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E manuel Swedenborg, better known for his writings in theosophy than in science, was born "Swedberg," in Stockholm; however, he spent the greater portion of his early life in Uppsala where his father, a Lutheran bishop, lived in comfortable circumstances.1 Even as a youth his mind was engaged in contemplation of God, salvation, and the spiritual ills of man. After attending the university at Uppsala where he concentrated on mathematics and mining, he began the first of several extended tours of England and the Continent, studying the natural sciences, conducting experiments, and making acquaintances with the learned men of his day. His imaginative mind at various times in his life dealt with such practical subjects as the construction of submarines, airplanes, mercury air pumps, hydraulic engines, machine guns, and canals; crystallography; shifting coastlines; improvement in mining and smelting of ores; and the determination of longitude from observations of the

The influence of Dr. Libman on medical men has extended into many places. His students, colleagues and associates, as represented by the contributors to these volumes, constitute a notable list. Their names and their articles reflect impressively his many interests. As is pointed out by Dr. William H. Welch in the preface, approximately one third of the papers relate to the cardiovascular system, but the others concern medical historical subjects, bacteriology, pathology and indeed the whole realm of science and the practice of medicine. It would be invidious to list particularly any of the notable names appearing in this work. Of special interest are such articles as that by Harlow Brooks on the heart of the athlete, that by Leroy Crummer on the early development of medical literature, that by Lawrason Brown on the significance of Koch to tuberculosis. Again there is a historical article by Fielding Garrison, an item

After a brief summary of Swedenborg's excursions into the fields of mathematics, astronomy, mechanics, chemistry, mineralogy and geology, the author presents more completely his later teachings on the structure and functions of the brain and a detailed analysis of the sources of these neurologic doctrines.Although Swedenborg's neurology was permeated by the absurd ideas current in his time, and long afterward, regarding the nature of the "animal spirits" or "fluidum spiritosum" and the seat of the soul, nevertheless the reader cannot fail to be impressed by the great advance of his views over those of most of his contemporaries.The most important of these are that the centers of the psychic functions are to be found in the cerebral cortex, that these functions are localized in definite cortical areas and that the cortical nerve cells ("cerebellula") are the functional units. All of these views are shown to be represented in

Numerous reports of percutaneous transluminal angioplasty have demonstrated its clinical usefulness as a nonoperative approach to coronary artery disease. Recently, this technique has been extended to coronary artery bypass grafts. To our knowledge, our report is the first to describe the anatomical changes induced by percutaneous transluminal angioplasty in a saphenous vein aortocoronary bypass graft.(JAMA 1983;249:3347-3350)

The relationship between maternal birth weight and future reproductive outcome was studied in a cohort of 748 white women with singleton pregnancies. Maternal birth weight was significantly related to stature, prepregnancy weight, pregnancy weight gain, baby's birth weight, gestational duration, relative intrauterine growth, the baby's need for neonatal intensive care, transient tachypnea of the newborn, and idiopathic respiratory distress syndrome. Mothers who weighed 2,000 g or less at birth were at elevated risk for poor pregnancy outcome, although their babies were not smaller than babies of most groups of mothers who weighed more at birth. This suggests that factors interfering with intrauterine growth have an impact on the next generation of babies. In view of the increasing survival of low-birth-weight babies, this possibility bears further investigation.(JAMA 1983;250:2016-2019)

According to the studies that we have made, cases of endocarditis can for the present be best classed as rheumatic, syphilitic, acute bacterial, subacute bacterial, and indeterminate.The cause of rheumatic fever has not yet been discovered. There exists, however, a lesion specific for the disease, the Aschoff body. It is to be remembered that this is a perivascular lesion, in contradistinction to the lesion later to be noted as occurring in cases of subacute bacterial endocarditis. In rheumatic fever, a secondary infection by anhemolytic streptococci was found by Kinsella and Swift in 8.3 per cent, of the cases studied by them. At the postmortem examinations, cultures yielded the organisms in 50 per cent, of the cases. They found no immunologic reactions present for these cocci, whereas in cases of subacute streptococcus endocarditis they observed, as we did, that a complement fixation test is uniformly present when the serum of

