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The scapulocostal syndrome is manifested by the insidious development of pain in the superior or posterior aspect of the shoulder girdle with radiation into one or more of the following regions: (1) the neck and occiput, often associated with severe headache; (2) the upper arm, particularly in the upper triceps and point of insertion of the deltoid muscle; (3) around the chest to the front of the thoracic wall; and (4) down the medial aspect of the forearm into the hand and fingers. Often there is numbness and tingling of the fingers, most commonly the fourth and fifth. The syndrome is caused by long-standing alteration of the relationship between the scapula and the posterior thoracic wall. It is characterized by remissions and exacerbations and may become acute, but it is more often chronic and can persist for years. It is refractory to the usual forms of physical therapy and is

History. —The patient, a boy, aged 11, came under our observation in June, 1911, with the following history: Father and mother were both living and well. One child died four years ago from "ear trouble" following measles. Two oilier children were well. The patient had had scarlet fever at four years and measles at five years; he had not had diphtheria. He was always well except for occasional attacks of severe headache and nausea occurring suddenly and without prodromal symptoms since the attack of scarlet fever, which had become much more frequent during the last few months. Five weeks ago he left school and was up and about until three weeks ago with almost constant headache on exertion and frequent vomiting. Absolute quiet greatly diminished both these symptoms. Examination. —Temperature was 07.4, pulse 80, respiration not accelerated. The patient was well-developed and rather poorly nourished. He lay mostly on the

HEADACHE is unquestionably the commonest and one of the most distressing ailments within the entire realm of medicine and, paradoxically, is even at the present time one of the least well understood; it has usually been considered an annoying accompaniment of many and diverse derangements of the human body, and its descriptions and analyses have been largely clinical and little concerned with its causative processes. Examination of many thousands of inductees into military service at the Boston Induction Station in World War II revealed that headache was the most frequent bodily complaint, and it was demonstrated that in over 50 per cent of persons who showed unfitness for service the chief complaint was headache. The implications 1 of this symptom may be serious or benign; and, although the intensity of the headache may bear little relation to actual tissue injury, failure to distinguish between the severe headache of subdural hemorrhage

The scarcity of recorded cases of bilateral herpes zoster lends interest to the following case: REPORT OF CASE The patient, a man aged 36, a hotel clerk became suddenly ill, with dizziness, fever, vomiting and severe headache, for which he was confined to bed. One week later an eruption appeared in the right supraorbital region, and this was followed in three days by involvement of the left ilioinguinal area. When he entered the Cook County Hospital a few days later, the lesions were typical groups of vesicles on inflamed bases and arranged segmentally, each group stopping at the midline. Throughout the eruptive stage the patient was comfortable; and, as usual in a healthy young man, the disease lasted about two weeks. COMMENT Cases in which there is a variation from the usual unilateral arrangement of herpes zoster, particularly the generalized form, are occasionally noted, but not cases in which

In a recent report on the frequency with which tumors in various parts of the brain produce certain symptoms, 1 I pointed out some inconsistencies in the assumption that a considerable number of symptoms are due to increased intracranial pressure. Further study of the material (1,545 verified cases of tumor of the brain) has afforded information as to the percentage incidence of severe headache in cases of variously located tumors (chart). Headache is a symptom which, like projectile vomiting, generalized convulsions and choked disk, is generally supposed to be produced by increased intracranial pressure in cases of intracranial tumor. The difference in the curves for percentage incidence of these symptoms shows that they cannot all be produced by an identical mechanism. The curve for severe headache resembles more nearly the curve for generalized convulsions than any other symptom studied. 1 This similarity is particularly interesting in view of the relationship

To the Editor.— The EDITORIAL, "Dangers of Eating Bear Meat," (220:274, 1972) triggered recall of information acquired as a medical student and unused to date. In the seventh (1943) edition of Cecil's Medicine (p 662), there is a report of the pathology attributed to hypervitaminosis A, over the signature of Tom D. Spies. Severe illness from the ingestion of polar bear liver by dogs and men has long been known to Eskimos, and has been reported by members of arctic expeditions. Signs and symptoms include complete loss of hair, peeling of the skin, drowsiness, severe headache, and vomiting. In 1940, Douty reported development of violent headaches, nausea, and torpor the morning after he and several others ate freshly killed polar bear liver. Harrison's Principles of Internal Medicine (sixth edition, 1970, p 419) lists among the effects of an excess of vitamin A in adults, headache, blurred vision or diplopia, nausea

