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At the close of the last meeting of the Association, held in St. Louis, I promised Dr. Miller, the Chairman-elect of this Section, to write a short paper on this subject, which had been pressing itself upon my mind for several years, and with growing force since the discussion in the Academy of Medicine, of Paris, of Gautier's paper on the result of the very important—not to say startling—investigations of Selmi in 1877, including much original matter as presented by himself. Continued researches in this direction have only confirmed the principles enunciated by earlier workers. The discovery of tyrotoxicon by Prof. Vaughan, with the increasing number of suggestive cases and reports, seemed to me to justify the contribution I proposed to offer to this Section. Since commencing the preparation of this paper Dr. Emmet Holt has given us a valuable article on the same subject published in the New York

A paper based on practical experience with small-pox and giving further striking evidence of the remarkable protective value of vaccination is never untimely. This is especially true in these days when common ignorance of the disgusting horror of the ravages of small-pox has caused so much ill-advised and even fanatical opposition to the one essential weapon against it, vaccination. This paper is also timely in that it offers some corollaries on frequent Mexican medical abuses, the results of which may be brought forcibly to our notice in case of intervention by our country in the internal affairs of Mexico. In October, 1912, I was in the Yaqui Valley, Sonora, engaged in making a climatic and hygienic survey of the region for a large irrigation project. In the spring of 1912 small-pox had become epidemic in a group of towns about eighty miles to our south, but the spread had been

This is a comprehensive, well-balanced treatise on both the theoretical and practical aspects of chromatography. The basic theory and general principles of chromatography are succinctly presented and then applied in a very practical way to the steroids. The primary emphasis is on paper chromatography, in which the author has made many noteworthy contributions. Much new, useful, and practical information is included in the section on techniques and apparatus. Quantitative chromatography, both colorimetric and radioisotopic, are very well treated with primary emphasis on paper chromatography. The use of chromatographic methods for structural analysis and identification of steroids is developed as a valuable application of chromatography. The section describing typical analytical problems in steroid biochemistry covers all the major hormones. There is a glossary of terms and nomenclature and appendices describing purification of reagents and adsorbants, microchemical reactions for steroids, and methods of detections of steroids on paper chromatograms. The book is

While refraction is a science based on mathematical principles and theoretically very exact, yet there are other questions involved besides that of measuring the radius of curvature, finding the far and near points, range of accommodation, etc. What I shall have to say in this short paper will not be new to many, but it is a phase of refraction about which very little has been said or written. Hence my excuse for presenting this paper. Has psychology any practical bearing on the subject of refraction? In many cases perhaps very little, while in other cases quite a good deal. If all brains were of the same quality, all minds trained to think alike, all nervous systems equally well balanced, every individual reared in a pure atmosphere with proper and healthful environments, refraction would in a measure be reduced to the simple question of accurate observation and correct measurements. It

A SURVEY of textbooks and recent publications 1 indicates that asteroid tissue forms of Sporotrichum in human cases of sporotrichosis are found not uncommonly in South America and South Africa but are extremely rare in the Northern hemisphere. No case reports were found from Europe, and only 1, by Moore and Ackerman, 1a from the United States. The following case, therefore, may be of interest. REPORT OF A CASE J. H., a native-born white man aged 57 years, was referred to one of us (H. P.) because of a lesion on his right hand which had not healed in spite of medical treatment. The patient was a red-haired person with weather-beaten skin who presented several senile keratoses on face and hands. He was employed receiving baled waste paper in one of the local paper factories, and he related that a year and a half previously the end of a

A number of methods have been designed for recording roentgen-ray findings, particularly in cases of fracture. These methods vary from a simple tracing to an elaborate colored photograph. During the war, the French had a very good idea in which colored chalk was used; but while this method is excellent and graphic, it requires considerable time and experience. At the Post-Graduate and Beekman Street hospitals I have recently been using a modification of this French plan; our roentgen-ray records are now in black and white, and for want of a better name, I call them silhouettes. An ordinary tracing is first made ( A ) on architect's tracing paper (sometimes called vellum), and then the interosseous and extra-osseous parts are painted solid black ( B ) with a small brush, a dull black paint, such as black japan, being used. The parchment-like tracing paper is quite absorptive, and the paint will not run. An

