JAMA

Fox, Meyer S.

doi: 10.1001/jama.1956.02970310001001pmid: 13366740

• A worker's hearing can be damaged temporarily or permanently by sufficiently loud occupational noise, whether explosive or continuous. Audiograms made before and during the course of employment are essential to a program of conservation of hearing; they are also essential for medicolegal purposes. Medical supervision is important. The physician who is consulted in disputes about cases of allegedly occupational deafness is on safe ground when he confines himself to statements of demonstrated fact and when he avoids suppositions. The otolaryngologist is especially qualified to collect the facts needed to conserve the hearing of workers and to prevent economic loss to employers from ill-founded claims.

Greene, Nicholas M.

doi: 10.1001/jama.1956.02970310004002pmid: 13366741

• Respiratory disease in a surgical patient can represent a serious complication to the giving of anesthesia. Preoperative management must include correction of the underlying pulmonary pathology, where possible. For preanesthetic medication, the barbiturates are preferable to analgesics. While the anesthetic agent itself cannot be related to any adverse effects on preexisting pulmonary infections nor, alone, have influence on postoperative respiratory complications, it must still be admitted no presently available agent or technique is ideal. The selected procedure must therefore be considered in the light of its particular advantages (e. g., bronchodilating qualities, rapid postoperative response) over predicted disadvantages (e. g., anoxia, respiratory depression). Competent postoperative supervision, preventing interference with adequate respiration, completes the program of providing safe anesthesia for patients with respiratory disease.

Koprowski, Hilary; Norton, Thomas W.; Hummeler, Klaus; Stokes, Joseph; Hunt, Andrew D.; Flack, Agnes; Jervis, George A.

doi: 10.1001/jama.1956.02970310009003pmid: N/A

• Two types of living attenuated poliomyelitis virus were administered by mouth to 24 bottle-fed infants by adding the virus preparations to the formula. Sixteen received the SM strain (representing type 1), two received the TN strain (type 2), and six received both strains at different times. Ingestion of SM was followed promptly by an asymptomatic alimentary infection, demonstrated by isolating the virus from the feces. Repeated doses were necessary to establish the carrier state in three of these infants. Ingestion of TN by two infants was followed similarly by the isolation of type 2 virus from the feces. All infants developed active immunity after the inapparent alimentary infection. It was found safe to administer the virus to infants less than a month old. Two infants who had not received the virus were placed in cribs between those of other infants carrying SM but did not contract the infection. The presence of homotypic antibodies congenitally acquired from the mother did not prevent an active response in infants who received an adequate amount of virus.

Grossman, Moses; Benson, Ralph C.

doi: 10.1001/jama.1956.02970310017004pmid: 13366743

• The gross fetal mortality associated with cesarean sections ranged from 4.5 to 15.6% in 13 institutions. The causes of death and indications for sections have been reviewed in detail for the last 16 years, covering 569 sections, at University of California Medical Center. The maternal mortality has been reduced by such factors as briefer trials of labor, blood transfusion, and new surgical techniques, but the fetal mortality has not shown corresponding improvement. Erythroblastosis, congenital anomalies, and atelectasis with its complications accounted for many deaths occurring within an hour after birth. Prematurity, however, is the largest single contributing factor to the high mortality rate. An accurate appraisal of arrival at term is important in order that a premature infant will not be delivered by ineptly timed and purely elective section.

Knighton, Robert S.; Fox, J. DeWitt

doi: 10.1001/jama.1956.02970310022005pmid: 13366744

• The diagnosis of eosinophilic granuloma of bone was made in five cases here reported; in each there was a circumscribed area of swelling or tenderness on a cranial bone, a characteristic circumscribed lytic lesion in the roentgenograms, and confirmation by microscopic examination of tissue obtained at operation. Headache attributable to extension of the tumor along meningeal blood vessels was severe in one case and present in two others; the intracranial pressure was normal and the neurological findings were negative in all cases. Surgical removal and subsequent irradiation to a total of 600 to 2,000 r in air was followed by healing and complete relief of symptoms. Eosinophilic granuloma should be considered as a diagnostic possibility whenever a patient presents a localized tenderness of the scalp or a lytic lesion of the skull.