Current literature is replete with accounts of prolapse of the gastric mucosa through the pylorus as a cause of symptoms; nevertheless, there is still a wide variation of opinion regarding its incidence, etiology, and clinical significance. Rees1 found only 4 cases in 3,000 examinations of the upper gastrointestinal tract; Scott2 observed 14 cases (1.04%) in 1,346 examinations; while Ferguson3 found prolapse of the gastric mucosa in 23 (7.7%) of 297 consecutive patients.The pathogenesis of this condition is still unknown. The mucosa of the normal stomach is loosely attached to the muscularis and is movable over it. However, at autopsy Scott2 found that this mobility did not permit the mucosa to be drawn through the pylorus into the duodenum. Various explanations for this phenomenon have been advanced. Hypertrophic gastritis,4 developmental anomalies,5 pylorospasm followed by hyperperistalsis,1 failure of the normal "stretching mechanism" of the

The following account presents an abstract of part 1 of an extensive study under way in the Research Department of the Welfare Council of Metropolitan Los Angeles for the purpose of determining: (a) the magnitude and nature of the need for obstetric, pediatric,1 and hospital care for wives of servicemen;2 (b) the manner in which these needs are currently being met through local medical resources; and (c) the expressed reactions of the servicemen's wives in regard to present provisions for such care.This article briefly discusses (1) the concept of need as it operates as a frame of reference for study findings; (2) the method employed in part 1 of the completed study and of the method used in part 2 now under way; (3) some characteristics of the geographic setting of the study population; (4) composite case abstracts representing typical cases; and (5) a review of some

The need for an objective evaluation of strabismus has been recognized for a long time, but only in recent years has the role of the corneal light reflex in determination of the true position of a deviating eye and its associated image responses been scientifically explored. Impetus was given to this study by the development of the major Wheatstone stereoscope and, somewhat later, of the major Brewster stereoscope,1 in which opaque targets were replaced by brightly illuminated translucent targets to elicit meaningful corneal light reflexes.Ophthalmologists, physicists, physiologists and anatomists have all contributed to the present knowledge of strabismus. In a brief report the names of only a few of the early pioneers who have stimulated present-day thinking and practice can be mentioned. In 1858 Alfred Carl Graefe2 introduced the familiar cover, or screen, test, by means of which alternate covering of one eye yields useful information with

The object of this investigation was to evaluate the use of aureomycin in obstetric patients. Since the advent of the sulfonamide drugs and penicillin investigators have continued to search for new antibiotics which would be effective and less toxic. One of the products of this search, aureomycin, was discovered by Duggar in 1948.1 Extensive bacteriologic and clinical studies have established the effectiveness of this agent in a wide variety of infections. Its mode of action, as determined in vitro, is predominately bacteriostatic, but it also possesses bactericidal properties at high concentration. Because of the promising results reported with aureomycin, including its use in obstetric complications,2 a study of this drug and its effect on the bacteriologic flora and infections during pregnancy and the puerperium was believed warranted. MATERIAL AND METHODS Aureomycin was prescribed according to various dosage schedules as noted under the individual descriptions. The in vitro studies

STATISTICS: showing the frequency, gravity and long continuance of trachoma.—Of 324 new patients received as house cases at the Illinois Eye and Ear Infirmary from June 1, 1898, to Nov. 1, 1898,123, or about 38 per cent. were cases of trachoma. Other patients come and go, but trachoma patients stay on interminably, so that of 41 patients now under my observation, 23, or 56 per cent., are cases of trachoma. Trachoma can never be called cured. The lids may become perfectly smooth, and the disease seem apparently mastered, but in the course of a few weeks or months the patient will return with a trachoma which has all the characteristics of an acute disease.Of 50 cases of trachoma, in which I made careful records, 38 were cases where the disease had endured over two years, 13 where the disease had lasted more than five years, 7 where it had

Two regimens of measles vaccination were tested in Alaskan Eskimo villages in March, 1963. Clinical reactions to vaccines were no more severe than those observed in other populations. From 7 to 11 days following administration of live attenuated vaccine plus γ-globulin, 18% of vaccinees had a temperature of 103 F (39.4 C) and 24% developed a rash. One dose of killed vaccine followed in six weeks by live attenuated vaccine produced a temperature of 102 F (38.9 C) in only two instances and measles-like rash was not observed. Height of antibody response following live attenuated vaccine and γ-globulin was related significantly to age and maximum temperature. Rash occurred more frequently in the very young.