Thirty years ago as a college sophomore intending to study medicine, I enrolled in a course on the English drama. For the inevitable term paper, I found "Medicine in the Modern Drama" a fascinating and rewarding subject. I explored the works of such then well-known playwrights as Ibsen, Shaw, Guitry, Romains, Schnitzler, Kingsley, and Howard. Since there was enough material for a book, I could prune and refine my paper rather than struggle to attain adequate length. That essay constituted my first publication. 1 I still regard that first publication with affection. The judgements still seem sound, and there is little that I would change as the result of greater maturity. However, now I can see more clearly that the plays I discussed fall into five distinct categories. Plays for the stage, movies, and television utilize medicine as part of social criticism, or satire, or history, or medical tract, or

If the short paper which I present to you to-day is productive of any good results, personally, I look for them not so much from the paper itself as from the discussion which I hope it will inaugurate—"many men, many minds." I do not expect that all my hearers will agree with the opinions which I have formed after some years' experience, and I trust that to-day the views of not a few will be freely expressed in order that the subject may be thoroughly thrashed out. In short it would seem advisable for us to hold what may be termed an "experience meeting" and my remarks may simply be looked upon as prefatory to what I hope may be a full and fruitful discussion. I shall speak briefly of work done by others and by myself sometime ago, and shall supplement this by my own experience in two series

This book consists of 139 reports and abstracts of papers presented at the First International Congress on Medical Photography, Dusseldorf, September, 1960. The remarkable advances in endoscopic photography are reflected in the numerous papers on the subject and the high quality of the results. Other subjects covered include time lapse cinematography, macrophotography, roentgencinematography, and operating room techniques. Of particular interest to dermatologists are 2 papers on the photography of fluorescent subjects. Both recommend 35 mm. high speed Ektachrome with Wratten 2B and 2E filters. The details of the photographic technique for the study of nail growth are given in a short paper by R. Morton. L. Heigl emphasizes the quality of lighting to record acne or other skin lesions. F. Ehring discusses histophotography of the living skin. Only 36 papers are in English, the remainder being French or German. Most of the equipment described is of European origin, and some

The recent advocacy of chlorine in the treatment of respiratory infections has tended to create the belief that industrial poisoning from low concentrations of this gas is improbable. The concentration of chlorine recommended for therapeutic purposes approximates 0.015 mg. per liter of air. This concentration is fairly close to that present in the bleach rooms in paper mills, laundries and textile mills. Barring accidents, it is believed that chlorine concentrations in such industries range downward from 0.03 mg. per liter of air. Apart from minor inconveniences, such low concentrations will not produce any acute harmful effects. When, however, exposure is continued over a period of years, an occasional worker may be expected to become severely harmed. Such an instance is cited below. REPORT OF CASE History. —L. R., white laborer, began employment in a paper mill in 1920. His work, family and personal history up to that time were without

ALEXANDER 1 published a paper in 1919 entitled, "A Pericardial Fluid of 'Gold Paint' Appearance Due to the Presence of Cholestern." His patient had myxedema and the purpose of his short paper was only to point out that cholesterol crystals can occur in pericardial fluid and can impart to such fluid a shimmering, satiny beauty. Within a few years, however, the term "cholesterol pericarditis" had been coined and Alexander was being credited with having described the first case of an unusual but specific form of pericardial disease in which effusion was produced by the presence of cholesterol crystals that had somehow coated the epicardium and the inner aspect of the pericardium; the whole thing being possibly associated in some vague way with a disturbance in lipid metabolism. In recent years a few authors 2,3 have risen to challenge the existence of any such entity as "cholesterol pericarditis." The purpose of

In presenting my paper on the surgical treatment of acute peritonitis I have not thought it necessary to review my experimental work, or to report all my cases operated upon. Neither is it possible in a short paper to enter into a discussion of the anatomy, etiology, pathology and the various clinical phases found in this formidable disease, because inflammation of this membrane may have so many different causes and assume such varied clinical aspects that it is difficult to formulate a uniform and satisfactory classification. Suffice it to say that, anatomically and physiologically considered, the peritoneal cavity may be said to be a large lymph-sac, and noted for its capacity of absorption. This capacity is not surprising when we take into consideration that in its parietal and visceral enfoldings, it presents nearly as large a surface as the entire integumentary covering of the body. Idiopathic peritonitis is considered doubtful by most modern pathologists, and it has become an established practice to search for a local cause in all cases of peritonitis. I believe in every instance, micro-organisms from some source or other have gained access to the

For several years, those associated with the profession of pharmacy have become increasingly aware that the graduating pharmacist is overtrained for the usual duties he performs in the drugstore or hospital pharmacy. This development has resulted from a variety of influences, among which are an extra year of study for the Bachelor of Science degree, more sophisticated and technical classes in the pharmacy curriculum, and increased efforts by drug manufacturers to improve the ease of drug dispensing, which practically eliminates the compounding of prescriptions. Both local and national pharmacy organizations, recognizing the problem, have proposed new roles for the pharmacist in an effort to make better utilization of his considerable knowledge. One such proposal adopted by the American Pharmaceutical Association (APhA) was presented to organized medicine in the form of a white paper entitledThe Pharmacist's Role In Product Selection. This paper contains the premise that the pharmacist is best

