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Background: Cat scratch disease (CSD) is a relatively common cause of chronic lymphadenopathy in the USA. In the present paper the authors describe recent advances in the understanding of this disorder focusing on etiology, clinical aspects, diagnostic management, and therapy., Etiology: Rochalimaea henselae and Afipia felis, two gram-negative bacteria, have recently been isolated from lymph node tissue of patients suffering from CSD. The current literature reveals that Rochalimaea henselae seems to be the most probable agent responsible for CSD. Serum samples from CSD patients' cats have shown titers of 1:64 or higher for antibodies to Rochallmaea henselae., Epidemiology: The incidence of CSD in the USA is between 0.77 and 9.3 per 100,000 per year. The incidence of CSD in Europe is unknown, but the prevalence of antibodies to Rochalimaea henselae among cats is comparable., Clinical Manifestations: Most common symptoms of CSD are regional lymphadenopathy, fever, and malaise. Other manifestations occur in about 5% of patients and include encephalitis, granulomatous hepatitis, and Parinaud's oculoglandular syndrome. Fatal complications and irreversible sequelae have not been reported., Diagnosis: To establish the diagnosis of CSD, the presence of regional lymphadenopathy, cat contact, and papula are required. Additional procedures include indirect fluorescent antibody assays and PCR., Therapy: Up to now there is no standard therapy for CSD. Antibiotic treatment, however, might be considered for CSD patients with severe symptoms. Rifampicin, ciprofloxacin, trimethoprim sulfamethoxazole, and gentamicin are known to be effective antibiotic agents.

"This paper investigates how education influences marriage behavior in three countries: the United States, West Germany, and former East Germany. Following family economics we postulate that for women a longer education decreases marriage rates both during education (institutional effect) and after the degree has been obtained (human capital effect). For men family economics predicts the delaying institutional effect, too, but the human capital effect is expected to increase marriage rates. Further considerations lead to the additional hypothesis that for younger birth cohorts these sex differences should attenuate.... For the United States and West Germany the observed marriage patterns confirm our hypotheses for the most part. For East Germany, however, we observe different marriage patterns. This was expected because the institutional context in this former socialist country was a very different one." (SUMMARY IN ENG), (excerpt)

Following a brief historical look at international developments in medical examinations of life insurance applicants, the paper goes on to examine the criteria used today for screening in clinical medicine. There are great similarities between the main reasons for screening in clinical medicine and insurance medicine. On the one hand, there is the need to detect a disease early in its history. On the other, the need to identify risk factors. The procedures used by life insurers are also described. The USA is taken as an example to show the direction that international developments are taking. Future aspects are considered with particular regard to future availability of genetic tests. An insurance medical discussion on genetic tests is followed by a description of the debate on the ethics of biotechnology in the Council of Europe and European Parliament. A conceivable scenario is developed which assumes the future availability of genetic test results in doctors' surgeries. The decisive factor here is that the insurer continues to have full knowledge of the applicant's state of health at the time of application. Only by this way can antiselection be avoided. This is followed by a detailed representation of the responsibility that insurance medicine and insurers have in connection with screening modalities. Genetic tests are not used by insurers today. There exists a kind of wait-and-see attitude which amounts to something like a moratorium. The time until further decisions are made should be used to gather further scientific findings and also to correct possible misconceptions at all relevant levels.

The aim of quality assurance should be to ameliorate the medical treatment. Also it is automatically part of the medical profession. This paper defines the terms quality assurance and quality. Concepts existing in the USA and in Germany are partly just formed in Switzerland or work at the ASF (Arbeitsgemeinschaft Schweizerischer Frauenkliniken) successfully since 10 years. The quality assurance in hospitals and in the health system should be reached throughout Switzerland.

Issues of unequal risk distribution among sickness funds are given increasing attention in the current discussions on the reform of the statutory health insurance system in Germany. This paper raises the question on the structural determinants of risk segregation and points towards the links between social stratification, health risk and insurance status. A model showing the links between basic structural determinants is presented. Using health survey data from Germany and the U.S. statistical analyses are conducted. The results support the model and indicate its applicability for both health care systems. The paper concludes by indicating the relevance of such findings for health policy and future research.

