Abstract: The possibility that irradiation might be an etiological factor in carcinoma of the thyroid in children and adolescents was suggested by Duffy and Fitzgerald, 1 who found that 10 of 28 patients, 18 years of age or younger, seen at the Memorial Hospital had been subjected to irradiation to the thymus gland some time between the 4th and 16th month of life. Simpson, Hempelmann, and Fuller 2 studied the frequency of neoplasms in 1,400 of 1,722 children who had received x-ray therapy to the thymic area between 1926 and 1951 and found that the number of cases of thyroid cancer was markedly higher in the treated group than in either the untreated siblings or the general population. As short courses of low voltage x-rays have been widely used in children for benign conditions about the head, neck, and upper thorax other than thymic enlargement, a search of the literature was

Abstract: Metacortandralone and metacortandracin, two new synthetic steroids, were subjected to clinical trial by the National Institute of Arthritis and Metabolic Diseases. The biological experiments in animals conducted by the investigators who prepared these steroids indicated that the compounds possess three to four times the activity of cortisone or hydrocortisone. The chemical, toxicologic, and biological studies performed prior to our studies in man will be reported by them elsewhere. The antirheumatic, anti-inflammatory, metabolic, and endocrinologic effects of metacortandralone were studied in seven patients with rheumatoid arthritis. The patients were selected by the following criteria: (1) arthritis of more than two years' duration, (2) unequivocal activity of the disease process, ( 3 ) joint changes that were partially or completely reversible, and (4) therapy previously administered that was of conventional type and produced unsatisfactory results. COMPOSITION OF SERIES Three patients had taken adequate doses of salicylates but had not received steroid therapy before admission

Abstract: In every clinic caring for a volume of children there are seen, from time to time, infants with skeletal lesions resembling those due to trauma but unaccompanied by readily volunteered and adequate account of injury. While such cases would appear to be of interest to a variety of disciplines, discussion of them has been chiefly by roentgenologists. Caffey 1 first emphasized the frequent association of chronic subdural hematoma and fractures of the long bones in 1946, but, since he was unable to obtain histories of violence in the material he considered, no conclusion as to the nature of this complex was advanced. He was also the first to point out the frequency with which defects in the metaphyses, as contrasted to the shafts of bones, were encountered. Smith, 2 in Canada, two groups in France, 3 and Lis and Frauenberger, 4 in this country, noted the same relationship in single

Abstract: Through the interest and cooperation of private practicing physicians and health officers in the various communities of metropolitan Washington, D. C., and Leesburg, Va., we observed over 300 cases of an acute respiratory illness that appears to represent a newly recognized communicable disease entity. In brief, the clinical disease was characterized by fever, pharyngitis, and conjunctivitis, occurring either singly or in combination. A newly discovered virus, adenoidal-pharyngeal-conjunctival (APC) type 3, was recovered from 80 of the patients, and a specific serologic antibody response was found in practically every patient tested. Epidemiologically, cases occurred in all age groups but predominantly in children. The disease occurred in epidemic form in a summer day camp and in two residential neighborhood outbreaks, and it has occurred sporadically throughout the area. The disease was apparently infectious and spread from person to person, with an incubation period of five to nine days. The adenoidal-pharyngeal-conjunctival viruses are

Abstract: Two new synthetic steroids, prednisolone and prednisone, formerly known as metacortandralone and metacortandracin, respectively, have recently been introduced as antirheumatic agents in rheumatoid arthritis.1They have been found to be four times more potent than cortisone in suppressing the inflammatory joint changes produced by the disease. They also cause depletion of the circulating eosinophils and significant reduction of urinary 17-ketosteroid excretion. In contrast to cortisone, administration of the new steroids is not associated with sodium and water retention or with potassium loss. Early experience with the new steroids revealed the occurrence of minor undesirable side-effects, such as facial rounding, hirsutism, diminished carbohydrate tolerance, insomnia, restlessness, weakness, transitory mental clouding, acne, increased skin pigmentation, and vague abdominal distress. The purpose of this paper is to report three cases of major undesirable side-effects that occurred in a series of 18 successive cases of rheumatoid arthritis treated with prednisolone or prednisone. A

Abstract: It has been repeated frequently within recent years that mental deficiency is not in itself a clinical entity but rather a symptom present in a large number of diseases of varying etiology 1 This symptom, present according to different estimates in from 1 to 2% of the population of the United States, is probably the most serious single public health problem from the point of view of chronicity, cost of care, loss of productive and earning capacity, and tragedy in the family Within this century the thinking concerning the etiology of this entity has swung from considering the majority of cases of mental deficiency to be of hereditary or familial origin to the belief that only a small minority of cases falls within this category 2 As an increasing number of exogenous factors has become causally implicated, the so-called endogenous role of heredity that had previously been applied largely on