The use of lantern slides showing tables, classifications and sketches, during scientific presentations, lends much to the clarity of a paper and has had an increasing vogue. The following method was worked out to obviate the expense of the photographic method of making such lantern slides : A sheet of cellophane, the size of a standard lantern slide, is placed between two sheets of heavy carbon paper, the carbon side toward the cellophane. These are then placed between two sheets of thin white paper, folded into an envelope of the same size. The material to appear on the slide is typed in the usual manner, a three-fourths inch blank border being left. A clear carbon copy is thus produced on the cellophane, which is then removed and mounted between two lantern slide coverslips, the edges being taped with standard lantern slide binding tape. Free-hand sketches can be made directly on

IT HAS BEEN observed that when toluidine blue, a quinone-imine group histologic stain, 1 is injected intravenously into dogs it preferentially concentrates in the parathyroid glands, panceas, and gastric corpus, imparting a distinct coloration to these organs. 2 Presented in this paper is a study of the intravenous and oral use of this dye in a series of dogs. The results of this investigation and the possible clinical implications of this study will be discussed. Methods and Materials Twenty-two mongrel dogs were anesthetized with intravenously administered sodium pentobarbital (30 mg per Kg of body weight). Toluidine blue (Toluidine Blue O) was prepared as a 1% solution in normal saline. The solution was then filtered through filter paper and autoclaved at 105 C for ten minutes. In ten animals, the dye solution (10 mg/kg of body weight) was injected intravenously over a one-minute period. In ten animals, the dye solution (10

At a meeting of the Indiana State Medical Society in May, 1882, I read a very short paper on the above subject, in which I cited five cases in support of the position therein assumed, that the deferred operation was preferable to the immediate, and that neither was as frequently required as the profession generally supposed. In consequence of the very unpopular stand I took upon this subject, I was quite surprised, though agreeably, at the favor with which my paper was received by the Society. I must mention, however, one notable exception, a leading gynecologist of Indianapolis, and a prominent member of the Society, who was absent at the time it was read. This gentleman, a year later, while reading a paper on "Laceration of the Cervix Uteri," took occasion to refer to my paper of the previous year, and to express his regret that he was not present

While studying the specificity of opsonins last summer in Professor Wright's laboratory I sought for a method of quickly separating organisms from the liquid in which they are suspended, centrifugating alone requiring from thirty minutes to one hour. The following device was used with splendid success: A constriction (A) is made in a piece of small-caliber glass tubing; the tubing is then bent on itself (B), terminating in an opening (C). Moist filter paper fiber (D) (conveniently made by scraping filter paper with the edge of a knife) is placed against the constriction and packed firmly. Into the long arm is placed the liquid (E) to be filtered and the device is placed in the centrifuge. Working with staphylococci, I obtained practically bacteria-free filtrates (F) in ten to fifteen minutes from thick suspensions of staphylococci in normal sera. The filtrates showed scarcely any opsonin, and stained specimens practically no organisms.

To the Editor:— In the Feb. 26, 1955 issue ofThe Journal, page 719, W. T. Caraway describes a "Rapid Turbidity Test for Diagnosis of Uremia" and refers to the spot test by Patterson (Lancet1:1061, 1934) that was found unsatisfactory. In 1942, with Plotz and Reich, I devised (J. Lab. & Clin. Med.28:335, 1942) a modification of the Patterson spot test performed by dropping Ehrlich's aldehyde reagent (p-dimethylaminobenzaldehyde "Kodak" 0.5 gm., trichloracetic acid 100 gm., distilled water up to 100 ml.) on filter paper, placing a drop of blood on the still wet surface, and drying the paper over a desk or microscope lamp. A positive reaction in the presence of blood urea nitrogen levels of more than about 50 mg. per 100 cc. is indicated by a distinct yellow zone diffusing around the brown spot of coagulated blood. This test proved simple, speedy, and

