Showing papers in "JAMA in 1919"
TL;DR: In the latter part of October, 1918, when the epidemic of influenza was at its peak in this locality, the seriousness of the disease as seen in pregnant women caused considerable alarm among those in charge of obstetric cases.
Abstract: In the latter part of October, 1918, when the epidemic of influenza was at its peak in this locality, the seriousness of the disease as seen in pregnant women caused considerable alarm among those in charge of obstetric cases It soon became apparent that there was a great diversity of experience as regards the mortality, some of the practitioners losing most of their cases, others very few In addition to its importance in contributing toward a more definite knowledge concerning the prognosis of influenza in pregnant women, it has seemed to me that a statistical study based on a large number of cases would also be of value in showing the effect of the influenza on the course of pregnancy Owing to its severity and wide occurrence, and to the fact that it was especially prevalent among young women of the child-bearing age, the epidemic offered the best opportunity we
450 citations
TL;DR: How rarely Staphylococcus aureus infection of the lung occurs and how grave the prognosis is may best be stated by noting that in a series of about 800 cases of pneumonia, drawn from all classes of the population of New York City, only thirteen cases were treated at the hospital of the Rockefeller Institute under the direction of Dr. Rufus Cole, in.
Abstract: In the standard textbooks the staphylococcus is usually noted among other micro-organisms as a possible etiologic agent in the production of bronchopneumonia. A detailed description of the clinical picture of the disease associated with the presence of this organism in the lung has thus far failed to come to our attention. This is no doubt due in part to the relative rarity of this infection as encountered in civil practice, and possibly to the lack of careful study of the bacteriology of acute respiratory affections until but recently. How rarely Staphylococcus aureus infection of the lung occurs and how grave the prognosis is may best be stated by noting that in a series of about 800 cases of pneumonia, drawn from all classes of the population of New York City, only thirteen cases were treated at the hospital of the Rockefeller Institute under the direction of Dr. Rufus Cole, in
145 citations
TL;DR: A tentative grouping of the cases of coronary thrombosis based on clinical symptoms was made: Cases of instantaneous death, a group graphically described by Krehl, in which there is no death.
Abstract: In a paper 1 on certain clinical features of sudden obstruction of the coronary arteries, read six years ago before the Association of American Physicians, I called attention to the fact that while such obstruction as by a thrombus was very often suddenly fatal, it was not necessarily so; for the coronary arteries were not in the strictest sense terminal arteries; there were often anastomoses capable of reestablishing circulation in the infarcted area to such an extent as to enable the heart to functionate for a time at least. This had been shown by anatomic study of the coronaries, by necropsy observations by the pathologists, by experimental ligation of these vessels, and by clinical experience controlled by postmortem examinations. A tentative grouping of the cases of coronary thrombosis based on clinical symptoms was made: Cases of instantaneous death, a group graphically described by Krehl, in which there is no death
143 citations
TL;DR: In the second of a series of articles on epithelioma published in 1918, MacCarty and I1classified such tumors into six types or apparent types and described each.
Abstract: In the second of a series of articles on epithelioma published in 1918, MacCarty and I1classified such tumors into six types or apparent types and described each. The tumor commonly known as the rodent ulcer has been termed basal-cell epithelioma because its cells tend to differentiate to a form similar to the cells of the basal or germinative layer of the epidermis. This type, which, like other epitheliomas, may be found on any surface covered with protective epithelium, develops practically always above the clavicle. The majority of its lesions attack the cheek, the eyelids, the nose, the forehead, the ear, the canthi and the temporal regions. Basal-cell epithelioma often appears in the skin as an elevated, whitish nodule which resembles an adenoma or cyst of a sebaceous gland, as an ulcer with indurated borders, or as a scaly lesion. The latter type, which exfoliates its superficial layers to
86 citations
TL;DR: It is suggested the necessity of including, in the routine examination of a prospective donor for blood transfusion, questions relative to the various anaphylactic manifestations, in actual practice.
