Archives of Internal Medicine

STONE, WILLARD J.;PHILLIPS, BRUCE G.;BLISS, WALTER P.

doi: 10.1001/archinte.1918.00090150003001pmid: N/A

Abstract INTRODUCTION Only completed cases of pneumonia treated at the U. S. Army Base Hospital, Fort Riley, Kan., during the seven months' period, Oct. 18, 1917, to May 18, 1918, are included in this report (Fig. 1). This series is made up of 668 instances of lobar pneumonia, 181 instances of measles pneumonia,1 and 22 instances of bronchopneumonia. During the period, Oct. 1, 1917, to May 18, 1918, there were 22,854 admissions, making a total incidence for pneumonia of 4.5 per cent. Of the 668 completed instances of lobar pneumonia, 154 patients died, a mortality of 23 per cent. Of these 154 deaths, 87 were complicated by empyema. The mortality of lobar pneumonia without empyema was therefore 12.7 per cent.During the period, Oct. 18, 1917, to May 18, 1918, 2,956 cases of measles were treated in this hospital. The total number of measles pneumonia has been 181, making, for the References 1. The term "measles pneumonia" refers to pneumonia following measles. It was impossible, in many instances, to distinguish, clinically, lobar from bronchopneumonia, especially if empyema was an early complication. 2. The method followed was that of the Rockefeller Institute mouse injection until Jan. 10, 1918, since when Avery's synthetic medium has been used. Until about March 15, 1918, a gram stain, a subculture in plain broth and on blood agar plate was made from the Avery medium culture. Since that date the subculture in broth has been discontinued. The precipitin method was used for a long period, but the agglutination method was found to be preferable and compulsory, of course, when bile was not available. In the differentiation of pneumococcus Type IV from the streptococcus, the bile test and the cultural characteristics on the blood agar plate were used. 3. Cole, Rufus, and MacCallum, W. G.: Jour. Amer. Med. Assn. , 1918, 70, 1146.Crossref 4. We are indebted to Prof. A. S. Warthin of the Department of Pathology, University of Michigan, for the preparation of microscopic specimens and photomicrographs. 5. A throat swab for culture of streptococcus is made on all measles patients on admission. 6. Hatcher, Robert A., and Brody, J. G.: Am. Jour. Pharm. , 1910, 82, 360. 7. Eggleston, Cary: Archives Int. Med. , 1915, 16, 1.Crossref 8. The tincture of digitalis was made from Allen's leaves with 75 per cent. alcohol instead of the 50 per cent, alcohol prescribed by the U. S. P. 9. Desensitization was carried out as follows: 0.5 c.c. subcutaneously followed in one hour by 1.0 c.c. subcutaneously. One hour later the serum was administered intravenously. 10. Dr. Rosenow has kindly prepared for us an antigen containing a large fraction of our local strains of pneumococci which will be used in the treatment of pneumonia patients. 11. May 18 there were under treatment 182 patients with pneumonia, among whom there were forty-six instances of empyema in which operation was performed. 12. The mortality has been decreased since this table was completed in May.

VAUGHAN, WARREN T.;SCHNABEL, TRUMAN G.