The immediate precursor of homogentisic acid has been the subject of speculation since Neubauer first postulated the metabolic pathways from phenylalanine and tyrosine to the citric acid cycle. 1-10 In fact not all features of this theoretical flowsheet have as yet been substantiated by experimental evidence. The occurrence of 2,5 dihydroxyphenylpyruvic acid (2,5 DHPPA) in human urine has remained largely hypothetical. In 1958, Nishimura and coworkers 11-12 demonstrated for the first time the presence of 2,5 DHPPA in the urine of patients with connective tissue diseases. However, the method used by them for detecting the 2,5 DHPPA was qualitative and subject to question with respect to the amount and identity of the material found. In 1959 Tye et al., 13 using ultraviolet spectrophotometry and paper chromatography, reported that 2,5 DHPPA was not detected by their methods. This paper is concerned with presenting evidence which supports the view that 2,5 DHPPA

BOTH GYNECOLOGISTS and pediatricians have long recognized foreign bodies as a cause of pediatric vaginitis. Gray 1 described three foreign bodies in 200 cases. Lang 2 found two foreign bodies in 110 children and Schauffler 3 noted nine foreign bodies in 302 children. The objects removed from the vagina constitute a veritable museum of curiosities 1-8 and include such items as safety pins, hairpins, bits of folded paper, crayons, twigs, splinters of wood, cherries, plum pits, paper clips, beads, bits of toys, pencil erasers, sand, stones, marbles, cotton, shells, nuts, corks, and even insects. The purpose of this paper is to describe a new entity, toilet tissue, as a cause of pediatric vaginitis. Dewhurst 5 mentioned "paper" along with other objects, but did not specify toilet paper. Huffman 6 described "bits of paper rolled into small pellets," but the implication was not that it was toilet tissue. In all our

In a previous paper 1 a method for the study of organisms under conditions which facilitate aerobiosis was described. METHOD White blotting paper stained with alcoholic nigrosine (used because the black of the dye efficiently contrasted the light-colored growths studied) was cut into 4 inch strips of a width which would fit the culture tubes. A central portion of the strip was measured off so that its area would fit the diameter of the tube. Each end of the strip was bent perpendicularly on this central portion. The platform was forced into the test tube, stilts foremost, and the medium was poured to within 1/2 inch (1.27 cm.) of the horizontal portion. The tube was plugged with cotton and sterilized. The plant was made on the horizontal portion and the medium washed over the plant so as to allow the organisms to distribute themselves in the broth. The fluid medium

The recent "position paper" of the American College of Physicians1and the associated review of the efficacy of cardiac rehabilitation services2provide an excellent summary of selected studies and discussions concerning cardiac rehabilitation. The features and outcomes of clinical trials of exercise training, undertaken predominantly during the last decade, were compared as a basis for providing guidelines for the use of rehabilitative services. However, we were concerned that some pivotal questions were not addressed and that some contemporary issues were not highlighted; thus, a less-than-complete overview of current cardiac rehabilitative practices has been provided for primary care physicians caring for coronary patients and for third-party insurers funding their care. WHAT ARE APPROPRIATE GOALS OF EXERCISE REHABILITATION FOLLOWING MYOCARDIAL INFARCTION OR MYOCARDIAL REVASCULARIZATION? WHY CAN EXERCISE TRAINING AS AN ISOLATED INTERVENTION NOT BE CONSIDERED SYNONYMOUS WITH CORONARY REHABILITATION? Most physicians recommend, and most coronary patients undertake, exercise rehabilitation with

To the Editor.— Berg and colleagues 1 have provided a good start toward "establishing the cause of genitourinary symptoms in women." I am, however, interested in some of the data that they did not report. Rates of gonorrhea and Chlamydia have been reported to be increased in women with intrauterine devices (IUDs) and decreased with the use of oral contraceptives. Was this effect seen? Subjects were asked about their clothing habits—did they confirm previous reports 2 of an increase in candidiasis in women who wear tight-fitting clothes? Finally, with respect to cases of unexplained vulvar symptoms and external dysuria, was any attempt made to identify contact allergens/ irritants? It has been my observation that approximately half of the women with otherwise unexplained vulvar symptoms report the recent introduction of one of the following: (1) fabric-softener-impregnated sheets for the dryer, (2) a new brand of toilet paper, (3) a new laundry

This is a timely publication that addresses the important topic of containment of medical care costs and improvement in general health and fitness of the work force in order to improve productivity and decrease costs that are health or injury related. This is a comprehensive volume covering all aspects of health promotion and contains state-of-the-art descriptions of these programs. It is well organized, and, despite the fact that it has 30 contributing authors, each author's contribution is balanced with the general theme of the text and there is a minimum of repetition. Of particular value are the appendices of resources available to a corporate medical director or chief executive officer for use in addressing health promotion in their particular work force. The volume is well indexed and has an individual bibliography for each section, making it easy for the manager to present a proposal or produce a position paper on