Abstract: Although the experimental demonstration of passive anaphylaxis has been clearly established by Nicolle, Otto, Friedmann, Richet and others, I wish to call attention to its importance in actual practice and suggest the necessity of including, in the routine examination of a prospective donor for blood transfusion, questions relative to the various anaphylactic manifestations. REPORT OF CASE H. T., man, aged 35, waiter, white, born in Greece, who had been five years in this country, underwent blood transfusion for primary anemia. He had never had asthma, hayfever, bronchitis, urticaria, angioneurotic edema, or any other condition which might indicate a hypersensitiveness to some foreign protein. The family history was negative. Two weeks after receiving 600 c.c. of blood, the patient left his home and went for a carriage ride in Central Park; almost immediately on entering the open carriage, he experienced some difficulty in breathing which within five minutes developed into a
84 citations
TL;DR: The consideration of asthma as a reflex from nasal disease has been a matter of interest to all of us for many years, primarily because of clinical results that are sometimes obtained by its treatment, and also because of the scientific interest the authors have in its problems.
Abstract: The consideration of asthma as a reflex from nasal disease has been a matter of interest to all of us for many years, primarily because of clinical results that are sometimes obtained by its treatment, and also because of the scientific interest we have in its problems This chapter of medicine was an enigma to me until the past few years: none of the observations published seemed to explain the mechanism of the disease 1 Now, the question seems to me to present possibilities, if not of solution, certainly of interesting speculation These ideas came to me in the course of my observations on the "lower half" headache 2 produced in sphenoidal and nasal ganglion lesions To my mind, the explanation of the pain produced from the nasal (sphenopalatine-Meckel's) ganglion, necessitates the assumption of functions on the part of the sympathetic nervous system which cannot be proved, according to the
82 citations
TL;DR: In the course of the hookworm survey of increments of troops arriving at Camp Travis, Texas, and of various military units of the Southern Department by the Laboratory CarMetchnikoff, a nematode ovum, apparently undescribed, has been found in 429 cases among approximately 140,000 soldiers examined.
Abstract: In the course of the hookworm survey of increments of troops arriving at Camp Travis, Texas, and of various military units of the Southern Department (Texas, Oklahoma, New Mexico and Arizona) by the Laboratory CarMetchnikoff, a nematode ovum, apparently undescribed, has been found in 429 cases among approximately 140,000 soldiers examined. This ovum is the largest ovum of intestinal worms encountered in human stools. Its dimensions average 95 by 40.2 microns, with a ratio of length to diameter of 2.4: 1. It is extraordinarily variable in size and proportions, its length ranging from 68 to 133 microns and its diameter from 33 to 43. The ova ofNecator americanusin our material measured 69 (from 63 to 72) by 38 (from 35 to 43) microns. These are averages of twenty measurements in both species. This new ovum is characterized by two marked diagnostic features that clearly distinguish it from
73 citations
TL;DR: It is the purpose in this paper to call attention to some of the peculiar drug reactions occurring in man and, at the same time, to offer an explanation of them.
Abstract: It is my purpose in this paper to call attention to some of the peculiar drug reactions occurring in man and, at the same time, to offer an explanation of them. In a perusal of the recent textbooks on pharmacology, it was found that the word "idiosyncrasy" appears in all; but the definitions are almost as numerous as the books themselves, and in none is there any explanation for the peculiar effects of many drugs on certain people. Given a normal person, any drug exhibited in therapeutic doses manifests a certain normal action, a side action and, in larger amounts, a toxic action, both the normal and the toxic action being more or less definitely fixed, symptomatically, for all individuals of the same species. On the other hand, there are individuals within any species that manifest exaggerated normal and side actions from many such reasons as alterations in rate of
72 citations
TL;DR: The suggestion is to test in jaundice and biliary colic the local application of a 25 per cent, solution of magnesium sulphate by means of the duodenal tube, which may relax the sphincter of the common duct and permit the ejection of bile, and perhaps, even promote the relaxation of the intestinal wall.