doi: 10.1001/archinte.1918.00090150034002pmid: N/A

Abstract Recent rather numerous reports from the various army camps throughout the country concerning the incidence and causative agent of pneumonia, during the last winter, have mentioned frequent infection with Streptococcus hemolyticus and less frequent occurrence of pneumococcus infection. Reports from the different camps would indicate that the predominating organism is not the same in all localities. In Camps Funston, Dodge, Custer and Lee hemolytic streptococcus has been reported as the prevailing organism. At Camps Wheeler, Beauregard, Hancock, Jackson, Logan, Sheridan and Travis more pneumococcus infections are reported. In the findings so far published attention has been directed chiefly to the study of bronchopneumonia and, more especially, empyema. There has been very little comparative study of lobar and bronchopneumonia. The studies of the commission headed by Cole and McCallum1 at Fort Sam Houston, have been made with this point in view and their results would indicate that the true lobar pneumonia References 1. Cole, Rufus, and McCallum, W. G.: Pneumonia at a Base Hospital , Jour. Am. Med. Assn. , 1918, 70, 1146.Crossref 2. Avery, O. T.: Determination of Types of Pneumococcus in Lobar Pneumonia , Jour. Am. Med. Assn. , 1918, 70, 17.Crossref 3. Duncan, Louis C.: An Epidemic of Measles and Pneumonia in the Thirty-First Division , Camp Wheeler, Ga., Mil. Surgeon , 1918, 42, 123. 4. Vaughan, Warren T.: Type Determination of Pneumococcus Infection as Practiced in the Field with Avery's New Cultural Method , Jour. Am. Med. Assn. , 1918, 70, 431.Crossref 5. Krumwiede, Charles, Jr., and Valentine, Eugenia: Determination of the Type of Pneumococcus in the Sputum of Lobar Pneumonia , Jour. Am. Med. Assn. , 1918, 70, 513.Crossref 6. Beckler, Edith A.; Marden, Katherine, and Gillette, Helen H.: Pneumococcus Type Determination by Avery's Cultural Method , Jour. Am. Med. Assn. , 1918, 70, 836.Crossref 7. Cross, J. G.: Analysis of Two Hundred Cases of Lobar Pneumonia , Jour. Am. Med. Assn. , 1915, 65, 1778.Crossref 8. Cole, Rufus, and McCallum, W. G.: Jour. Am. Med. Assn. , 1918, 70, 1146.Crossref 9. Avery, Chickering, Cole and Dochez: Acute Lobar Pneumonia , Monographs of the Rockefeller Institute for Medical Research, No. 7.

WALKER, I. CHANDLER

doi: 10.1001/archinte.1918.00090150060003pmid: N/A

Abstract In a recent paper1 many important clinical facts were brought to light from the study of a series of 400 patients with bronchial asthma. These facts all have a direct bearing on the determination of the cause of the condition and therefore indirectly they indicate the proper treatment. Among other facts, it was shown that 48 per cent. of the 400 patients were sensitive to some type of protein and that the younger the patient was when he began to have bronchial asthma the more apt was he to be sensitive to some protein. A table was presented showing the number of patients who were sensitive to the four chief sources of protein, namely, animal hair, food, bacteria and pollens, at the various ages of onset of bronchial asthma. The skin or cutaneous test was employed to determine whether or not the patients were sensitive. The object of the present References 1. Walker, I. C.: A Clinical Study of 400 Patients with Bronchial Asthma , Boston Med. and Surg. Jour. , 1918, 179, 288.Crossref 2. Walker, I. C.: The Treatment of Patients with Bronchial Asthma with the Proteins to which They Are Sensitive , Jour. Med. Research , 1917, 36, 423. 3. Mr. Charles F. Choate, Jr., of Boston, to the Peter Bent Brigham Hospital are as follows: Studies I-V , Jour. Med. Research , 1917, 35, 373, 391, 487, 497, 509 4. Studies VI-VIII , Jour. Immunol. , 1917, 2, 227, 237, 243 5. Study IX , Am. Jour. Bot. , (July) , 1917 6. Studies X-XIII , Jour. Med. Research , 1917, 36, 231, 237, 243, 295 7. Study XIV , Jour. Med. Research 1917, 36, 423 8. Study XV , Jour. Med. Research , 1917, 37, 51 9. Studies XVI and XVII , Jour. Med. Research , 1917, 37, 277, 287 10. Study XVIII , Jour. Am. Med. Assn. , 1918, 70, 897.Crossref 11. The Cause and Treatment of Bronchial Asthma , Med. Clinics of North America, Boston , 1918, 1, No. (4) .