Abstract: During recent years extracts of Rauwolfia serpentina have been utilized freely in the treatment of hypertensive vascular disease and varied psychiatric illnesses. Initial preparations for clinical investigation were provided only in crude form; but a highly purified alkaloid, reserpine, is now available. In general, the pharmacological properties of the crude and the purified derivatives are essentially the same.1These compounds are considered to be free of serious toxic reactions.2Mild side-effects frequently encountered are nasal stuffiness, decreased initiative, fatigue, weight gain, drowsiness, nightmares, and diarrhea. These symptoms usually can be relieved by reducing the dosage of the drug without appreciably sacrificing its hypotensive effect.3In some patients receiving Rauwolfia preparations in large doses, depression may develop.4Although this complication occurs with significant frequency, it has received comparatively little emphasis in the literature. The purpose of this paper is to report the cases of 7 patients (of

Abstract: With the increasing use of whole blood transfusions, a variety of untoward reactions have been recognized. One such complication is the development of a hemorrhagic diathesis. This has been observed after hemolytic transfusion reactions 1 and after the infusion of blood that has been contaminated with bacteria. 2 More recently, abnormal bleeding has been observed after transfusion of unusually large amounts of compatible blood. 3 Recently a patient was observed to develop severe abnormal bleeding and profound thrombocytopenia after the rapid infusion of 20,500 ml. of whole blood during a surgical procedure. This observation prompted a study of the effects of blood transfusions on the platelets and the blood coagulation mechanism. MATERIAL AND METHODS During the period from July, 1954, through January, 1955, 32 patients were studied. These patients were hospitalized on the surgical, medical, or pediatric services of the Johns Hopkins Hospital. With one exception, donor blood was collected

Abstract: In an investigation in the anesthesia laboratory of the Harvard Medical School of mood and other psychological changes induced by a variety of drugs, an opportunity arose to correlate the personality of the subjects involved and the nature of their responses. This was of interest because of the likelihood that the preexisting mental state of a person would affect his psychological responses to drug stimulation. Our results support this assumption and are presented, despite the relatively small number of subjects involved, because of the scarcity of such data in the literature. They indicate profitable areas for further study. METHODS The subjects, drugs, and procedure for eliciting subjective responses are described in a previous paper by us. The volunteers were 20 healthy young males, aged 21 to 27 years, and were, with a few exceptions, college students. Psychological data on each subject consisted of an interview, which lasted from one to

Abstract: To the Editor:— An unusual syndrome has been described recently in association with malignant carcinoid of the small intestine and hepatic metastases (Isler, P., and Hedinger, C.: Metastasierendes Dunndarmcarcinoid mit scheren, vorwiegend das rechte Herz betreffenden Klappenfehlern und Pulmonalstenose—ein eigenartiger Symptomenkomplex?Schweiz. med. Wchnschr.83:4-7 [Jan.] 1953). This syndrome is principally manifested by peculiar cutaneous flushes, chronic diarrhea, respiratory distress, and valvular disease of the heart. Personal experience with five cases of this syndrome within the past few months and the knowledge of several other such cases makes it likely that there are many more such cases as yet undiagnosed. Because of protean clinical manifestations, the "carcinoid syndrome" may mimic a variety of diseases. The cutaneous flushes are characterized by episodic erythema, patchy cyanosis, and blanching and may be confused with other types of vasomotor instability. They were erroneously ascribed to the menopause in one of our patients. A

Abstract: In spite of the well-documented reports that administration of corticotropin (ACTH) stimulates the gastric secretion of acid and pepsin and may be complicated by the development or reactivation of peptic ulcer,1it does not necessarily follow that the increased secretion is the cause of the ulceration. The possibility, therefore, still exists that while adrenal stimulation by corticotropin undoubtedly can produce an increased secretion of acid and pepsin, it may also in some way interfere with the natural defenses of the gastric and duodenal mucosa against the digestive action of the gastric juices. The hypothesis that increased secretion of acid and pepsin is the cause of ulcers rests largely upon indirect evidence, such as the presence of increased gastric secretion of