Abstract: Two years and a half ago a paper was published by S. J. Meltzer 1 of the Rockefeller Institute which carried at the end this footnote: In experiments with magnesium sulphate I observed that the local application of a 25 per cent, solution of that salt on the mucosa [of the duodenum] causes a completely local relaxation of the intestinal wall. It does not exert such an effect when the salt is administered by the mouth, that is, when it has to pass through the stomach before it reaches the intestines. The duodenal tube, however, apparently has reached an efficient practical stage. I make, therefore, the suggestion to test in jaundice and biliary colic the local application of a 25 per cent, solution of magnesium sulphate by means of the duodenal tube. It may relax the sphincter of the common duct and permit the ejection of bile, and perhaps, even
71 citations
TL;DR: The insidious onset of a malignant tumor with the lack of positive evidence, in the majority of instances, until the case is far advanced, is perhaps the greatest difficulty in the way of a decided reduction in cancer mortality.
Abstract: The insidious onset of a malignant tumor with the lack of positive evidence, in the majority of instances, until the case is far advanced, is perhaps the greatest difficulty in the way of a decided reduction in cancer mortality. Certain well established facts of cancer etiology may be briefly stated in order to explain the basis of the experiments of which this paper constitutes a preliminary report. Broadly speaking, the development of malignant tumors rather frequently follows irritation, though no irritant is specific. It is generally accepted that not every one exposed to the action of any given irritant develops a tumor. In other words, there is an apparent predisposition as well as an actual inciting irritant. Again, broadly speaking, since exact statements are not possible in the present state of our knowledge, this predisposition becomes more evident at a certain period in life, a period spoken of as the
58 citations
TL;DR: It is shown that the frequency with which verrucae occur at points of trauma, notably on the hands and feet, would at first glance speak strongly for trauma as well as the etiologic role of the gonococcus in the production of blenorrhagic keratoses.
Abstract: That certain micro-organisms can, by direct implantation, give rise to disorders of keratinization, notably localized hyperkeratosis, is an accepted fact clinically and bacteriologically. Thus, the etiologic role of the gonococcus in the production of blenorrhagic keratoses, the tubercle bacillus in its relation to verruca necrogenica, and the gonococcus and pus organisms as causative agents in the production of acuminate condylomas stand out as striking examples of the aforementioned fact. HYPOTHESES ENTERTAINED In explanation of. the etiologic factor in the production of common warts there have been advanced at various times the opinions that they are caused by an infecting organism, trauma or a foreign body. There are many clinical examples which stand out in favor of each of these hypotheses. The frequency with which verrucae occur at points of trauma, notably on the hands and feet, would at first glance speak strongly for trauma as
TL;DR: Hematologic examinations made during the past ten months in a base hospital in France on certain gassed patients (mustard gas) offer strong evidence that the deleterious action of the poison on the blood and bone marrow is an important factor in prognosis in many cases.
Abstract: Hematologic examinations made during the past ten months in a base hospital in France on certain gassed patients (mustard gas) offer strong evidence that the deleterious action of the poison on the blood and bone marrow is an important factor in prognosis in many cases. The first change in the circulating blood—apparently due to a stimulus to the bone marrow—is an increase in the erythrocyte and leukocyte count, that naturally varies greatly with the severity of the gassing and the individual's reactive powers. In view of the disproportionate increase of red and white cells, change in Arneth scale, etc., the possibility of this being due to a greater concentration of the blood may safely be disregarded. The leukocyte rise (due to the polymorphonuclear elements) may be as high as 36,000 per cubic millimeter, and in the present series averaged 12,000. Enumeration of the lobes of the nuclei (Arneth count) shows
TL;DR: In this report, based on approximately 200 necropsies, no attempt will be made to distinguish between changes due to the unknown virus and those from mixed or secondary infection; only the most outstanding features are discussed.