To the Editor:— I was called to a local hotel to treat a matron aged 28, who was working as a waitress. She had collapsed about 1 o'clock while serving lunch and complained of a severe headache in the occipital region with the pain referred down the back of her neck. She was taken to her room and when I arrived about twenty minutes after her collapse I found a semiconscious woman, pulseless, slightly cyanotic, and breathing about six or eight times per minute. I gave her, hypodermically, 2 cc. of 71/2 grains of caffeine with sodium benzoate. Almost immediately her pulse could be detected and her respirations increased. I remained with her for about one hour and left her after she was able to recognize her fellow workers and had normal respirations and a pulse of about 88. I could get no history of any recent head injury or

Psittacosis, or, better, ornithosis, is rarely encountered in New England. When a woman from Cape Cod entered the Massachusetts General Hospital with a fever of unknown origin of a week's duration, there was little to suggest such a diagnosis. Administration of 900,000 units of penicillin daily for the four days prior to entry had not apparently altered the course of the disease, but it may have affected later diagnostic procedures. REPORT OF A CASE History.— K. R. D., a woman, 61, had been leading an active life until May 31, 1950, when she felt exhausted; in a few hours severe headache and a fever of 102 F. with frequent small chills developed. The headache was frontal and occipital, and, in addition, there was generalized muscular pain, partially relieved by administration of acetylsalicylic acid (empirin®). The neck had not been stiff. After the onset the patient was continuously febrile, the temperature

I treated eleven cases of blackwater fever in 1918 in the republic of Panama. All of these patients were negro or a mixture of negro and Spanish, and ranged in age from 28 to 45 years. The temperatures ranged from 102 to 105 F. Severe headache, pain in the loins, vomiting, jaundice and insomnia were marked features, and estivo-autumnal malarial parasites were found in the blood of all patients. My worst case was that of a young native physician, aged 32. When I was called in to see him, his temperature was 103, and he had a severe headache, pain in the loins, nausea and vomiting, with slight jaundice. Urine examination revealed a large amount of hemoglobin. The treatment in all the cases consisted of dosages of quinin, calomel and coconut water. The calomel was given in 5 grain doses as soon as the patient was first visited, and before

M. C., an Italian woman, aged 45, who had lived fourteen years in New York, beyond the facts that three of her children had died in infancy (three were living and well), that her menopause had occurred at 38, that she had had right sided supra-orbital headache for nearly ten years, and that she suffered somewhat from constipation and "gas," had always been strong and well until thirty-six days before admission to the hospital, March 8, 1923. She awoke one morning with a severe headache, but worked at household duties for a day or two until a cold in the head, then fever, then cough and then greenish yellow sputum combined to force her reluctantly to bed. The physicians thought that she had influenza and bronchopneumonia, and sent her to the hospital because she was getting worse and they suspected that she had an empyema. Certain features in her physical

The case of cerebral neoplasm detailed in the succeeding context presents such striking and novel features in its behavior as to be deemed worthy of extended consideration. REPORT OF CASE History. —D. F., a man, aged 22, a salesman, referred by Dr. Martin Aune, April 14, 1920, while entering a building under construction, about the middle of the preceding January, struck his forehead a sharp blow against the edge of an overhead plank staging. There was severe headache for some hours, and he continued to feel somewhat listless and dull from that time on. About six weeks later a peculiar feeling developed in the lips on the left side, accompanied by tremor. Soon after this he noticed some difficulty in spelling and writing, so that it became necessary to dictate all his letters. He next found difficulty in comprehending what he was reading, and in one instance he was unable