Abstract: The polycythemic action of cobaltous salts in animals has led to the investigation of the effect of cobalt in types of anemia not amenable to other therapy. 1 Favorable hematological responses have been reported in the anemia associated with chronic infection, 1b the anemia of chronic renal insufficiency, 1c and sickle cell anemia. 2 Thus far the most frequent adverse effects reported have been anorexia, nausea, and vomiting, 3 which appear preventable by the use of enteric-coated tablets. 4 Less frequent side-effects have included flushing of the face and extremities, 1c rash, 1f tinnitus and nerve deafness, 1d substernal pain, 1c and thrombocytosis. 5 It is the purpose of this report to describe five cases of an additional toxic manifestation of cobalt therapy, namely, thyroid hyperplasia associated with thyroid hypofunction. In the past three years small groups of cases of anemia associated with chronic renal insufficiency and sickle cell anemia

Abstract: Subtotal or total colectomy for certain colic lesions was described by one of us in 1943.1This procedure has been applied with increasing frequency to lesions of the left half of the colon in succeeding years. On the surgical service of one of us (O. H. W.) since 1946, subtotal or total colectomy has come to be the surgical procedure of election in cases of cancers of the left colon as well as for multiple polyps of the colon. Moreover, in many instances of diverticulitis, a total or subtotal colectomy has been done in which multiple diverticula extended into the upper reaches of the descending colon or well into the transverse colon. Undetected polyps have been uncovered by these wider excisions, and, in one instance of diverticulitis, an occult cancer was found in the cecum when the operatively removed specimen was opened. In fact, total or subtotal colectomy has

Abstract: Anxiety neuroses or tension states occur so frequently that there is a real need for rapid therapy to relieve the patient and enable him to recover. Attempts to find a useful drug are being made constantly, and among the most promising of these drugs are the propanediol derivatives developed by Berger. 1 Studies of mephenesin suggested that tension states and other psychoneurotic conditions could be alleviated, 2 but the drug was not consistent in its activity. The second propanediol derivative to appear was 2,2-diethyl-1,3-propanediol, which showed much more promise. 3 Although it was consistent in its control of tension states, its duration of action was too short. The most recent compound of this type, Miltown (2-methyl-2-n-propyl-1,3-propanediol dicarbamate), is the subject of the present study. The pharmacology of Miltown was described by Berger. The drug has a selective blocking action on interneurons. It produces relaxation of skeletal muscles without affecting respiration

Abstract: Ten years ago the possibility of clinical citric acid intoxication during the transfusion of citrated blood was thought to be negligible. 1 Shortly thereafter the development of exchange transfusion techniques, with the replacement of two or three times an infant's (or adult's) blood volume, brought attention to this problem again. Wexler and co-workers 2 and Ames, Syllm, and Rapoport 3 demonstrated high concentrations of serum citrate during the administration of moderate to large amounts of citrated blood and plasma to infants. In each of these investigator's groups of cases there was a death for which citric acid intoxication may have been responsible. More recently, the development of new medical and surgical methods of treating bleeding esophageal varices in patients with portal hypertension and the development of bold techniques in the surgery of the heart and major vessels have created new possibilities for citrate toxicity to develop. To study this problem

Abstract: The problem of acute and chronic deposits of calcium about the shoulder area is familiar to physicians and public alike. Much has been written concerning the cause and treatment of deposits in this area, but calcium deposits in other areas of the body are not so well known. The purpose of this paper is to focus attention on acute calcium deposits in the hand and to suggest a proper course of treatment for care. This condition has usually been overlooked; familiarity with the clinical picture should lead to more frequent recognition of the symptom pattern. The literature contains relatively few reports concerning calcium deposits in the hand. We feel that this reflects a lack of recognition by physicians of the clinical picture presented by calcium deposits with acute symptoms in this area. First mention of the problem was made by Cohen 1 in 1924. It was 10 years before another

Abstract: Much prognostic pessimism has been associated with polycystic disease of the kidney. When the variability of the clinical manifestations and course of this not uncommon clinical entity is considered, the pessimistic prognosis is oftentimes unwarranted and unjust to the patient. The present study was undertaken to elaborate further on the various aspects and manifestations of the disease that, when properly evaluated, permit the physician to outline treatment more accurately and prognosticate in a given case. PATHOGENESIS The pathogenesis of polycystic disease is not completely understood. The various theories of etiology that have been proposed were summarized by Rall and Odel1under the categories of metabolic, inflammatory, neoplastic, and developmental defects. Since Rall and Odel covered this aspect of the condition, we will mention only two recent contributions. Experimentally, Bagg2has been the only one successful in producing a true polycystic kidney. He treated the abdomens of mice with