Abstract: In this report, based on approximately 200 necropsies, no attempt will be made to distinguish between changes due to the unknown virus and those from mixed or secondary infection; only the most outstanding features are discussed. Perhaps the most lasting impression from long association with lobar pneumonia in postmortem examination is that when it alone is responsible for death, with very few exceptions,1a considerable part of the total pulmonary parenchyma is consolidated, undistensible and heavier than normal; even when limited to one upper lobe, that lobe is as a rule huge, and the lung weight as a consequence frequently doubled. Therefore, the first feature of the lungs in influenza to attract attention was the relatively small amount of lung tissue solid with grossly demonstrable pneumonia. Even when measured, the total of such regions is so small that it is difficult to ascribe death to the pneumonia with an
TL;DR: In cases in which there is only a limit of dorsal flexion — "muscle bound feet" — especially in children, a marked change in the position of the tarsals, metatarsals and toes may be prevented from developing by a restoration of freedom in dorsalflexion.
Abstract: The term "claw foot" is generally accepted to mean a foot with exaggerated arch, prominent metatarsals and hammer toe, with corns on the toes, and callosites on the sole of the foot over the distal end of the metatarsals. The cause of this deformity may be either a limit to dorsal flexion, or an impairment of the intrinsic muscles of the foot from paralysis, or both. In cases in which there is only a limit of dorsal flexion — "muscle bound feet" — especially in children, a marked change in the position of the tarsals, metatarsals and toes may be prevented from developing by a restoration of freedom in dorsal flexion. In cases in which a gross change has taken place in the position of the tarsals and metatarsals, with shortening of the plantar structures, exaggerated arch and hammer toe, a much more complicated problem is encountered. The shortening of
TL;DR: It was found that a certain strain of B. mucosus-capsulatus possessed particular virulence within the meninges of laboratory animals, and a typical acute and fatal leptomeningitis was produced by the direct subarachnoid injection of very small numbers of these organisms.
Abstract: In the course of the experimental study of meningitis, it was found that a certain strain of B. mucosus-capsulatus possessed particular virulence within the meninges of laboratory animals. A typical acute and fatal leptomeningitis was produced by the direct subarachnoid injection of very small numbers of these organisms; the affected animals showed characteristic signs of meningeal infection, dying in from eight hours to five days. The number of these bacilli necessary for the production of such an infection was far smaller than with any other strain or class of organisms tested. The particular strain of B. mucosus-capsulatus used in these observations is, according to the classification of Perkins, B. lactis-aerogenes , being differentiated from others of the group by the sugar reactions. It is an encapsulated, nonspore-forming, gram-negative, nonmotile bacillus, with a tendency to occur in varying lengths of chains. This organism was isolated from the lungs and blood of a
TL;DR: It is observed that two children in a ward containing about twenty-five infants, from a year to a year and a half in age, were developing a yellowish complexion, which was most evident on the palms of the hands, which showed also distinct signs of desquamation.
Abstract: About a year ago one of us (A. F. H.) observed that two children in a ward containing about twenty-five infants, from a year to a year and a half in age, were developing a yellowish complexion. This coloration was not confined to the face, but involved, to a less extent, the entire body, being most evident on the palms of the hands, which showed also distinct signs of desquamation. The sclerotics were not at all affected. The urine was amber, and the stools normally yellow. For a time, we were at a loss to account for this peculiar phenomenon, when our attention was directed to the fact that these two children, and only these two, were receiving a daily ration of carrots in addition to their milk and cereal. For some time we had been testing the food value of dehydrated vegetables, and when the change in color was
TL;DR: Any proper discussion of the epidemiology of the disease should cover at least one full cycle, preferably the last, from 1889 to the present, since there is no concrete specific and continuous record of the prevalence or mortality of influenza during such a period of years.
