be a specialist according to the talk of the town; this was initiated on the physician's own prompting, not because he had had adequate preparation and experience or could conduct a really good follow-up on his patients. During these same years, genuine and self-styled specialists took on their role largely because medicine and medical education were making great strides that made it impossible

Stempien, Stephen J.; Weinberg, Joseph A.

doi: 10.1001/jama.1953.03690170007003pmid: 13069221

Adequate therapy of duodenal ulcer should not only accomplish healing of the ulcer but should prevent its recurrence. Since the advent of vagotomy as a surgical treatment of duodenal ulcer the question of its effect on ulcer recurrence has been raised repeatedly. The literature on this subject is inadequate, and in most of the reports the data are inconclusive. For example, a report by Weber, Goldblum, and Gregg1 cites three cases of gastric ulceration following vagotomy. No insulin tests were done in two of these cases, and in the third case the insulin test would be considered by us to be inadequate, since the blood sugar level attained was only 58 mg. per hundred cubic centimeters. In addition, this patient had a gastroenterostomy, which in our experience frequently causes false negative results in insulin tests. Dragstedt2 states that persistence or recurrence of duodenal or gastrojejunal ulcer is almost

Slattery, R. V.

doi: 10.1001/jama.1953.03690170009004pmid: 13069222

In recent years, the chest microfilm has been used extensively in surveys of large numbers of persons for pulmonary tuberculosis. In some of these surveys, it has been noted that many cardiac, as well as pulmonary, abnormalities were found, and, as a result, it has been recommended that the microfilm be used in surveys for the detection of heart disease. No attempt has been made, however, to determine the accuracy of the microfilm in demonstrating heart disease. It was felt that, before its recommendation for this purpose could be justified, a study of its accuracy should be made. This is a report of such a study. The incidence of heart disease found on clinical investigation of an unselected group of patients was compared with the incidence of abnormal cardiac silhouettes found in the chest microfilms of the same patients. METHODS Beginning July 1, 1948, the chest microfilms of all new

Markham, J. David; Hoff, Ebbe C.

doi: 10.1001/jama.1953.03690170011005pmid: 13069223

The tetraethylthiuramdisulfide * (Antabuse)-alcohol reaction is an essential element in the indoctrination of the patient in the use of tetraethylthiuramdisulfide (TETD) as an adjunct in the treatment of chronic alcoholism. Recently this drug was released to the medical profession, although much investigative work on its effects is still in process and the full hazards of its use have not been completely established. The tetraethylthiuramdisulfide-alcohol reaction represents a controlled physiological response, in which there are measurable alterations in the cardiovascular system affecting pulse rate, cardiac output, cardiac stroke volume, the electrocardiogram, and peripheral circulation. Many of these changes have not been investigated, while others have been described in detail. The present study was undertaken after an extensive clinical experience with the reaction in 519 patients treated in the inpatient service of the Division of Alcohol Studies and Rehabilitation, Department of Health, Commonwealth of Virginia, at the Medical College of Virginia Hospital. The

Herrell, Wallace E.; Nichols, Donald R.; Martin, William J.

doi: 10.1001/jama.1953.03690170015006pmid: 13069224

One of the most important current problems in the therapy of infectious disease is the management of infections due to strains of Micrococcus pyogenes (Staphylococcus aureus) that are resistant to many antibiotics. We have attempted to evaluate the effectiveness of erythromycin in the treatment of such infections. Although we have used erythromycin in a variety of infections due to organisms susceptible to its action, this report is concerned only with the results obtained with its use in M. pyogenes infection. In most of these cases the organisms were relatively insensitive to penicillin, streptomycin, aureomycin, and oxytetracycline (Terramycin). There are indications that in the constant changes that are occurring in the bacterial population many strains of M. pyogenes are naturally or have become resistant to penicillin, streptomycin, aureomycin, and oxytetracycline; for example, it was evident in a report from the Mayo Clinic by Needham and Nichols1 that 60% of the

Rees, Rees B.; Bennett, James H.

doi: 10.1001/jama.1953.03690170020007pmid: 13069225

Hellerström, of Stockholm, first mentioned the possibility of cutaneous tuberculosis developing in abrasions from public swimming pools. He described six facial lesions, five of which followed abrasions sustained in the same pool.1 Water and sediment from the pool involved in the sixth case produced tuberculosis in a guinea pig. With material from the infected animal, tubercle bacilli were grown on a special medium. Hellerström's patients were males, aged 14 to 29 years, with no history of tuberculosis. In five pulmonary findings were normal, and in the sixth there were small hilar calcifications. In five the tuberculin reaction was negative before and positive after the injury. The clinical picture was strikingly uniform, with soft reddish-brown papules, pinhead to split pea in size and crusted and coalescent. The initial swimming pool abrasions became covered with epithelium but gave rise to granulomas without a period of perfect healing. Diascopy showed lupus vulgaris

Splithoff, Clarence A.

doi: 10.1001/jama.1953.03690170024008pmid: 13069226

Chronic lumbar backache continues to be a source of difficulty, both to the patient and to the physician called on for treatment. There is hardly a person who has not, at some time, experienced low backache. The vast majority of the backaches are transitory and will subside with little or no treatment. There are, however, many instances in which these bothersome backaches become chronic and tax the ingenuity and resourcefulness of the physician. In order to determine the relationship between the roentgenographic findings and chronic lumbar backache, a study was made comparing 100 patients with backache and an equal number of persons not bothered by backache. The group of persons with chronic backache included the first hundred who applied for treatment at the New York Orthopedic Dispensary and Hospital in the year chosen for study. They were not screened except that those persons with obvious pathological changes, such as herniation

Grow, John B.; Neerken, A. J.

doi: 10.1001/jama.1953.03690170028009pmid: 13069227

Formerly considered a mere curiosity in pathological annals, esophageal atresia and tracheoesophageal fistula have recently assumed a new importance to all physicians who deal with the care of the newborn infant. The disease itself has been known for many years, and Durston described the condition accurately in 1670.1 The first attempt at surgical treatment, a gastrostomy, was made in 1888; however, it was in 1913 that Richter suggested the operation that is followed today, i. e., closure of the fistula and reestablishment of the continuity of the esophagus.2 To Haight (1941) goes the credit for the first successful one stage operative repair.3 A consideration of the normal embryologic development of the trachea and esophagus is of interest, since it will explain the occurrence of the anomaly. The trachea and esophagus originate as a common portion of the foregut. Early in the second month of intrauterine life two

Zoeckler, Samuel J.; Keil, Philip G.; Hegstrom, George J.

doi: 10.1001/jama.1953.03690170031010pmid: 13069228

The value of peritoneoscopy, direct cholangiography, and liver biopsy in the diagnosis and treatment of hepatic and biliary tract disease has been established.1 Use of the peritoneoscope in evaluation of the patient with carcinoma has not been sufficiently stressed. The diagnosis of intra-abdominal malignant lesions can frequently be established by this procedure. During the period November, 1949, to December, 1952, we performed 660 peritoneoscopic examinations. Of these, 84 were on patients with known or suspected carcinoma. A review of these cases forms the basis for this report. METHOD The records of 84 patients examined peritoneoscopically for possible malignant lesions were reviewed. The patients were placed in one of three groups: (1) group A, patients with a clinical diagnosis of carcinoma, in whom it was desired to establish operability; (2) group B, patients with previously resected carcinoma, in whom the presence of recurrence or metastases was suspected, and (3) group