The metabolism of amino acids and its inborn errors have played an important part in the development of the entire field of human genetics. This field represents one of the better examples of the close union of science and medicine. Advances in methods since the end of the Second World War have resulted in an exponential growth of knowledge in this field. Even the numbers of disorders of amino acid metabolism in man that have been discovered or defined have been increasing at an exponential rate. There is no sign that this is slackening. The period from about 1945 to 1967 reflected the application of chromatographic techniques, particularly paper chromatography, and the triketohydrindene hydrate (Ninhydrin) stain to the study of body fluids. In more recent years we have been seeing the effects of techniques of organic acid analysis and particularly the influence of gas chromatography and mass spectometry. The facts

To the Editor.— I have used the new Clearon skin closures by Ethicon in my office for the past year and have not found them as satisfactory as Drs Stegman and Tromovitch indicated in their letter to the editor published in theArchives(113:1134, 1977). It has been my experience that wounds in the seborrheic areas or in areas of frequent facial movement tend to lose their Clearon skin closures within several days. If the closures are not lost, they are rolled up at the ends and are unsightly. They do not hold well when the patient sweats. I have found a much more satisfactory method of wound support that is both cosmetically elegant and unremovable by normal mechanical forces present on the skin. I use Skin-tone Steri strips (3M), or Skin-tone Micropore paper tape (3M). Prior to application of the Steri strips, the skin is painted with spirit gum.

This book has numerous photomicrographs and illustrations with six full-color plates and is printed on heavy white paper with large margins. The author explains the genesis of the book thus: "There is need for a textbook that weds the gross and microscopic features of skin diseases and simultaneously provides a logical systematic and reproducible method of histologic diagnosis." The book is aimed at "all students of skin disease be they dermatologists, pathologists, surgeons, residents, or medical students." This approach, however, "presumes a rudimentary knowledge of general pathology and hardly any of dermatology." The dilemma posed by writing for such a readership is that trained pathologists and dermatologists will find much of the content elementary, while those without such knowledge will find large sections difficult to comprehend.

To the Editor: —InThe Journal, July 15, is a current comment in which the statement is made that, "contrary to the theory of 'desensitization' by internal administration of tincture of rhus, it appears that the susceptibility may be increased with successive intoxications." The question of desensitization by internal administration of the tincture of the drug is unrelated to the question of increasing susceptibility to successive external exposure to the plant. It is to be regretted that destructive criticism of the treatment by desensitization should be published without adequate clinical testimony, for many patients may, as a result, be deprived of the value of this treatment. In October, 1919, I published a short paper inThe Journalon "Desensitization of Persons Against Ivy Poison." Since that time I have treated in the neighborhood of fifty patients who were susceptible to ivy poison, and most of whom were subject to yearly

The desirability of excluding all types of vacuum cleaners from hospitals is disputed. The efficiency of one type of machine was tested by a variety of physical and bacteriological procedures, including the use of freshly generated aerosols of a standard strain of staphylococci. When fresh paper filter cones were used in the machine, penetration by the cocci never exceeded 0.49%, and when dust-coated filter cones were used, apparent arrestment of bacterial droplet nuclei rose to more than 99.99% The evidence did not justify an indiscriminate condemnation of vacuum cleaners as unfit for use in hospitals. It indicated, rather, that the machine tested was very efficient in many hospital situations when used by welltrained personnel. The observations also suggested various improvements in design (such as disposable containers for dirt) and operation (such as heat sterilization of dustladen canisters) that should be explored further.

To the Editor:— In "Some Notes on the Administration of Atomic Cocktails" inThe Journal( 175 :806, 1961), Collica, Lentino, and Rubenfeld remark that an observed technique complied with all factors required for radiation protection except those of common sense. I'd agree that common sense is often lacking. A little science would be helpful, too, and a good way to develop science is to make measurements, which Collica and associates have apparently not done. I see no harm in picking up a paper cup holding 10 μc of I 131 in 30 ml. of water and handing it to the patient to drink. This is better than having the patient drink out of the bottle in which the diluted dose was stored. Patients occasionally spill some when they drink from a bottle. I do add rinse water to the cup and have the patient drink the rinse water, although it

Four patients had evidence of acute pancreatitis occurring during infectious hepatitis. Paper electrophoresis of serum and urine of one patient revealed migration patterns of amylolytic activity identical to those of saline extracts of human pancreas. Definite gross and histologic pancreatitis was seen at autopsy in two patients who died of acute fulminant hepatitis. The fourth patient had only mild increases in the level of urine amylase but a classical "reversed 3 sign" on roentgenograms of the uppergastrointestinal tract, that largely disappeared in eight days.