Abstract: The history of influenza so far as it is known, that is, for several centuries, comprises a series of long cycles in which great pandemics alternate with periods of relative quiescence, the length of cycles as measured by the intervals between pandemics being usually a matter of decades. The special characteristics of influenza pandemics are their wide and rapid extension, their high attack rates, and great effect on general mortality rates. Since these cycles are undoubtedly of fundamental significance in the natural history of influenza any proper discussion of the epidemiology of the disease should cover at least one full cycle, preferably the last, from 1889 to the present. The material for such a discussion must, however, be collected from many and diverse sources and laboriously fitted together, since there is no concrete specific and continuous record of the prevalence or mortality of influenza during such a period of years.
TL;DR: The research work in the laboratories of the James Buchanan Brady Urological Institute has been given over largely to the study of antiseptics with a view particularly to the development of drugs applicable to the genito-urinary tract.
Abstract: During the past two years the research work in the laboratories of the James Buchanan Brady Urological Institute has been given over largely to the study of antiseptics with a view particularly to the development of drugs applicable to the genito-urinary tract. Attention was first directed to internal antiseptics, since Hinman1had previously shown in our laboratories the questionable value of hexamethylenamin. Starting with the remarkable selective activity of the kidneys on phenolsulphonephthalein, as shown by the work of Abel and Rowntree2and developed as a functional test in our clinic, we tried to attach other chemical agents to phenolsulphonephthalein and thus produce an effective internal urinary antiseptic. Some interesting drugs were produced and studied by Davis and one of us (E. C. W.3). The war interrupted these studies, but the urgent need of really effective antiseptics for local use in the genito-urinary tract induced us later
TL;DR: The act of sneezing is, in its entirety, quite complex, and may be subdivided for convenience of presentation into two phases, a nasal and a mucous membrane phase.
Abstract: Sneezing may be defined as a spasmodic expiration preceded by one or more spasmodic inspirations. The expiration is momentarily opposed by the closure of the nasopharynx and a more or less complete closure of the mouth. With the onset of the expiration there is a rapid rise of intrapulmonic pressure which, when a certain value is attained, suddenly forces open the nasopharyngeal partition. In consequence, a blast of air is driven into and through the nasal chambers; at the same time, however, the mouth, not infrequently, is partially opened, thus permitting a portion of the blast to be driven through the buccal orifice. The object of the sneezing spasm is the dislodgment of mucus or other fluid from the surface of the nasal mucous membrane. The act of sneezing is, in its entirety, quite complex, and may be subdivided for convenience of presentation into two phases, a nasal and a
TL;DR: The term "athrepsia," as used in this paper, refers to that well known condition of extreme malnutrition of infants otherwise known as "marasmus," "infantile atrophy," or "dekomposition."
Abstract: The term "athrepsia," as used in this paper, refers to that well known condition of extreme malnutrition of infants otherwise known as "marasmus," "infantile atrophy," or "dekomposition." PATHOGENESIS OF ATHREPSIA The essential factors in the pathogenesis of the condition, as determined by recent investigation, are discussed elsewhere,1and they need now only be referred to briefly. The condition of athrepsia may be considered as the end result of an insufficient intake or of a failure to utilize food in sufficient amount to supply the demands of the body; in other words, a condition of virtual starvation. In this condition the volume flow of the blood, that is to say, the amount of blood flowing through a given portion of the body per minute, is diminished. This diminished volume flow, it has been shown, is dependent, in part at least, on a decreased blood volume, seemingly the result of a
TL;DR: The brain and spinal cord lie within a space of fixed capacity formed by the closed cranium and the spinal canal, and the pressure within the meninges is determined by two factors, the amount of cerebrospinal fluid present and the volume of the brain.
Abstract: The brain and spinal cord lie within a space of fixed capacity formed by the closed cranium and the spinal canal. The pressure within the meninges is determined by two factors, the amount of cerebrospinal fluid present and the volume of the brain. The removal of spinal fluid by lumbar puncture is commonly employed in controlling intraspinal pressure in a large number of conditions. If there is a very marked increase in the bulk of the brain, however, the intraspinal pressure may still be high, even after the maximum amount of spinal fluid has been drained off. It is also true that the withdrawal, when the high pressure is due to the increased volume of the brain, may cause a herniation of the base of the brain through the foramen magnum, with resulting collapse and death. The one medical condition in which we are most interested in intracranial pressure is
TL;DR: On Jan. 22, 1908, the right common carotid artery of a young, adult, female dog was divided, and a segment of vena cava was interposed and sutured to the ends of the artery, revealing an active circulation through the segment.