MARRIOTT, W. McKIM;HOWLAND, JOHN

doi: 10.1001/archinte.1918.00090150071004pmid: N/A

Abstract In the course of nephritis severe acidosis may develop. Although all the usual evidences of acidosis are present, there is no increase in the ammonia of the urine. To this extent it differs from the acidosis resulting from the ingestion of strong mineral acids or from the overproduction of organic acids in the body such as beta-oxybutyric and aceto-acetic acids. Henderson and Palmer1 have pointed out that the titratable acidity of the urine in the acidosis of nephritis may be normal in amount though the total excretion of acid is low, due to "a never failing deficit in urinary ammonia." These observations would indicate that the acid responsible for the disturbance of the acid base equilibrium in nephritis is distinctly different in character from those acids causing acidosis in other conditions. We have previously demonstrated2 that an accumulation of inorganic phosphate occurs in the blood plasma of nephritics coincident with References 1. Palmer, W. W., and Henderson, L. J.: Jour. Biol. Chem. , 1915, 21, 37. 2. The Archives Int. Med. , 1915, 16, 109. 3. Marriott, W. McK., and Howland, J.: The Archives Int. Med. , 1916, 18, 708.Crossref 4. Spiro: Beitr. z. chem. Phys. u. Path. , 1902, 1, 269. 5. Austin and Jones: Am. Jour. Med. Sc. , 1917, 153, 81.Crossref 6. Henderson and Palmer: Jour. Biol. Chem. , 1913, 13, 393. 7. Henderson and Adler: Proc. Soc. Biol. Chem. , 1908, p. 38. 8. Folin and McCallum: Jour. Biol. Chem. , 1912, 11, 523. 9. A represents the total titratable acid for twenty-four hours, and NH3 the total urinary ammonia, each expressed in cubic centimeters of decinormal solution. 10. Jour. Biol. Chem. , 1915, 21, 37.

DICKSON, ERNEST C.

doi: 10.1001/archinte.1918.00090150077005pmid: N/A

Abstract In a previous report1 it was shown that prior to September, 1917, there had been twenty-two recorded outbreaks of botulism in the United States, in which eighty-one persons were poisoned and fifty-five died. In this collection of cases one important outbreak had been overlooked. In January, 1912, Dr. A. R. McCracken2 of Seattle reported a series of six cases of poisoning by home-canned asparagus, in which three of the patients died. In all, therefore, there have been at least twenty-three recorded outbreaks of botulism in this country, of which nineteen occurred in the Pacific Coast States. The mortality of these recorded cases was 66.6 per cent. In addition to the outbreaks in which human beings were affected there were also at least six instances in which domestic fowl were poisoned and showed symptoms which were identical with those produced experimentally by feeding with the toxin of Bacillus botulinus. ETIOLOGIC FACTORS References 1. Dickson, E. C.: Botulism: The Danger of Poisoning from Vegetables Canned by the Cold-Pack Method , Jour. Am. Med. Assn. , 1917, 69, 966.Crossref 2. McCracken, A. R.: Botulism , Leucocyte , 1912, 19, 80. 3. Dickson, E. C.: Botulism: A Cause of Limber-Neck in Chickens , Jour. Am. Vet. Med. Assn. , 1917, 50 (New Series III), 612. 4. Buckley and Shippen: Preliminary Report on the Relation of Anaerobic Organisms to Forage Poison Am. Vet. Med. Assn. , 1917, 50 (New Series III), 612. 5. Buckley and Shippen: Preliminary Report on the Relation of Anaerobic Organisms to Forage Poisoning , Am. Vet. Med. Assn. , 1917, 50 (New Series III), 809. 6. Graham, Bruekner and Pontius: Studies in Forage Poisoning V and VI , Kentucky Agricult. Exper. Sta., Bull. 207, 1917.

VOGEL, KARL M.