In the course of a discussion of the results of the year's work, at a recent meeting of the gynecologic staff, it was suggested that we might, with profit, briefly analyze the histories of our fatal cases, inasmuch as one can often learn more from failures than from successes. At Dr. Cullen's request, I have prepared this short paper. During the year 1919, 1,024 patients were admitted to the gynecologic service. Of this number, 793 were anesthetized. From the accompanying table, one can gather a clear idea of the number and character of the operations performed. From this table, it will be seen that in only two cases was the kidney suspended, whereas, in former years, from fifteen to twenty such operations were performed. A loose kidney is very common. especially in thin individuals, but rarely gives rise to symptoms requiring operative interference. Formerly, it was deemed necessary to stitch

Two broad approaches to perinatal studies are set forth in these published Proceedings of the Conference on Research Methodology and Needs in Perinatal Studies held in Chapel Hill, NC in September of 1963. Most of the volume is devoted to the details of collecting massive amounts of data and processing the data (computer talk: "gigo" or "garbage in garbage out"). The jargon is impressive; the results have not been so impressive. The short paper on "Gaps in our Knowledge" by Dr. William Silverman makes a plea for planned experiments with careful observations of individual subjects by trained observers—the need for "deeper probe of the individual patient with a problem." Dr. Silverman's plea for more emphasis on the techniques which have proven so fruitful in the past is eloquent. The necessity for his restatement of this thesis is disappointing. The volume serves no great purpose except as commentary on the current

To the Editor:— With reference to the question and answer ( JAMA 176: 1060 [June 24] 1961) on the blood pressure recorder, may I draw your attention to a remarkable new machine, the Winston Blood Pressure Follower. (Dynamics Corporation of America). This instrument records electronically both visually on a sphygmomanometer dial and on graph paper a continuous reading of the systolic pressure. The working of it is well within the power of the office nurse as it consists simply of a piezoelectric cell placed over a digital artery and a small "G-Suit" surrounding the finger: From then on it is automatic and the graphical record may be attached to the chart in the same way as an electrocardiogram.

The cause of peptic ulcer is unknown, and, unlike many diseases, even its control on empirical grounds is unsatisfactory. The amount of clinical and experimental work that has been done on the subject is enormous, and, as may be expected, there is a wide difference of opinion concerning its many phases. It is impossible to review all of the prevailing ideas adequately in this short paper; however, a brief summary of current opinion is important in order to lay the foundation for successful study. From the standpoint of the clinician and the experimental surgeon, three theories have been advanced as to the cause of peptic ulcer: first, the physiologic or secretory theory; second, the local anatomic or mechanical theory, and third, the general constitutional or systemic theory. The secretory theory, or the theory based on the digestive action of the gastric juice and the normal resisting powers of gastric and

To the Editor: —An ultrafiltrable preparation of adrenocorticotropic hormone, effective clinically in daily doses of only 3.5 to 7 mg., has been prepared. This preparation has been used successfully in total doses not exceeding 60 to 80 mg. in the treatment of rheumatoid arthritis, purpura annularis telangiectodes (Majocchi's disease), lupus erythematosus and certain ophthalmologic conditions. No toxic manifestations have as yet been noted. A dose of 3 mg. induces a fall in eosinophils in persons with normal adrenal functions, according to Thorn's technique. The preparation is obtained by ultrafiltration of an aqueous solution of anterior pituitary powder buffered at pH 5.2. It is slightly yellow and thermostable and contains about 2.5 mg. of solid substance per milliliter. The nitrogen content is about 5 per cent of the organic substance. Amino acid analysis by paper chromatography reveals a limited number of amino acids, including aspartic acid, glutamic acid, tyrosine, glycine and

Ultraviolet irradiation of chloroquine diphosphate in 0.1 M phosphate buffer pH 7.4 results in a marked depression of the characteristic spectral peaks at 3,280 Angstrom units (A) and 3,420 A, and a significant increase of absorption in the 2,670-3,000 A range. This spectral shift phenomenon is probably due to radiation between 2,900 and 3,100 A. Under the condition of the study it did not occur when the irradiation was carried out on chloroquine-containing serum, sweat, or homogenized epidermal cells. Nor did it occur when chloroquine was extracted from the skin of rats which were irradiated after a single intraperitoneal injection of the drug. In addition, it did not occur at a pH below 5.0. Paper chromatography of the irradiated chloroquine isolated one of the compounds responsible for the spectral shift.