Abstract: Jan. 22, 1908, the right common carotid artery of a young, adult, female dog was divided, and a segment of vena cava, preserved for sixty days in formaldehyd solution, was interposed and sutured to the ends of the artery. The implanted tissue was treated with ammonia and absolute alcohol, and was impregnated with petrolatum, just prior to the operation. Feb. 12, 1908, the artery at the site of the operation was exposed, and a direct examination revealed an active circulation through the segment. 1 The animal was demonstrated before the St. Louis Medical Society, Feb. 29, 1908, at which time, as far as could be determined by palpation, pulsation in the common carotid arteries was the same on the two sides. Clinical examination, from time to time, demonstrated like pulsations in the two common carotid arteries. On the right side, at the site of operation, a dense nodular structure could
TL;DR: While the mortality is highest in children under 5 years of age, and particularly under 3, the recent experience in the army camps of this country shows that it may produce a high mortality among adults under certain conditions.
Abstract: Measles is perhaps the most widespread and common of all infectious diseases. Practically all human beings are susceptible to it. If one escapes a childhood infection, adult life is no protection. No age, sex, race or climate is exempt. Contrary to popular conception, it is a disease serious to life. In the year 1913 it was the cause of 8,108 deaths in the registration area of the United States, embracing 65 per cent, of the total population. In the same year, there were 5,498 deaths from scarlet fever. While the mortality is highest in children under 5 years of age, and particularly under 3, the recent experience in the army camps of this country shows that it may produce a high mortality among adults under certain conditions. Methods of controlling this disease in private life or in institutions have been of little avail, so that any new method that bids
TL;DR: The dispute is concerned more particularly with the part played by the Bacillus inflenzae of Pfeiffer, which some authors have found so regularly present as to lead them to consider it the cause not only of the pneumonia but also of the original epidemic disease influenza.
Abstract: Contributions to the study of the pneumonia following influenza in the recent epidemic are still desirable because of the difference of opinion as to its nature and causes that has been evidenced by numerous published papers. All have agreed as to the uniform character of the disease influenza wherever it has appeared in its swing across the continent, but conflicting views have been presented as to its etiology and as to the relation of various bacteria discovered in the respiratory tract, especially in cases of pneumonia, to the original disease and to the pneumonia. The dispute is concerned more particularly with the part played by the Bacillus inflenzae of Pfeiffer, which some authors have found so regularly present as to lead them to consider it the cause not only of the pneumonia but also of the original epidemic disease influenza. Indeed, it was launched by Pfeiffer as the cause of
TL;DR: The existence of an epidemic of influenza at Camp Pike was recognized when 214 cases of influenza were admitted to the base hospital, September 23, and the number continued in the neighborhood of 1,000 a day until October 3, when the final decline began.
Abstract: The existence of an epidemic of influenza at Camp Pike was recognized when 214 cases of influenza were admitted to the base hospital, September 23. The epidemic was foreshadowed by a steady increase in the number of admissions to the base hospital diagnosed as acute bronchitis. This increase began about September 1, and on September 18 there were fifty admissions with this diagnosis. Beginning September 23, the number of cases showed a sudden and alarming increase. September 27, there were 1,037 new cases, and the number continued in the neighborhood of 1,000 a day until October 3, when the final decline began. During the period from September 20 to October 19, there were 11,899 cases of influenza. Table 1 gives the number of cases of influenza by days from September 1 to October 31, including those cases diagnosed as acute bronchitis during the first part of September, and also the
TL;DR: The largest number of influenza and pneumonia patients admitted to the base hospital was on September 30, when 785 were received, and the largest total number of patients in the hospital was 5,666, October 8, of whom 2,951 had influenza and 719 influenzal pneumonia.