WITH reference to the effect of diminished atmospheric pressure on the vital powers, alluded to in Prof. Bonney's review of Mr. Whymper's “Travels among the Great Andes of the Equator” (NATURE, April 14, p. 561), I do not know whether it is worth while recalling the well-known fact that numerous passes in the Himalayas, ranging from 17,000 to 19,000 feet, are habitually traversed by the hillmen, in the summer, with their flocks of sheep and goats carrying borax, &c. The highest pass is said to exceed 20,400 feet. In the same mountains Messrs. Schlagintweit reached an altitude of about 22,200 feet (Proc. As. Soc. Bengal, January 1866), while Mr. W. W. Graham ascended to 23,500 feet in 1883 (NATURE, September 11, 1884). I have myself, on several occasions, been to elevations of 17,000 to 19,000 feet, and beyond shortness of breath when climbing, never experienced any ill effects except once, when I, the four plainsmen with me, and three out of a considerable number of hillmen, felt severe headache during the evening after crossing a high pass. My companion on one trip, however, almost invariably suffered very severely from mountain sickness under similar circumstances.

The case reported in this communication is that of an extremely heavy calcium deposit in the subdural space of the spinal cord. A search of the literature failed to reveal a record of a similar observation. REPORT OF CASE History. —The patient, a white woman, aged 58, was admitted to the City Hospital, on the service of Dr. John McCabe, on May 16, 1927, because of paralysis of the legs, shooting pains and headache. She had always been well until ten years previously. At that time she became acutely ill with dizziness, vomiting, severe headache and backache. The symptoms persisted, with gradual improvement over a period of six months. For one year she remained well. Then there developed slight spasticity and shooting pains of the legs. The condition gradually progressed, and in three years she became completely helpless and bedridden. For the last two years, voluntary motion of the legs

IN CERTAIN CENTERS for about a decade anticoagulation has been the therapy of choice for various syndromes of cerebrovascular insufficiency, myocardial insufficiency, and peripheral vascular insufficiency. 1-5 The hemorrhagic complications associated with anticoagulation have been well documented. 6,7 A review of the literature, however, reveals no case of rupture of cerebral aneurysm while the patient was receiving adequate anticoagulation with subsequent survival of the patient. Such a case is presented here. Report of a Case A 51-year-old white man with a cutaneous angioma in the right supraorbital and maxillary area, indicative of the Sturge-Weber syndrome, had experienced two previous myocardial infarctions and had been given anticoagulant therapy (sodium warfarin in dosages which varied from time to time). His course was satisfactory until Oct 20, 1965, when he noted the onset of severe headache in the occipital region which rapidly involved the entire head. Following a normal neurological examination in the

There has been much enthusiasm recently for metrazol therapy of the functional psychoses. This is based on the dramatic remissions, on its ease of administration and on its adaptability to the treatment of large groups of patients. The literature, however, is still too meager to acquaint one with all the potential dangers attendant on the treatment. Meduna has treated more than 400 patients without a single death; in all, upward of 1,500 patients must have received metrazol therapy. 1 Severe headache, nausea and vomiting, fractures and dislocations, and many minor complications are common, but to date only three fatal cases have been reported. We record in detail, with autopsy, a case under metrazol therapy which terminated fatally. REPORT OF CASE History.— D. G., a white man aged 24, since June 1936 had complained of nervousness, weakness, trembling, pains in the head, back and abdomen and a subjective sensation of

Many general hospitals lack the facilities to treat the withdrawal symptoms of acutely exacerbated chronic alcoholism. The postalcoholic syndrome thus must often be managed on an outpatient basis. It devolves on the private physician to determine and to apply the most effective treatment. The aim of therapy is alleviation or prevention of the symptoms of the postalcoholic syndrome— ranging from severe headache and insomnia to nausea, vomiting, tremulousness, acute hallucinosis, and incontinence of bowels or urine. Past efforts to control the postalcoholic syndrome in outpatients have been generally unsuccessful.Prop-perly administered, several agents introduced in recent years can prove helpful in such outpatient treatment. Our experience has included fair success with both mephenesin 2 and mephenesin plus glutamic acid. 3 Reserpine and certain other ataraxics also have been evaluated by other investigators. 4 However, such drugs fall short of the ideal therapeutic agent. A therapeutically efficacious agent obviously will prevent development