"We will not anticipate the past, our retrospection will be all of the future." It is my purpose in this short paper to take a hasty retrospective glance at the history of dental education in the United State, that I may hold before you for a moment a picture of progress that has seldom been equaled in the history of educational advancement, and then to change the view and hold before you another picture, a prospective view, the realization of which will be no more difficult to us and our children than was that of the first picture to our fathers and ourselves. "Past and to come seems best; things present worse." Shakespeare never wrote a truer line than this, for, if we were satisfied with the present, there would be no progress in the future. Satisfaction with the present brought decay and ruin on the ancient Egyptians and on

To the Editor: —In the name of economy let us have some editorial regulation as to the form and manner of reporting cases and clinical statistics. System, uniformity, conciseness and graphic contrasts make for saving of comprehension, of patience, of time, of space, of printing, of white paper, and, above all, for the securing of attention to invaluable data which, under the most favorable circumstances, are tedious reading. The symptoms of a case, I would urge, should be uniformily contrasted thus; ( a ) positive findings; ( b ) negative findings, and ( c ) dubious, uncertain or debatable points which an author finds it necessary to mention. There should be no difficulty and no objection in adopting a uniform method of recording, such as the following: (1) positive data, which the reader needs to note and bear in mind: (2) negative data for purposes of knowing what might have been expected but did not appear

The object of this short paper is to call attention to the course and prognosis of syphilis in certain patients who may present many of the physical and mental characteristics of general paresis, and yet, unlike sufferers from paresis, are to a certain extent amenable to antisyphilitic treatment. These cases are more common now than they were a decade ago. This is probably due to the ever-changing character of the two factors which cause their development—"syphilization and civilization." Secondly, this increased frequency is also doubtless due to our ever-increasing skill in diagnosis. There can be but little doubt that the specific case of to-day differs from the one of twenty years ago. The following case is a typical one. Case 1. —History. —J. A. G., came into my office with the story that for the previous six months his business associates and the employees in his office had noticed

Electricity, while not old in medicine, can not be considered new. One of the first advocates of static electricity as a medical agent, I believe, was John Wesley. While endeavoring to educate the people to his ideas of a religious life he spent some time writing and teaching how to apply static electricity for the relief of pain and the cure of certain diseased conditions. He must have given the subject considerable thought and study for much of his advice is as good as that of any of the writings we have at the present time. While there is no doubt in my mind that static electricity may be used to advantage in nearly all forms of neurotic troubles, I shall confine myself in this short paper to its use in the treatment of morphinism. There is no royal road to the cure of drug addictions. There are no specifics, so

In recent years the search for etiologic factors in psychosis has turned to examination of the serum proteins. 1-6 Workers have claimed to be able to distinguish differences in the serum proteins of psychotics versus normals. The techniques have varied from highly individualized extraction procedures, 1 such as those employed for taraxein, 7 to the simpler paper electrophoresis. 6 With the recent postulation of an abnormality in autoimmune mechanisms in the psychotic patient 3 it was felt that investigation of their sera by immunoelectrophoresis would be of interest. Materials and Methods Sera were obtained from patients admitted to Western State Psychiatric Institute in Pittsburgh. Each patient's chart was abstracted for significant information relating to medical history, physical examination, routine laboratory data, and medications received prior to our obtaining serum samplings. Patients were excluded from the study if the history or physical suggested a possible

Notwithstanding the increasing penetration of surgery into many other fields, cardiovascular, respiratory, renal, neural and endocrine, I feel sure that the digestive tract presents by far the most borderline problems, in which one must decide in each individual case whether surgical or nonsurgical treatment is the more likely to bring about cure or improvement. To operate or not to operate for peptic ulcer, gastric or duodenal, disease of the gallbladder, chronic appendicitis, cancer of the esophagus, stomach or small and large intestine or nonspecific ulcerative colitis—that is the question; and, if operation is decided on, when to operate, what operation to perform and who is to operate. On the proper answers to these questions depend in large measure the end results in each case. While the main purpose of this short paper is to discuss treatment, it is axiomatic that for the optimum results correct diagnosis or, at least, a

Crystalline proteins have been isolated from the urine up to the present time in only eight cases.1In the course of work on human blood proteins, difficulty was experienced in obtaining blood for the preparation of sufficient quantities of albumin. This led to an attempt to separate this protein from the urine of patients with nephritis that were eliminating large quantities of protein. In the course of this work it was discovered that, under certain conditions, proteins in the cases studied tended to become crystalline. As a preliminary treatment, the urine was saturated to 25 per cent with ammonium sulphate, left standing for a few minutes until flocculation had taken place, and then filtered. The filtrate was placed back on the filter paper until a clear fluid was obtained, which was completely saturated with ammonium sulphate. The precipitate was dissolved with the requisite amount of distilled water giving a