doi: 10.1001/archinte.1918.00090150090006pmid: N/A

Abstract Owing to the complexity of structure and function of the central nervous system its disorders manifest themselves in clinical pictures of the utmost variety. Furthermore, in the case of one large group of these affections, the syphilitic and parasyphilitic diseases, it is highly desirable to recognize their nature as early as possible in order that the necessary treatment may be begun and the progress of the malady be arrested before destructive lesions have supervened. The difficulties of diagnosis are consequently often very great and all suitable methods of investigation yielding objective results are therefore likely to be of much assistance, particularly if they aid not only in diagnosis, but also in observing the effects of treatment. Among such procedures are the various methods of examining the cerebrospinal fluid, such as determining the pressure under which it is held in the spinal canal, counting its cells, testing its globulin content, and References 1. Phil. Tr., Roy. Soc., London , 1861, 151, 183.Crossref 2. Bayliss: Principles of General Physiology . London, Longmans, Green & Co., 1915, p. 109. 3. Bayliss: Principles of General Physiology, 1915, p. 89. 4. Ostwald: A Handbook of Colloid Chemistry . Philadelphia, P. Blakistons Son and Co., 1915, p. 31. 5. Perrin: Comptes rend. de l'Acad. Française , 1908, 146, 967. 6. Schulz and Zsigmondy: Beitr. z. Chem. Phys. , 1903, 3, 137. 7. Zsigmondy: Liebig's Ann. d. Chem. , 1898, 301, 29Crossref 8. Ztschr. f. analyt. chem. , 1901, 40, 697.Crossref 9. Glaser: Neurol. Centralbl. , 1914, 32, 688. 10. Miller, Brush, Hammers and Felton: Bull. Johns Hopkins Hosp , 1915, 26, 391. 11. Wood, F. C., Vogel, Karl M., and Famulener, L. W.: Laboratory Technique. The Methods Employed at St. Luke's Hospital . Ed. 2. New York: James T. Dougherty, 1917, p. 86. 12. Lee, O. I.: A Simple Procedure for the Preparation of Colloidal Gold for Diagnostic Purposes , Am. Jour. Med. Sc. , 1918, 155, 404.Crossref 13. The Wassermann reactions were performed under the direction of Dr. L. W. Famulener. The technic included the use of an antisheep hemolytic system and waterbath fixation. Two antigens were used, namely, the Noguchi acetone-insoluble, and alcoholic extract of guinea-pig heart, and in each case the reaction was performed in duplicate with two different specimens of antigen.

RACKEMANN, FRANCIS M.