While epidemic meningitis is by no means a rare disease, the number of cases occurring when there is no epidemic is small. It seems worth while, therefore, to call attention to certain facts in regard to the disease based on a study of meningeal conditions in New York covering a period of sixteen years. During this time there has been no epidemic, so that the data show what occurs under normal conditions.We have been impressed with the fact that most of the laity and many physicians think that patients recovering from epidemic meningitis are liable to be seriously handicapped, especially in their mental development. For this reason we have followed up as many of our patients who recovered as possible to learn what percentage of cases show after-effects, and the nature of them.EPIDEMIOLOGYEpidemic meningitis is apparently a disease to which most persons have a natural immunity. In

Prior to the advent of chemotherapy, tuberculous meningitis was almost invariably fatal. The status of the disease has been altered considerably by the use of streptomycin administered intramuscularly and intraspinally. By means of this antibiotic regimen combined frequently with other tuberculostatic agents, remarkable results have been achieved that yield a high rate of remissions. After prolonged observation, however, the end-results were discouraging, since there were few long-term survivors. Smith1 reported only six five-year survivors among 81 patients with meningeal tuberculosis treated with streptomycin. One of us (E. A.) observed a series of 120 patients with tuberculous meningitis who were treated with streptomycin among whom there were only six six-year survivors.The recent discovery of the antituberculous activity of the isonicotinic acid hydrazides has stimulated many investigations on the value of these agents in the therapy of the various forms of pulmonary and extrapulmonary tuberculosis. This paper is based on

Primary atypical nonbacterial pneumonia has been reported with increasing frequency during the past fifteen years.1 This disease has since received particular attention. The intensive studies on disease of the respiratory tract conducted during World War II served to differentiate "primary atypical pneumonia" from similar pulmonary infections of established bacterial, viral or rickettsial causes.2 Clinically, diseases caused by the viruses of influenza, psittacosis, ornithosis and the rickettsiae of Q fever resemble atypical pneumonia.2 No causative agent has been isolated from patients suffering from this disease, although pooled sputum from patients has been shown to be capable of inciting the disease in human volunteers, even after it was passed through Corning sintered glass or Seitz filters.3 At present, there is no specific laboratory procedure available for confirming the clinical diagnosis. It has been noted that cold hemagglutinins and agglutinins for Streptococcus MG often develop in the serum of

Aureomycin is an antibiotic derived from a strain of Streptomyces aureofaciens).1 It has been found to protect mice and guinea pigs infected with the rickettsia of Q fever, Rocky Mountain spotted fever, murine typhus and rickettsial pox.2 The drug is readily absorbed after oral administration. Although quantitative assay in the body fluids has not been satisfactory, low levels (0.3 to 2.5 micrograms per millimeter) have been detected in the blood serum and levels up to 320 micrograms per milliliter3 in the urine. Pharmacologic studies in animals have shown that the toxicity of the drug is low except after intravenous administration where hemoglobinuria and anemia have been noted.4 In human beings, therapeutic doses up to 60.0 milligrams per kilogram of body weight per day given orally have not been associated with any toxic manifestations except for occasional nausea and vomiting.5 The latter has been transient and

Five patients had normal pressure hydrocephalus (NPH) within the context of a psychiatric dimension. The incidence of NPH is highest in the older age group. Psychiatric sequelae can be the predominant, as well as initial, clinical manifestation of this syndrome. Normal pressure hydrocephalus is an organic brain syndrome that is potentially reversible by a neurosurgical shunting procedure. The mental status of the patient and the necessity for the inclusion of NPH in the differential diagnosis are important.

Our experiments constitute part of an investigation on the alleged relation of the adrenal medulla to certain diseases, particularly diabetes mellitus and hypertension. The supposition of such a relation is a basis for the clinical practice of surgical intervention at the adrenals or roentgen irradiation of the adrenal region as a therapeutic measure. Therefore it is important to determine if possible whether this alleged relationship can be supported by unequivocal experimental evidence.The prevailing concept that increased epinephrine secretion from the adrenal glands has an important role in the etiology and the pathology of hypertension rests largely on the experimental basis for the theory of an "emergency" function of the adrenals. In a discussion of their experiments on epinephrine secretion during emotional excitement, on which the well known emergency theory rests, Cannon and de la Paz1 stated:Injected epinephrine is capable of inducing an atheromatous condition of the arterial