German psychiatrists do not have an easy access to Adolf Meyer. The reasons include: his influence on American psychiatry was mainly exercised by his personal influence; he did not have the gift of writing his important and influential ideas in a clear language; these ideas, furthermore, were scattered over great number of papers in a variety of periodicals; there is only one unsatisfactory (from the point of view of edition) collection of Meyers papers; no textbook of Meyerian psychiatry exists. There seems to be no German translation of any of Meyers papers. Meyer, who was always in close contact with German psychiatry and psychiatrists, transmitted their ideas to the American scientific public, although in a critical vein. His own psycho-biological or genetico-psychodynamic theory pointed to the importance of the biological and personality structure and its reactions, of how the patient reacts to which live events and which illness in his or her body contrasts to Kraepelins concept of self-sufficiency of the endogenous psychoses. Whereas DSM I und II had been moulded in Meyers spirit, DSM III led far away from it.

The history of modern cardiology begins with William Harvey, the history of cardiodiagnostics, however, with William Heberden and the inaugurators of percussion and auscultation. Nearly all methods needed a long initial period, before they stood the test as routine measures. The revision of positive judgments of their value became necessary whereever new methods entered into competition with techniques which proved their value for long years and which apparently could not be renounced. Up to now schemes of thinking remained characteristic for the heart, the historical basis of which was shown in the present paper.

"Radio-cancer" arises in a tissue or organ damaged by radiation; the ionising rays have caused somatic radiation damage but have not produced cancer. A higher risk of cancer as a sequel to constantly increasing exposure to medicinal radiation has not been demonstrated so far. The statements quoted in the paper are due in particular to faulty comparative evaluations in retrospective surveys and to inadmissible extrapolations of findings after the action of high radiation doses to expected effects with low doses. In addition to radiobiology, and radiophysics, knowledge of oncology and clinical radiology must also be taken into account in future.

The paper submitted deals with the shrinking number of in-patients in psychiatric institutions and proves that this downward trend is not to be explained merely by the introduction of psychotropic drugs.--The method of calculation and the term "average duration of stay" are critically discussed, with reference to other possible parameters as indicators of psychiatric in-patient facilities.--It is shown, in the light of recent and controlled studies, that short hospitalization can be at least as effective and successful as a conventional hospital treatment program, and that a shorter stay in hospital does not inevitably imply an increased risk of readmittance.--A comparison between the Psychiatrische Universitätsklinik Bern (PUK) and all psychiatric hospitals in Switzerland shows in 1980 a 50% higher rate of admissions per hospital bed, a 20% shorter duration of stay, and the extremely high average rate of 98% of beds occupied, that is approximately 10% more than the average number of beds occupied in the other clinics referred to. In spite of the comparatively short duration of stay in the Psychiatrische Universitätsklinik Bern, that is 27 days (median), a further cut in length of stay seems feasible, without provoking an increase of the low rate of 21% of readmissions per annum.

The paper presents a survey of the radiation induced bronchial carcinoma with particular reference to occupational conditions. The central subject is the so-called Schneeberg disease as the most frequent and best studied type of such carcinoma, concerning the aetiology and epidemiology of the disease. After a short historical introduction the importance of the shortliving radon daughters as the actually injurious agents in the underground mines with a radioactive climate is discussed. The evaluation of this type of radiation exposure after inhalation of alpha-emitting radionuclides by means of the measuring quantities working level and working level month is described. From the several publications on the results of epidemiological investigations concerning the incidence of bronchial carcinoma among uranium miners the reports from USA and CSSR are referred to somewhat more in detail. The possibility of a radioactive climate in nonuranium mines and other underground installations is pointed out. Other types of radiation induced bronchial carcinoma are mentioned, emphasizing the character of the Schneeberg disease as a model for all these other kinds. Finally, the possibility to derive risk estimates from the results of epidemiological investigations is demonstrated by means of some selected examples.