Karzon, David T.; Barron, Almen L.; Winkelstein, Warren; Cohen, Seymour

doi: 10.1001/jama.1956.02970310026006pmid: 13366745

• Symptoms of aseptic meningitis occurred in 17 children and in 7 young adults out of 500 inhabitants of a village in July, 1955. Seven boys were hospitalized, and all had fever, headache, signs of meningeal irritation, and gastrointestinal complaints. Pain, lethargy, mild muscular weakness, and altered reflexes were present in some cases. Improvement was rapid, and all patients were discharged well, within 3 to 10 days, with no residual findings except occasional slight muscular weaknesses and minimal hamstring spasm. Laboratory observations included detailed virus studies of the cerebrospinal fluid, blood, throat swabs, and fecal specimens. No rise of poliovirus neutralizing antibody was demonstrable in any of the patients, but in all there were rises in circulating antibody to ECHO (enteric cytopathogenic human orphan) type 6 virus. Specific antibody appeared on the fifth day of illness and was still present after seven months, when the only residual finding was absence of the abdominal reflexes in two patients. The virus was isolated, and evidence of its etiological role is given. The disease could not be distinguished clinically from preparalytic poliomyelitis when the patients were admitted to the hospital. There are indications that epidemics of this kind are not unusual or isolated occurrences.

Ferguson, John T.; Linn, Frank V. Z.; Sheets, John A.; Nickels, Mervyn M.

doi: 10.1001/jama.1956.02970310031007pmid: 13366746

• Methylphenidate hydrochloride was administered in 10-mg. doses by intravenous injection to 164 hospitalized mental patients who manifested sleepiness and other symptoms of overdosage with tranquilizing drugs. The conditions of only 4 of the 164 were refractory to the analeptic effects of the methyphenidate; the other 160 all responded to one, two, or at most three injections by increase in alertness and decrease in side-reactions. Safe and effective dosages were thus determined, and in addition it was found that the improved condition of 151 of the 160 patients could be maintained by giving the methylphenidate solution thrice daily by mouth. A group of 11 chronic, regressed, underactive patients were then treated with intravenous injections of the drug. Three injections of 10 mg. sufficed in every case to cause marked clinical improvement, with increased activity, sudden awareness of surroundings, and other marked changes of behavior. These changes were obtained repeatedly, appeared promptly, were of limited duration, and were not seen after injections of a placebo. They are exemplified in the case histories of two patients who, after 21 and 17 years of extreme inactivity in the hospital, showed dramatic improvement in behavior.

Birdsong, McLemore; Smith, David E.; Mitchell, Fred N.; Corey, J. Hicks

doi: 10.1001/jama.1956.02970310033008pmid: 13366747

• Generalized cytomegalic inclusion disease is an intrauterine infection that, in its most serious form, causes symptoms at or soon after birth. The two infants here described had icterus, extensive petechial or ecchymotic hemorrhages, hepatomegaly, splenomegaly, and various laboratory findings indicating a severe blood dyscrasia. One infant died an hour after birth; the other at birth exhibited signs of hemolytic icterus and an anemia that progressed at first but was ultimately controlled. Numerous fresh urine specimens obtained from the second infant during the first two weeks yielded a sediment that, on fixing and staining, exhibited enlarged cells with typical cytoplasmic as well as intranuclear inclusions. The second infant is one of three now known to have survived this disease. The causative organism is a salivary gland virus that probably infects a large proportion of the population subclinically at an early age. The infant who survived was treated with vitamin K intramuscularly, benzathine penicillin G orally, prednisolone, and corticotropin.

Woodward, Doris J.; Solomon, James D.

doi: 10.1001/jama.1956.72970310001009pmid: 13366748

Promazine (Sparine) is 10-(3-dimethylaminopropyl) phenothiazine hydrochloride, one of the newer ataraxic drugs recently introduced into clinical practice. It is chemically related to chlorpromazine, both compounds containing the phenothiazine nucleus. The structure of promazine is the structure of chlorpromazine minus the chlorine atom. Promazine has been used in the management of patients with acute mental disturbances1 and at this stage is not recommended for patients with chronic conditions. Nevertheless, a clinical trial in such patients was planned. In March, 1956, it was decided to give a course of promazine therapy to 97 patients (50 female, 47 male), all with chronic conditions, who had been hospitalized for from 5 to 25 years. So far as is known, there has been no report in the literature of a case of agranulocytosis resulting from promazine therapy. In order to furnish the first known direct evidence of toxic effects of promazine on the bone

Darrow, Daniel C.

doi: 10.1001/jama.1956.72970310003010pmid: 13366749

Rational treatment of disturbances of the body potassium level is based on the physiology of water and electrolytes. Beginning with Ringer's studies of the effects of electrolytes on the heart, numerous investigations have indicated that the activity of all cells is altered by changes in the concentration of the potassium surrounding the cells. High plasma concentrations exert their most important effect on the heart, because arrhythmia and heart block are produced at plasma potassium concentrations of 8 to 10 mEq. per liter.1 A flaccid paralysis of skeletal muscle has been observed at high concentrations in some patients with advanced renal failure. The paralysis resembles that seen with low plasma potassium levels except that the electrocardiograms are characteristic of those of patients with potassium intoxication. The high-peaked T waves are the earliest electrocardiographic alterations, but absent P waves, spreading QRS complexes, and more advanced disturbances develop later. When the potassium