The first authentic case of influenza bacillus meningitis was described by Slawyk1 in 1899. Pfeiffer himself supervised the bacteriologic work. Earlier cases in which gram-negative bacilli were demonstrated were reported by Pfuhl,2 Haedke3 and Fraenkel,4 but the bacteriologic studies were inconclusive. During the years that followed a few scattered cases were reported, but it was not until 1911 that a real impetus was given to the study of influenza bacillus meningitis by Dr. Martha Wollstein,5 who reported eight cases that she had studied in a little more than a year. She made a careful analysis of the spinal fluids and did virulence tests on the strains of the bacilli, including the experimental production of the disease in monkeys, and treated successfully two of these monkeys with a serum that she had prepared by immunizing goats. In these publications the literature was carefully reviewed.Since 1911

For over thirty years I have been interested in the varying symptomatology of disease of the same kind occurring in different individuals. The subject of pain naturally received most attention. In this paper I shall take up mainly individual sensitiveness to pain, substitution symptoms, and radiations of pain. Some other important subjects, such as sensitiveness of diseased blood vessels and pains due to them, can only be touched on.Besides summarizing my earlier publications,1 I shall give a survey of recent investigations. Theoretical questions will not be discussed. Nor can the vast and remarkable general literature on pain be reviewed. Like all others, I am deeply indebted to the studies of Ross, Goldscheider, Head, Mackenzie, Hurst and many others.Many methods of gaging sensitiveness to pain have been suggested. The simple test that I employ is carried out by first pressing the thumb against the tip of the mastoid

Specific treatment of bronchial asthma, such as avoidance of offending allergenic agents and specific hyposensitization, so far are the best methods to pursue in order to obtain complete relief of symptoms. However, when a patient is observed during an acute asthmatic attack, satisfactory symptomatic relief is desired as quickly as possible. The type of treatment instituted will depend on the severity, frequency, and duration of the asthmatic attack. In acute asthma, and even in chronic asthma, the acute exacerbatiohs can be relieved without difficulty with epinephrine or aminophylline, and in mild attacks with oral or aerosol bronchodilators. The administration of cortisone is not the first line of approach in the treatment of acute asthma.In a small number of patients the asthmatic paroxysm increases in severity, the usual therapeutic measures fail, the patient becomes epinephrine-fast and remains in a severe, constant asthmatic state, designated as status asthmaticus. In these patients

Hepatitis due to inoculation with homologous serum has received considerable prominence in medical literature during the past few years owing to its widespread incidence following inoculation of troops with normal human serum employed as a vehicle for the yellow fever virus. While the pathogenesis of this disease has not been definitely established, the result of considerable investigation in both this country and England suggests that the icterogenic agent is a virus which retains its virulence after storage for long periods in a dried state. Hepatitis has been produced experimentally in human volunteers by parenteral injection,1 by feeding2 and by nasal inoculation3 of material containing the infective agent.Similar sequelae following whole blood or plasma transfusions were reported in 9 cases by Morgan and Williamson4 and in 5 cases by Steiner.5 Beeson,6 in describing the occurrence of jaundice in 7 cases following the use of

During a period of nearly thirty-five years the members of the Division of Acute Infections of the Central Nervous System of the New York City Health Department have been studying the effect of the various forms of therapy in bacterial meningitis. Before the newer chemicals became available the case fatality in pneumococcic meningitis was 100 per cent.The use of azosulfamide and sulfanilamide slightly improved the prognosis. The advent of the more potent sulfonamides marked a further advance in the treatment of this disease. In an unpublished series of 139 cases of pneumococcic meningitis treated with sulfapyridine, sulfadiazine, sulfathiazole or a combination of these (and specific serum when available) we obtained 49 recoveries. The recent introduction of penicillin led us to try the use of this drug in pneumococcic meningitis.MATERIALThis report is based on a series of 67 consecutive cases seen between Oct. 10, 1943 and May 1,

During a period of nearly thirty years we have been studying the effect of various forms of therapy in bacterial meningitis. Before the newer chemicals became available the case fatality in pneumococcic meningitis was 100 per cent in our experience and in meningitis due to Haemophilus influenzae more than 95 per cent.The use of azosulfamide and sulfanilamide moderately improved the prognosis. In a series of fifty-three cases of pneumococcic meningitis treated by one or both of these chemicals (and specific serum when available) there were nine recoveries. In treating meningitis due to H. influenzae by means of these chemicals and specific serum the results were much less encouraging. In a series of twenty-nine cases there were only two recoveries.The excellent results obtained with sulfapyridine in pneumonia due to the pneumococcus led us to try the use of this chemical in pneumococcic meningitis. This report is based on a