The USP XIX is to be published in the summer 1975. In this paper the most important passages of its sterility test are compared with the regulations of the EP 1. So a test should be rendered possible to come up to both Pharmacopoeia. a) Both the membrane filtration method and the direct inoculation of media may be used as the test methods. The membrane filtration method is the method of choice. But the mentioned pore diameter of 0.45 +/- 0.02 mum is too large. Those filters with a pore diameter of 0.2 +/- 0.02 mum are preferable. b) While EP 1 does not mention the culture media, USP XIX prescribes Fluid Thioglycollate Medium and Soybean-Casein Digest Medium. These culture media are not sufficient. The use of Fluid Thioglycollate Medium, Soybean-Casein Digest Medium and Fluid Sabouraud Medium is suggested. c) The same organisms are recommended for the control of the culture medium as well as for the determination of the minimal inhibiton concentration (Clostridium sporogenes, Bacillus subtilis, Staphylococcus aureus, Candida albicans and perhaps a mould fungus). d) In the USP the number of samples is decided by the risk of contamination. This is preferable to the EP 1, where the number of samples is fixed by the size of the charge. e) While EP 1 lays down 7 days as an incubation time for bacteria as well as fungi, the USP XIX prescribes a time between 7 and 14 days, depending on the contamination risk and on the method used. As a compromise 10 days for bacteria and 14 days for fungi are recommended.

The paper gives a survey of the studies with interferon-gamma and the actual status of the clinical trials with this substance concerning rheumatoid arthritis (RA). About 60% of the patients with RA respond to the therapy. In the initial therapy which covers a time of 2 to 6 weeks 50 micrograms (in case of side effects 20 or 10 micrograms) should be given 3 to 7 times per week by the subcutaneous route. When the disease is improved, the maintenance therapy starts. According to the patient's status, the dosage frequency and the dose have to be reduced to sustain the effect.

Albert Mueller-Deham played a role of great importance in the history of American and general geriatrics. He was born in 1881 in Vienna where he studied medicine. After graduation he was an intern, and later assistant professor at the First University Department of Medicine in Vienna. Among his teachers were such famous names as von Nothnagel, von Noorden und Wenckebach. In 1925 he was appointed chief of the medical department in the large, renowned "Versorgungsheim Lainz" in Vienna and became director of the geriatric research unit established by his initiative. With many scientific papers and his most important work, the textbook on geriatrics "Internal Medicine in Old Age" (in three languages) he became one of the pioneers of modern geriatrics. His main interest laid in the importance of the pathology of old age and its connection with clinical diseases. In 1938 he emigrated to the United States for politico-racial reasons and worked as attending physician at the Goldwater Memorial Hospital in New York. There he had the chance to continue his scientific work and pass on his vast experience to colleagues and students until his retirement from clinical practice in 1951. His new interests were philosophy and art, resulting in a book entitled "Human Relations and Power". Mueller-Deham died at the age of 90 in Santa Barbara, California. Albert Mueller-Deham deserves an important place in the history of medicine for recognizing, as one of the first in Austria, the characteristic features of diseases in old age as opposed to younger age groups. His clinical observations in the light of subsequent post-mortem analyses laid the foundation of modern geriatric medicine.

Publications concerning herpes virus hominis and other viruses of the herpes group have appeared with increasing frequency in the last few years. The mechanism of recurrence is yet not fully elucidated and therapy still remains a problem. The fulminant course of herpes sepsis in the newborn and the generalized herpes infection in the immunodeficient patient can be treated only with difficulty. Neurologic and ophthalmic disease in children can often be linked to neonatal herpes infections. In the category of sexually transmitted diseases, herpes genitalis is becoming more significant. Numerous observations indicate that herpes virus hominis and other members of the herpes group are potential oncogenic agents. This paper presents an overview of recent findings.

The present paper is based on the analysis of congress reports and gerontological journals and points up new trends in gerontological research. Quantitatively, there was an increase in the number of psycho-gerontological publications. However, relatively seen, they represent an almost unchanged percentage of the contributions to gerontological literature on the whole. Predominant themes in USA and West Germany are discussed. There is, on the one hand, an increasing differentiation and specialization of methodical contribution and, on the other hand, an increasing number of contributions which neglect the methodical aspect. A trend toward practically oriented research is shown, as can be seen in intervention gerontology. Aging is seen as a phanomena with biological, social, and ecological determinants. In conclusion the universality and generality of aging is questioned, the concept of a differential gerontology is proposed and so a greater consideration of the individuality of the aging process is found to be necessary.