of History A white adult male, 44 years old, traveling salesman, was admitted to Barnes Hospital, Dec. 14, 1920, complaining of headache and high fever. The patient gave a history of furunculosis for the past 4 or 5 months and of having had a small pimple on the outside of his nose about 2 weeks before admission. The illness commenced Dec. 6, 1920, with a chill. Dec. 8, the patient complained of cold in the head and fever. Dec. 9 severe headache developed, with chills, and the temperature rose to 100 to 104 F. and continued until admission. Symptoms of meningitis became more and more evident. The cerebrospinal fluid was turbid and under increased pressure. The cell count was 2,300, 88% were polymorphonuclears. Globulin and albumin were increased. The patient died Dec. 20. Necropsy Report (F. A. Mcjunkin).?The body was that of a well developed and well nourished man. Both eyes protruded slightly; the conjunctivae were swollen and ecchymotic. On the pleural surface of the left lung were about two dozen raised areas from 2 mm. to 2 cm. in diameter, which were firm and rather sharply circumscribed; the peripheries were dark red, and the centers were yellowish white, and purulent. A small amount of gas was present in a few. The pus was viscid and tenacious and brownish gray. The right lung contained about half a dozen similar nodules. A smaller vessel at the periphery of one of the consolidated areas was occluded. Received for publication, Sept. 10, 1921. 1 Philippine Jour. Sc, 3 Sec, B, 1908, p. 483. This content downloaded from 157.55.39.255 on Wed, 25 May 2016 06:37:33 UTC All use subject to http://about.jstor.org/terms

THE INDICATIONS for pneumoencephalographic and pneumorachiographic studies are well known. 1 It is also well known that patients undergoing these procedures complain of severe headache for five days or more and are considerably incapacitated. It is not unusual to hear them referred to by patients in the ward as "skull busters," "nut crackers" and other terms signifying their great dread of and anxiety toward submitting to these diagnostic procedures. Many attempts to overcome such undesirable after-effects have been tried by various workers in the field. 2 Liberson 3 described the use of various gases in an attempt to reduce the severe headache reactions to encephalographic procedures and concluded: ... whereas the question of safety in encephalography has been dealt with and met in great part by the simultaneous displacement apparatus, nothing substantial has been found to obviate the discomforting post-injection headache. The displacement of the cerebrospinal fluid by gases other than

Intraspinal injection of autoserum has recently been used with considerable success in the treatment of pneumococcus meningitis; 1 but references in the literature 2 warn against its use in cases complicated by syphilis, for fear of spreading this disease to the meninges. This caution seems to be founded on premature judgment, for the patient with syphilis who develops a secondary meningitis may be safely and wisely so treated by combining the autoserum with arsphenamin in the form of modified Swift-Ellis treatment. REPORT OF CASE History. —G. H. S., an American farmer, aged 22, married, entered the hospital, Feb. 22, 1920, complaining of headache, vomiting and fever. Two weeks before, he had had influenza complicated by influenzal pneumonia, but for three or four days had been up and around the house. Twenty-four hours before admission, he began to ache all over, and had a severe headache, high fever, rigidity of the

THE PATIENT with acute poliomyelitis is often much more concerned with the pain of the disease than he is with the paralysis. Patients have been known to remain awake for an entire week as a result of the pain, yet, despite the importance of this symptom in poliomyelitis, little is known of its cause. One of us (A. C. G.)1was the victim of a severe attack of poliomyelitis in 1946. Since that time animal experiments, to be described in the present paper, have been conducted in an attempt to correlate experimentally induced lesions with the sensory disturbances of the disease. Clinicians have known for many years that there are several types of pain in poliomyelitis.2In the early stages of the acute disease the patient usually has severe headache. At the same time he has severe pain in the lower part of the back, and he may