Pain is the most common complaint in arthritis, neuralgia and related conditions. These ailments at times may be dominated by discomfort so intractable as to subordinate all other considerations until symptomatic relief is provided for the patient. Failure or delay of the clinical measures in giving adequate comfort in such situations presents a not infrequent and difficult therapeutic problem.The relief of pain in arthralgia and neuralgia for these reasons has been the subject of investigation in our clinic for several years. The current interest in the use of venoms for relief of pain, particularly in rheumatic disease, leads us to publish this preliminary report on our therapeutic experience with cobra toxin. Our studies are continuing and will in time cover the treatment of a larger group of patients than are represented here. Among other remedies, we have observed the effects of copperhead and rattlesnake extracts. These substances were in

Live measles vaccine was given to almost the entire population of the village of St. Paul in the Pribilof Islands in 1963, where exposure to measles had not occurred since 1942. Reactions among susceptibles tended to be mild, with temperatures of 102 F (38.9 C) or over occurring in 7%, and rash appearing in 6% of 164 individuals. No clinical or serologic response was noted among seroimmune individuals when vaccine was administered with or without γ-globulin.

Fulminating miliary tuberculosis in a 70-year-old man was mistaken for acute blastic leukemia. The clinical and hematologic findings as well as the necropsy are noted. This case is compared with 21 previously reported similar cases along with a review of the phenomenon of leukemoid reactions. The correct diagnosis is rarely made during life. With the availability of adequate antituberculosis agents it is now essential that clinicians be alerted in the search for a treatable disease, tuberculosis, which masquerades as an essentially untreatable disease, acute leukemia in the adult.

The seriousness of infections complicating injuries to the head and face prompted a study of 91 cases of post-traumatic meningitis. While all the injuries were severe, definite evidence of fracture of the skull or nose was noted in only 48 instances. In this series, the interval between the trauma and the development of meningitis ranged from several hours to five years. In addition to the typical symptomatology of meningitis, noted in all the patients, there were 15 instances of rhinorrhea or otorrhea and 13 cases with bleeding from the ears or nose. The pneumococcus was the etiologic agent in 47 instances and various other organisms were found in the remaining cases. The low recovery rate of 5 among 42 patients in the prechemotherapeutic era contrasted sharply with a recovery of 18 among 20 patients on antibiotic therapy. The occurrence of repeated bouts of meningitis in three patients was a disturbing problem.

The syndrome familial dysautonomia includes a combination of congenital abnormalities and clinical manifestations that make a patient a poor candidate for general anesthesia. Striking features are indifference to pain and diminished lacrimation, which predispose to corneal ulceration, and poor vasomotor control, which predisposes to hypertension during emotional crises and to hypotension during anesthesia. Three cases are described in detail. Among eight patients in whom this syndrome was observed, severe hypotension during anesthesia occurred six times and cardiac arrest twice. When this condition is suspected, a complete preoperative evaluation is needed. Patients who have this condition do not tolerate thiopental sodium or tribromoethanol as anesthetic agents. If local anesthesia after premedication with chlorpromazine is not suitable, the alternative is premedication with chlorpromazine and belladonna drug followed by a volatile general anesthetic.

Injuries to tendons and their sheaths is of frequent occurrence, and a perfect knowledge of anatomy and method of repair of these structures for the requisite surgical treatment is of great importance to the practical surgeon. In studying our text-books of surgery, one is struck by the liberal space allotted to fractures; while the subjects of laceration of tendons and treatment are superficially dealt with in a few lines. Although injuries to tendons occur both in hospital and private practice far less often than fractures, this subject should receive comparatively more consideration from authors, both from a pathological and surgical standpoint. It is not in recent cases where tendons are simply divided that surgeons meet with difficulties; but it is in old cases as in ancient fractures, where pathologic conditions have manifested themselves and produce the many complications which call for difficult surgical intervention. Therefore, before considering the treatment by

PRIMARY BILIARY CIRRHOSIS is a clinical entity characterized by features associated with interference with intrahepatic bile flow. Frequently, the first symptom is itching, usually followed by jaundice after varying time intervals, which may become severe without conspicuous malaise. Elevation of the serum alkaline phosphatase level, hyperlipemia, and subcutaneous cholesterol deposits are found. Eventually, after many years, manifestations of cirrhosis, such as a portal hypertension, ascites, and hepatocellular failure, appear. The average duration of life after onset of symptoms is about 10 yr.1 The anatomic basis of this disease has been described by MacMahon2 whereas others have denied the existence of a characteristic pathologic entity.3 Therefore, 15 open surgical biopsies, 19 needle aspiration biopsies, and 7 autopsy specimens in cases of primary biliary cirrhosis were studied by conventional microscopy, and biopsy specimens in 10 instances were examined by histochemical, electron microscopic, and immunocytochemical techniques in order to