Abstract: Tumors of the nasal fossa apparently related in origin to the olfactory area have been neglected by American pathologists, although several reports of their occurrence can be found in the European literature. Berger, Luc, and Richard 1 first recognized such a tumor in 1924 and reported it as an "esthesioneuroepitheliome olfactif"; the neoplasm occurred in an elderly man and was characterized by cells possessing true fibrils and forming rosets. Two years later Berger and Coutard 2 published a report on a similar tumor, which they diagnosed as an "esthesioneurocytome olfactif"; this lesion occurred in a 32-year-old woman with a 20-year clinical course and was characterized by cells that possessed only the ability to form fibrils. The authors considered it a more mature type of neoplasm in the same general group as the one reported on by Berger and co-workers. Schall and Lineback 3 recently reviewed the literature and collected accounts

Abstract: Several years ago one of the postpoliomyelitic patients at the Rancho Los Amigos Hospital was observed to be breathing in a peculiar manner, using his mouth and throat in what at first appeared to be a swallowing motion. Further observation revealed that these movements aided in breathing. With them he could breathe for many hours; otherwise he could breathe unassisted for only a few minutes. Vital capacity measurements were taken with and without the assistance of these movements and were found to be 600 ml. and 150 ml. respectively. This manner of breathing was observed in other patients, some of whom had learned it unassisted, while others had learned it from fellow patients. The first 15 cases have been reported previously. 1 The present report of 100 cases includes these 15 cases. Because of the structures involved, we have called this procedure "glossopharyngeal breathing." It is also being called "gulping"

Abstract: While performing oxygen tension determinations directly on the exposed dog's myocardium, which had been previously infarcted by experimental ligation of a small branch of the left anterior descending coronary artery, we observed a drop in the oxygen tension readings following a slow intravenous injection of 15 to 20 cc. of a fat emulsion preparation. Coinciding with this drop in the oxygen tension readings, an apparent decrease in the amplitude of myocardial contraction was noted.1These observations suggested to us that in humans the chylomicrons of postprandial lipemia might exert a similar adverse effect on the myocardium and that this effect is probably small and might most easily be demonstrable in patients whose myocardial blood supply is already compromised by severe coronary atherosclerosis and/or aortic valvular disease. The purpose of this investigation was to determine whether postprandial lipemia would actually precipitate the syndrome of angina pectoris and produce abnormal electrocardiographic

Abstract: Moore1first reported in 1948 his pioneer efforts to localize brain tumors by external counting of the gamma radiation from diiodofluorescein labeled with iodine 131. The method consists of intravenous injection of the radioactive substance and subsequent measurement of gamma radiation emerging from the head by means of a suitable detector placed at various positions on the scalp. The presence of a tumor is indicated by a reading of asymmetrical activity or by divergence from a pattern of normal observations. At the same time, Selverstone and Solomon2were demonstrating that the beta emitter phosphorus 32 injected as the phosphate would also localize in brain tumors. The localization and demonstration of these lesions by a probe counter during operation has since become an accurate, routine procedure with us.3The precision of the method has been shown in postmortem material by Selverstone and White.4A useful technique for

Abstract: Analgesia produced with ether (diethyl ether) was first described by John Snow in 1847.1Snow observed that an analgesic state existed after emergence from deeper degrees of etherization, but, in the ensuing years, it was not deemed feasible to use the analgesic state for surgical procedures. It was not until the 20th century that Gwathmey repopularized analgesia, using rectal ether in oil.2Championing this school of thought, Gwathmey and Karsnar reported the use of analgesia for operations of short duration and for dressing wounds during World War I.3Surgeons of Gwathmey's day sent him many reports of patients who, under the effects of ether analgesia, answered questions, suffered no pain, and had no memory for the entire event. Firmly convinced that the analgesic state was most physiological, Gwathmey introduced synergistic analgesia in 1921, using a combination of ether in oil rectally and morphine and magnesium sulfate parenterally.

Abstract: At times the urologist is surprised to learn that a prostate gland with enlargement that he had considered to be benign is found to be carcinomatous by histological study following prostatectomy. The therapeutic problem thus presented is one concerning which a divergence of opinion exists. One school of thought suggests that radical perineal prostatectomy should be performed in such cases, whereas the other believes that the conservative prostatectomy already performed, the one by which the diagnosis of occult carcinoma was established, is sufficient. Thus Brendler stated that "it becomes mandatory at this time, and until convincing evidence to the contrary be submitted, that the patient with occult prostatic cancer be given the benefit of radical prostatectomy, providing, of course, that he be a suitable candidate from the standpoint of physical condition and life expectancy." 1 The Hinmans supported this contention and cited results in five patients so treated and followed