This case of anaphylactic shock in cerebrospinal meningitis is reported in order to record the failure of serum administered intraspinally to desensitize the patient to its intravenous administration. The patient, a woman, aged 40, first seen by me one week after the onset of her illness, had had severe headache, with moderate temperature, at first declining and then rising, on the day when first seen, April 13. No focal meningeal symptoms had been observed. On the date of admission, April 13, her temperature was 104, pulse 90, and respiration 20. Physical examination revealed only a moderately rigid neck, absent patellar reflexes, and positive Babinski and Oppenheim reflexes on the right side. Kernig's sign was present. Lumbar puncture at 5 p. m. on the same day revealed a spinal fluid under pressure, moderately turbid, containing 810 cells per cubic millimeter, a + + + butyric acid test, and the intracellular and extracellular presence of

The report of Saphir and Howell 1 describing an apparent cure of a carrier of the typhoid-paratyphoid group by the oral administration of soluble iodophthalein has such potential significance from a public health standpoint that it was considered advisable to record another case in which the administration of the same drug was followed by the disappearance of Eberthella typhi from the stool. REPORT OF CASE C. B., a man aged 34, a Filipino living at the Hawaiian Homestead, Hoolehua, Molokai, was seen by a physician (P. W.) on the afternoon of Sept. 23, 1937. He gave a history of having felt "sick" since September 8 but he had not gone to bed. He complained of severe headache on September 17 but felt better on the 18th and 19th. On the 20th the symptoms became so severe that he went to bed. He summoned his physician on the 23d. The physician

The occurrence of diffuse tuberculosis of the pituitary gland as an isolated surgical lesion simulating tumor is practically unknown. Furthermore, when its removal is followed by apparent cure, together with relief of the associated severe headache and serious visual impairment, a report of the case in considerable detail appears not only justified but desirable. REPORT OF CASE Bitemporal headache and visual failure of twelve months' duration. Primary optic atrophy and enlargement of sella turcica. Incomplete bitemporal hemianopia; vision in left eye reduced to counting fingers. Large intrasellar mass disclosed at operation; diagnosed histologically as diffuse, noncaseous tuberculosis of pituitary gland. Satisfactory primary recovery with complete relief of headache and entire restoration of visual fields and visual acuity to normal, continuing three and one-half years after operation (to date). History. —Mrs. Laura Q., a housewife aged 57, white, was referred by Dr. E. G. Gill and Dr. J. Lawson Cabaniss, of

A report by one of us1 concerning a number of processes, with which fusiform bacilli were found associated, included three cases of meningitis and one cerebellar abscess. On account of the fact that these organisms were accompanied by streptococci and were, when isolated, non-pathogenic for animals, it was impossible to decide whether or not the fusiform bacilli caused the lesions or were saprophytic invaders of a process caused by the streptococci. An opportunity for additional information was afforded by the following case: History. —A man aged 40 was admitted to the service of Dr. Dean D. Lewis at the Presbyterian Hospital suffering from severe headache on the left side associated with difficulty in speech. He had had a drainage of a temporosphenoidal abscess three months before that time, with recovery. This had been preceded by a chronic bronchitis. The second abscess was opened and a quantity of foul-smelling pus obtained

There are two species, in both the leaf is lanceolate, dark green, glossy, hard, and brittle, and from both a thick milky juice exudes, while the fruit is like a long black pod, red at the end. One species is a tree with large leaves, and peculiar looking stem, the bark hanging down in large flakes, showing a fresh growth of bark underneath: in the words of my informant, “What a villainous-looking tree! nasty, rough, ugly!” The other species is a shrub, with smaller leaves, and the bark not peeling off the stem. Both species are said to possess the power of poisoning any living creature which approaches it; the symptoms of poisoning by it being severe headache, blood-shot eyes, and delirium, ending in death. The person affected dies either in delirium, or instantaneously without any delirium. A superstition is connected with this plant. Only a few persons in Zululand are supposed to be able to collect the fruits of the Umdhlebi, and these dare nut approach the tree except from the windward side. They also sacrifice a goat or a sheep to the demon of the tree, tying the animal to, or near the tree. The fruit is collected for the purpose of being used as the antidote to the poisonous effects of the tree from which they fall—for only the fallen fruit may be collected. As regards habitat, these trees grow on all kinds of soil, not specially on that which exudes carbonic acid gas, but the tree-like species prefers barren and rocky ground. In consequence of this superstition, the country around one of these trees is always uninhabited, althongh often fertile.