Certain biliary calculi become radiographically opaque after prolonged exposure to cholecystographic contrast mediums. The condition of prolonged exposure is fulfilled by the four-day iopanoic acid test. Opacification may be quite faint and recognized only by close scrutiny of the x-ray films. The four-day iopanoic acid test is a useful method for identifying bile duct stones. The test is, probably, the best available method for demonstrating bile duct stones in the presence of jaundice. The method is also helpful in identifying gallbladder stones in problem cases.

The progress made in the last few years in the various phases of immunotherapy has stimulated the search for more simple methods for the administration of such treatment. Attempts at substitution of the oral method for the hypodermic type in vaccine and allergen administration were begun many years ago. Among the first clinical conditions for which prophylaxis by ingestion was suggested is hay fever. The hope of safety, convenience, inexpensiveness and painlessness of the oral method has been the motivating factor stimulating this idea.In 1900, more than ten years prior to the advocation of hypodermic pollen therapy, Curtis1 had recommended the oral administration of extracts of ragweed pollen. He had previously observed the good effects of infusions of roses and other flowers in those sensitive to them. The patients were given, three times daily after each meal, from 2 to 10 drops of a tincture or infusion of

Pelvimetry is an important phase of modern obstetrics, yet the subject remains somewhat confusing and lacking in precision. The external pelvic measurements are at best inadequate as a true index of pelvic types. The internal measurements, however, offer certain accurate data covering the pelvic inlet, the contour, the sweep of the subpubic arch and the outlet. X-ray examination was originally employed for the purpose of attesting fetal presence, multiple fetus and fetal deformities. During the last fifteen years, as a result of the investigations of Thorns, Chambers, Jarcho, Spalding, Ball, Hirsch and others, several methods of x-ray pelvimetry have been introduced. These investigations culminated in the classic contribution of Caldwell and Moloy,1 who have provided, with the use of roentgen rays, a simple yet practical and accurate classification of the various pelvic types and have augmented our knowledge of the mechanism of labor.This study covers a series of

Stimulation of the the sympatho-adrenal system and catecholamine production are induced by several factors accompanying shock. The role of hypotension in evoking this response has been thoroughly investigated. Stimulation of epinephrine and norepinephrine in response to shock has been previously documented, both in experimental work and in clinical situations.1 The important role of acidosis has been less well elucidated. This report summarizes recent work in this institution, related to the role of acidosis in the stimulation of a sympathoadrenal system, as measured by plasma catecholamine levels. Three experimental models were studied to elucidate clinical observations made during cardiopulmonary bypass.The first series of experiments previously reported by Manger et al2 were designed to elucidate the effects of acid-base control on the sympathoadrenal response following irreversible hemorrhagic shock. Shock was produced in mongrel dogs with the preparation described by Wiggers,3 with maintenance of mean arterial-blood pressure of 50

In 1921, Kofferath1 reported a case of diaphragmatic paralysis resulting from injury to the phrenic nerve in association with an injury to the brachial plexus. The paralysis of the diaphragm was discovered shortly after birth, and that of the arm twenty-four hours later. Kofferath was unable to find a single reference to this complication detected immediately after delivery. Ehrenfest,2 in commenting on this unusual complication, observes that Weigert had collected records of thirty cases including one of his own, and that Kofferath's was the only one in which the diagnosis had been verified by fluoroscopic evidence. Reference to Weigert's3 original article, bearing the caption "Relaxatio diaphragmatica," makes it manifest that he includes related pathologic conditions. His own case bears the earmarks of diaphragmatic paralysis due to phrenic nerve injury; however, whether sustained at birth or not is not quite apparent. From his discussion we are permitted to