The pendular movement of the arm in walking is frequently found to be reduced or absent in patients with pyramidal or extrapyramidal disease. My purpose in this article is to point out that unilateral decrease or cessation of the arm-swinging movement in walking may be due also to disease of the cerebellum. This finding may constitute a fine and early sign of the involvement of the homolateral cerebellar hemisphere. When in 1930 I reported this clinical observation to my former teacher, the late Dr. Kinnier Wilson, he said that he considered it of great interest and worthy of further study. In the same year I read a short paper 1 on this cerebellar sign at the Congress of the German Neurologists in Dresden. In an article in 1931 Mann 2 concluded from his own experience that this sign deserves "marked attention." Marburg 3 referred to my first observation as extremely

The presentation of a paper based on the observation of a small number of cases must justify itself by dealing with a rare condition or by demonstrating new facts concerning a well known subject. With the advance of intestinal surgery, and the increasing number of "developmental reconstructions" and other operations which involve removal of the cecum and part or all of the first portion of the hind-gut, we are able to note with more frequency a pigmentation or melanosis of the mucosa of both organs. This pigmentation may or may not be transitory; but the rarity of its observation at the necropsy table, and the fact that at times a fading of color may be noted through the proctoscope, lead to the supposition that, in not all cases at least, is it macroscopically permanent. PATHOLOGY Gross Pathology. —Both the gross pathology and the histopathology of pigmentation of the hind-gut have

Read in the Section of Surgery and Anatomy of American Medical Association, May, 1884. When in July of last year I had the pleasure of taking the distinguished President of the American Medical Association, and Professor Dennis, over the wards of the London Temperance Hospital, Dr. Flint extorted from me a promise to send a short paper to the Washington meeting of the American Medical Association, containing some account of my surgical experience at that hospital. It is therefore in redemption of that pledge that I venture to lay this brief communication before this distinguished audience. In 1873 a house was taken in Gower street, London, and converted into a hospital for "the medical and surgical treatment of the sick, without the ordinary administration of alcoholic compounds;" and in 1882 the institution was removed to its present well-found and commodious building in the Hampstead Road. At first only 52 beds

[Read at the meeting the of Section on Medicine of the British Medical Association, in Liverpool, August 2, 1883.] Mr. President and Gentlemen: The subject which I have selected for a short paper cannot, perhaps, be said to belong in the higher regions of pathology and practice, but it is one which, as it seems to me, has considerable material importance. Most writers on practical medicine at the present time, as in the past, recommend tapping, in cases of ascites, as a last resort, to be employed only when the dropsical accumulation has occasioned an alarming interference with respiration, and after other measures of treatment have proved ineffectual. The practice of most physicians now, as hitherto, I suppose to be in accordance with this recommendation. Many years ago I was led by reasoning and by clinical observation to advocate tapping early in cases of that affection. In 1863 I communicated

To the Editor: —I was very interested in the recent article (A. M. A.Arch. Dermat.77:390, 1958) ``Keratoacanthoma Versus Squamous-Cell Carcinoma," by Drs. Moragas, Hamilton Montgomery, and McDonald. In a short paper on keratoacanthoma read at the Annual Meeting of the British Association of Dermatology in 1956 I made mention of one of the histological findings so clearly described by the above authors—namely the constant and well-marked inflammatory response occurring in the dermis close up to the base of all keratoacanthoma lesions. Considering this, and the extremely superficial placing of all these lesions, combined with the complete resolution of the lesions without treatment, I was emboldened to make a suggestion on etiology. I felt the major factor was an external one, in all probability a virus. I wonder whether any of your readers, having viral investigation facilities at hand, have already gone into this. I would

Elsewhere in this issue a group of investigators have presented a summary of their studies on attenuated measles vaccine together with their evaluation of the present status of this exciting development in immunization. This short paper, one of eight appearing in a recent issue of The New England Journal of Medicine devoted in its entirety to studies on attenuated measles vaccine, represents the cooperative studies of a number of investigators who have in a unique way combined their efforts to provide a carefully planned evaluation of a live attenuated measles virus vaccine first developed by Dr. John F. Enders and his associates between 1954 and 1958. In short, this live modified virus vaccine, requiring a single subcutaneous injection of 0.2 ml., results in a 2- to-3-day febrile illness from 7 to 8 days after inoculation. The mean maximum fever is 102.4 F by rectum, but there is apparent well-being in