doi: 10.1001/archinte.1918.00090150111007pmid: N/A

Abstract Within the past few years, there has been a growing interest in the association and relation between anaphylaxis and asthma. The original theories of this relation have been often discussed. This growing interest has served to emphasize the important point that the diagnosis of bronchial asthma is only the first step in the diagnosis of the absolute cause of the particular patient's difficulty. The writer's purpose in this present work has been to determine the cause of asthma in the 150 patients who form the basis of this report and, if possible, to arrange these patients in groups. These 150 patients were seen in the out-patient department and wards of the Massachusetts General Hospital, and a few outside the hospital. Each patient had been previously studied by a competent internist. Organic lesions of the heart, lungs and blood as a cause of dyspnea, had been considered and ruled out, often References 1. Meltzer, S. J.: Anaphylaxis and Asthma , Jour. Am. Med. Assn. , 1910, 55, 1021.Crossref 2. Walker, I. C.: Studies in Bronchial Asthma , Jour. Med. Research , 1917, 31, 243. 3. Walker, I. C.: Studies on the Cause and the Treatment of Bronchial Asthma , Jour. Am. Med. Assn. , 1917, 69, 363.Crossref 4. Schloss, O. M.: Am. Jour. Dis. Child. , 1912, 14, 341. 5. Frost, L. C.: A Case of Intense Food Anaphylaxis , Med. Rec., New York , 1915, 88, 483. 6. Muhsam and Jacobson: Deutsch. med. Wchnschr. , 1914, 40, 1067.Crossref 7. Smith, H. R.: The Archives Int. Med. , 1909, 3, 350.Crossref 8. Grant, Dundes: Nasal Disease in Relation to Asthma , Practitioner, Lond. , 1913, 90, 914. 9. Abbott, W. J.: Bronchial Asthma and the Relation of Nasal Conditions to It , Am. Jour. Otol., Rhin. and Laryngol. , 1914, 33, 83. 10. Gottlieb: Etiology and Treatment of Bronchial Asthma , New York Med. Jour. , 1917, 106, 313. 11. Bonnier: Arch. gén. de méd., Paris , 91, 197. 12. Matthews, J.: Med. Rec., New York , 1914, 84, 507. 13. Davies, B. C.: A Clinical Study of Asthma , Jour. Am. Med. Assn. , 1914, 62, 1006.Crossref 14. Hare, F.: Varieties and Treatment of Asthma , Brit. Med. Jour. , 1911, 2, 1442.Crossref 15. Babcock, R. H.: The Nature and Treatment of Bronchial Asthma , Jour. Am. Med. Assn. , 1915, 64, 2115.Crossref 16. Jackson, D. E.: Pharmacology of Bronchial Asthma , Jour. Lab. and Clin. Med. , 1915, 1, 126. 17. Longcope, W. T.: Susceptibility of Man to Foreign Proteins , Am. Jour. Med. Sc. , 1916, 152, 625.Crossref 18. Moss: Jour. Am. Med. Assn. , 1910, 55, 776.Crossref 19. Knox, Moss and Brown: Subcutaneous Reactions of Rabbits to Horse Serum , Jour. Exper. Med. , 1910, 12, 562.Crossref 20. Terry, M. C.: Precision Syringes , Jour. Infect. Dis. , 1913, 13, 80.Crossref 21. Cooke, R. A., and Vander Veer: Human Sensitization , Jour. Immunol. , 1916, 1, 201. 22. Talbot, F. B.: Asthma in Children, Etc. , Boston Med. and Surg. Jour. , 1916, 175, 191.Crossref 23. Staubli: Trichiniasis, J. F. Bergman , Wiesbaden, 1909. 24. Schlecht, Heinrich: Arch. f. exper. Path. u. Pharmakol. , 1912, 67, 137.Crossref 25. Staubli, Carl: Ergebnisse der Inn. Med. v. Kinderheilkunde , 1910, 6, 193. 26. Pröscher: Folia Haemat. , 1905, 2, 543. 27. Schlecht, Heinrich: Deutsch. Arch. f. inn. Med. , 1912, 98, 327. 28. Schlecht and Schwenker: Deutsch. Arch. f. klin. Med. , 1912, 108, 405. 29. Cooke, R. A.: Treatment of Hay Fever, Laryngoscope, 1915. 30. Goodale, J. L.: Vasomotor Disturbances of the Upper Air Passages , Boston Med. and Surg. Jour. , 1916, 175, 181.Crossref 31. Cooke, R. A.: Personal Communication. 32. Walker, I. C.: Jour. Med. Research , 1917, 35, 497. 33. Kahn and Emsheimer: The Archives Int. Med. , 1916, 18, 445.Crossref 34. Wells, H. G., and Osborne, T. B.: Biologic Reactions of the Vegetable Proteins , Jour. Infect. Dis. , 1913, 12, 341.Crossref 35. Rackemann, F. M.: Interesting Reactions Obtained During Treatment of Two Cases of Bronchial Asthma , Jour. Am. Med. Assn. , 1917, 69, 889.Crossref 36. Frankfurter, O.: Asthma and Tuberculosis , Wien. klin. Wchnschr. , 1913, 26, 961. 37. Frenquelli, J.: Tuberculous Asthma; Two Cases , Semana Med., Buenos Aires , 1916, 23, 583 38. Jour. Am. Med. Assn. , 1916, 68, 1011. 39. Giffin, H. Z.: Asthma and Tuberculosis , Am. Jour. Med. Sc. , 1911, 142, 869.Crossref 40. Blackfan, K D.: Am. Jour. Dis. Child. , 1916, 11, 441. 41. Schloss, O. M.: Arch. Pediat. , 1916, 33, 210. 42. Strickler and Goldberg: Anaphylactic Food Reactions in Dermatology , Jour. Am. Med. Assn. , 1916, 66, 249.Crossref 43. Talbot: Tr. Am. Pediat. Soc. , 1916, 28, 190. 44. White, C. J.: Anaphylactic Phenomena in Eczema , Jour. Cutan. Dis. , 1916, 34, 55. 45. The Treatment of Eczema in Childhood , Boston Med. and Surg. Jour. , 1918, 178, 5.Crossref 46. Barker, L. F.: Canad. Med. Assn. Jour. , 1913, 1. 47. Lemann, I. I.: Treatment of Bronchial Asthma , Am. Jour. Med. Sc. , 1911, 142, 781.Crossref 48. Kayser, C.: Therap. Monatsh. , 1911, 26, 157. 49. Von Jagic: Berl. klin. Wchnschr. , 1909. 50. Ephraim: Deutsch. med. Wchnschr. , 1912, 38, 1453.Crossref 51. Staubli: München. med. Wchnschr. , 1913, 60, 113. 52. Ebstein, W.: Deutsch. med. Wchnschr. , 1911, 38, 1921.Crossref