Since the introduction of the phentolamine (Regitine) methanesulfonate test1 for the diagnosis of pheochromocytoma, it has generally been regarded as a safe and reasonably accurate procedure. No reports of fatality after its use in patients with pheochromocytoma have been found in the literature, although there are reports of prolonged hypotension with its use during surgery for pheochromocytoma2 and of one death from ventricular fibrillation after the test in a patient without pheochromocytoma.3 This report describes a prolonged period of hypotension, cardiac arrhythmia, and death after intravenous administration of 5 mg. of phentolamine to a patient shown to have a pheochromocytoma at autopsy. REPORT OF A CASE The patient, a 65-year-old woman, was admitted to the hospital on July 9, 1955, because of "weak spells and convulsions" that appeared one year before admission. The spells were characterized by palpitation, nervousness, cold and clammy hands, profuse perspiration, and then

Urokinase, an enzymatic fibrinolytic activator, was used as the principal form of therapy in the treatment of ten patients with acute pulmonary thromboembolism. Although an absolute statement cannot be made about the efficacy of the drug in the management of this disease, this study seems to demonstrate that lysis of thromboemboli is considerably hastened by the use of this drug. Rapid lysis of emboli is necessary for the successful management of acute massive pulmonary thromboembolism. Three patients in this series previously could have been considered candidates for pulmonary embolectomy. All survived following urokinase therapy. After this experience, we have modified our surgical indications for the treatment of pulmonary thromboembolism to consider for urokinase therapy all patients with massive bilateral pulmonary emboli in shock and those in whom inferior caval ligation is usually recommended for the prevention of further embolization.

It is astonishing that until recently the relationship of malaria to drug addiction has been either not recognized or not fully appreciated. In 1929. Biggam1 reported ten cases of malignant malaria associated with the administration of diacetylmorphine (heroin) intravenously. In 1930, Biggamrafa Arafa2 a series of more than 100 cases of artificially induced malaria. All their patients were inhabitants of Cairo, tribution on this subject in this country was ma thede y tribution on this subject in this country was made by Eaton and Feinberg3in 1933. These authors reported two cases of malaria in intravenous diacetylmorphine addicts under their observation at the Cook County Hospital, Chicago.During the past six months t six moths admitted to Bellevue Hospital were found to be tal wer ing from malaria. Ten of these patients were observed in the Fourth Medical Division and formed the basis of our study.

Instances of recovery from streptococcic meningitis are exceedingly few. Kolmer1 states that the mortality of diffuse or generalized streptococcic meningitis is nearly 100 per cent, and also stresses the importance of radical forms of treatment in this dreadful disease. It seems, therefore, worth while to record three recoveries, particularly since all these patients were treated rather conservatively. REPORT OF CASES CASE 1. —J. P., a boy, aged 6 years, had a tonsillectomy performed, June 17, 1930. There was a slight hemorrhage from the left tonsillar fossa which required ligation. Shortly after the operation the child suddenly collapsed and became dyspneic and cyanotic. This condition, however, cleared up after a short interval. Several hours later the child became delirious and developed a fever of 103 F. There were no other symptoms at that time. June 18, the child began to complain of severe headache, had projectile vomiting, and the temperature

The abdominal viscera, while not exposed to such infrequent injury as the extremities, are of far greater importance as regards the life of the patient. The diagnosis of such injuries is often difficult, and time is of such great importance that a quick decision, followed by aggressive surgery in the proper cases, has in recent years made the prognosis much more hopeful. The etiology has an important bearing in making at least a probable diagnosis, such an important factor in meeting this grave pathologic condition. Either hemorrhage, shock or peritonitis is apt to follow, as a natural course, rupture of any of the abdominal organs. SPLEEN. The spleen is a ductless gland situated in the left hypochondriac region at the tail of the pancreas and behind the peritoneum. It weighs five to eight ounces and is of about the same size at birth, not increasing in proportion to the body.

Gastrostomy, since it was first suggested by Egeberg in 1837 and performed by Sedillot in 1849, has undergone many transformations in the evolution of technique. The primitive operations as done by Sedillot, Fenger, Foster, Durham, Langenbeck, Krönlein and Verneuil, consisted simply in making the external incision through the abdominal wall and fastening the stomach in the wound with sutures or steel needles as a support, and then incising it. There naturally was no resistance to the stomach contents, the great obstacle to gastrostomy. The operation fell into ill repute and practically lay dormant until the present decade, when it was revived and received an impetus in the modern methods of Von Hacker, Hahn, Witzel, Ssabanajew and Frank, in the hope of rectifying the disagreeable features that are inevitable in a continual leakage of a gastric fistula. It is rather strange when we compare the great mortality attendant upon gastrostomy with