Abstract: The search for a medicament with sedative and relaxant properties has been a never-ending one in the progress of medicine. The earlier agents used included paraldehyde, chloral hydrate, and bromides. In 1903, 1 the use of barbituric acid and its derivatives was a significant advance in this field, until the accompanying hazards of addiction, overdosage, and toxicity became apparent. While barbiturates are still the most widely used medicaments, the search progressed with the use of anticonvulsants (especially hydantoin derivatives). Even antihistaminic agents play a lesser role as sedatives. Meparfynol has also been introduced as a sedative-hypnotic, but here one must be alert to the possibility of liver damage. In recent years, mephenesin 2 has entered the field. Partial success has been obtained with its use in certain anxiety states, 3 in certain neurological and muscular disorders, 4 and as an adjunct in alcoholism. The relative success of this preparation suggested

Abstract: Puerperal tubal sterilizations were performed on 1,830 women in the department of obstetrics of the Johns Hopkins Hospital between June 1, 1936, and Dec. 31, 1950. Table 1 lists the indications for sterilization; the most common were: (1) great multiparity only, 33.3%; (2) chronic hypertension and/or repeated toxemia, 17.7%; and (3) repeat cesarean section, 15.4%. As used in the clinic and in this paper, the term "great multiparity" is defined rigidly as eight or more previous viable deliveries (each fetus weighing over 1,000 gm.). The number eight was used since maternal mortality has been thought to rise sharply after the eighth delivery 1 ; and, because of this fact, we have hitherto believed that great multiparity, so defined, is truly a medical indication. One-third of all the sterilizations here reported were done solely on this indication. In addition to this group, 161 women presented not only great multiparity but also had

Abstract: The occurrence of untoward physiological effects after systemic administration of cortisone and hydrocortisone provided a stimulus for investigators to develop hydrocortisone lotions and ointments for topical application. By applying hydrocortisone topically, the anti-inflammatory effects could be utilized without the risk of sodium and water retention, edema, and other undesirable physiological changes associated with systemic administration. In the three years since the introduction of hydrocortisone products for topical application, occurrence of systemic absorption after topical application has not been reported. During the past 15 months since we began evaluating the therapeutic effects of topically applied hydrocortisone in various concentrations and vehicles, we have become suspicious of possible systemic absorption of topically applied hydrocortisone. For example, in using the simultaneous paired comparison method, it was often noted that the area receiving the placebo lotion or ointment appeared to respond almost equally to the area receiving hydrocortisone. Also, it was observed in a

Abstract: During the last half century scores of papers have been written on pain in the upper extremity, but it is evident that the problem today lacks satisfactory resolution. There is little doubt that in certain instances compression of the neurovascular structures in the neck is due to a cervical rib. Essentially the same symptoms may be present when there is no cervical rib, and numerous authors have believed that the scalenus anterior muscle plays a major role in the production of these symptoms. A review of recent literature indicates growing discord regarding compression of the brachial plexus due to displacement (scalenus anticus syndrome), and many dissent from the idea that the scalenus anterior syndrome without cervical rib is a definite factor in upper extremity pain. In the past 16 years my associates and I have seen 117 patients whose symptoms and signs were such that a diagnosis of cervical rib

Abstract: Twenty-one cases of lead poisoning in children were uncovered in Chicago during 1953. Five of these cases were fatal. Since this is not a reportable disease, we have no data on the true incidence of this disease in previous years. Nevertheless, it was the consensus that the discovery of this number of cases in one year was unusual. Equally remarkable was the fact that over half of these cases were recognized at one hospital. Because central nervous system aberrations were characteristic of many of these cases of lead poisoning in children, the possibility of an epidemic of viral encephalitis was entertained initially. It was for this reason that aid was sought from the Communicable Disease Center of the United States Public Health Service. Although the epidemic, if indeed it be considered one, proved not to result from a communicable disease, the epidemiological approach found so helpful in studying such diseases

Abstract: It has been shown that adenoidal-pharyngeal-conjunctival (APC) viruses are responsible for certain hitherto undifferentiated respiratory illnesses and that they have been associated with certain external diseases of the eye. 1 These viruses produce neutralizing antibodies in human serum. 1 b Nine human and two simian adenoidal-pharyngeal-conjunctival virus serotypes have been delineated to date. 2 When types 1, 3, 4, and 5 are swabbed on the conjunctivas of susceptible volunteers, they regularly produce a moderately severe, self-limited catarrhal conjunctivitis, together with systemic symptoms similar to those of pharyngoconjunctival fever. Volunteers having specific serum antibodies are resistant to the disease. 3 This report describes initial studies with volunteers, studies designed to determine the ability of a formaldehyde-inactivated and a heat-in-activated type 3 APC virus vaccine to ( a ) produce specific neutralizing antibodies in the serum and ( b ) to prevent or modify artificially induced infection and disease. MATERIALS AND METHODS Preparation of Vaccines.— The J.