In recent years attention has been drawn to certain roentgenographic and pathological changes observed in the lungs associated with uremia. Although these changes seem to follow a certain pattern, there is no general agreement on their pathogenesis. The descriptions of these pulmonary alterations have not been numerous; on the contrary, there are few reports in the literature correlating the clinical, roentgenographic and pathological pulmonary changes in uremia.In 1932 Ehrich and McIntosh1 reported the pathological changes in the lungs of 3 patients dying from Bright's disease. They found fresh areas of pneumonia associated with older, more extensive areas of bronchiolitis obliterans. They recognized that these changes differed from those of the bronchiolitis seen after infectious pneumonias or exposure to chemical irritants. They believed that some toxic or metabolic factor resulted in edema and congestion with formation of an exudate which failed to resorb and then went on to organization.

Use of fiberoptic bronchoscopy to acquire pulmonary secretions has been shown to yield unreliable bacterial cultures. However, microscopic examination of such material has received little attention. In this study, 69 bronchoscopies were evaluated. Clinical assessment of the presence of a lower respiratory tract infection was made and cultures obtained. In addition, each specimen was analyzed with a Gram-stained smear. The Gram-stained smears of these specimens correlated extremely well with the clinical assessment. In 67 of the 69 cases, bronchoscopy yielded material whose Gram-stained smear accurately reflected the presence or absence of a pyogenic infection. In patients with lower respiratory tract infections, the smear also predicted the likely category of the causative organism. This study suggests that microscopic examination of lower respiratory tract secretions helps make fiberoptic bronchoscopy a potentially useful alternative in the evaluation of bacterial lung infections.(JAMA 244:2427-2429, 1980)

Data from 38,636 pregnant women were studied to determine the best criteria for diagnosing pregnancy hypertension based on the constellation of clinical factors yielding poorest perinatal and long-term results to the offspring. It was found that the combination of maximum diastolic blood pressure and maximum proteinuria, as observed during the interval 28 weeks to term, provided the closest correlation with outcome. This information offered an objective means for establishing a classification of hypertensionhypotension in late pregnancy.(JAMA 239:2249-2251, 1978)

The potent folic acid antagonists, aminopterin (4-amino folic acid) and amethopterin (4-amino-N10-methyl folic acid) are being extensively employed for the amelioration of certain types of leukemia and other neoplastic diseases.1 These antimetabolites induce a folic acid deficiency, manifested in patients by gastrointestinal cramps, diarrhea, hemorrhage, ulceration of the palate and oral mucous membranes, leukopenia, which may progress to an aplastic anemia, and alopecia. The appearance of these toxic manifestations may be delayed, and the cumulative toxic dose of drug may be exceeded before signs of toxicity become evident. For this reason, the dosage employed of these aminosubstituted derivatives of folic acid is often less than that necessary for therapeutic efficacy. These toxic manifestations have not been reversible clinically when folic acid, liver extract or vitamin B12 has been administered. Experimental observations have demonstrated that under certain specific conditions folic acid can completely prevent but not reverse

Prior to the advent of chemotherapy, the mortality of influenzal meningitis varied from 90 to 100 per cent. The status of the disease has been altered considerably by the use of sulfonamides and type B anti-influenzal rabbit serum. The introduction of streptomycin marked another advance. This paper is based on the use of streptomycin in a series of 90 cases of influenzal meningitis.The 90 cases in this series were consecutive and were seen between Feb. 2, 1946, and July 1, 1949.CLINICAL ASPECTSMost of the patients presented the typical picture of meningitis. Individual patients showed considerable variation in the severity of the disease, but most of them appeared critically ill. As is well known, this form of meningitis is essentially a disease of infants and young children. Table 1 shows the age distribution in this group of cases.The duration of illness before treatment with streptomycin varied from

It has been known almost since active diphtheria immunization was begun that systemic reactions to diphtheria inoculations were more common among adults than among children. Since 1928 the Moloney test1 has made it possible to detect many of these potential reactors. Because there has been little or no adult immunization since the widespread introduction of immunization in childhood, the problem of reactions has never been a serious one. However, with the recently increasing consciousness of the potential danger of a nonimmune adult population,2 immunization procedures among young adults may be indicated in suitable circumstances.The results of this study appear to demonstrate that the great majority of severe systemic reactions are avoidable, since they occur in immune persons who needed no immunization. They indicate also that the reaction to the ordinary Schick test, when positive, is not a completely reliable index of susceptibility to diphtheria. METHODS Young pregnant