Abstract: At the time of the epidemic of influenza1 and influenzal pneumonia, the military population of the United States Reservation at Fort Riley was 63,374, distributed as in Table 1. The total number of cases of influenza were divided as shown in Table 2. The influenza incidence for the population of the military reservation was 23.9 per cent. As will be observed in Table 3, 2,624 instances of pneumonia occurred during the epidemic, of which 2,496 were definitely traceable to influenza. The largest number of influenza and pneumonia patients admitted to the base hospital was on September 30, when 785 were received. The largest total number of patients in the hospital was 5,666, October 8, of whom 2,951 had influenza and 719 influenzal pneumonia. The largest number of pneumonia patients at one time under treatment in the base hospital was 1,338, October 15, as shown in the accompanying chart. The incidence
TL;DR: In an informal discussion 1 of a paper at the Detroit session in 1916, I announced that I had been able to protect persons susceptible to attacks of ivy poison by the internal administration of minute but increasing doses of the tincture of Rhus toxicodendron.
Abstract: In an informal discussion 1 of a paper at the Detroit session in 1916, I announced that I had been able to protect persons susceptible to attacks of ivy poison by the internal administration of minute but increasing doses of the tincture of Rhus toxicodendron . Later my assistant, Dr. Strickler, made an alcoholic extract of the plant, which after aqueous dilution was injected subcutaneously and was found to be effective in preventing attacks. During the past few years I have been employing this method in my private practice, with uniform success. I have treated almost a score of susceptible persons, and all have remained free of dermatitis during the ivy season, whereas prior to undergoing this treatment they rarely escaped. I may briefly mention the case of a 12-year-old girl who for several years had spent a couple of months in bed each year from severe and repeated attacks of
TL;DR: This case is so unusual, both as to the etiology and the failure to recognize the condition for a long period, that it is well worth reporting.
Abstract: This case is so unusual, both as to the etiology and the failure to recognize the condition for a long period, that it is well worth reporting. REPORT OF CASE A private, white, aged 22, a farmer before entering the Army, with negative family and past history, was admitted to one of the base hospitals, Dec. 19, 1917, suffering from measles and acute follicular tonsillitis. Tonsillectomy was performed, Jan. 16, 1918; the night of the operation the patient's neck suddenly became stiff, and had remained that way ever since. He arrived at General Hospital No. 6, in July, 1918, and the following brief history accompanied him: "1. Complaint: Pain in neck, stiffness of cervical muscles which permits of very little motion of the head, except anterior-posteriorly, which motion is limited. 2. Search for focal infection: (a) Tonsils (fragments); (b) roentgen ray, ostearthritis, first and second cervical vertebrae; (c) teeth, abscess
TL;DR: The increasing frequency with which antitoxic serums are being administered, both for curative and for prophylactic purposes, and the increasing number of diseases for which antitoxins can be prepared, make the subject of anaphylactic death of particular interest to the clinician
Abstract: The increasing frequency with which antitoxic serums are being administered, both for curative and for prophylactic purposes, and the increasing number of diseases for which antitoxins can be prepared, make the subject of anaphylactic death of particular interest to the clinician. That many cases of bronchial asthma are the result of sensitization to the emanations from horses presents an added complication, for the existence of this sensitization makes these persons unusually susceptible to horse serum, and thus it is occasionally dangerous to administer prophylactic or curative serum in amounts sufficient to be effective. There are many cases recorded in the literature in which serious collapse has followed the administration of antitoxic serum, and a few instances in which death has occurred. It is, of course, needless to remark that the total number of such cases is an almost negligible percentage of the total number of cases in which injection was
TL;DR: In the recent epidemic of influenza and bronchopneumonia at Camp Lewis, extensive subcutaneous and interstitial emphysema has occurred in nine patients as a complication of bronchipneumonia, with an explanation of the mechanics of these unusual complications.
Abstract: In the recent epidemic of influenza and bronchopneumonia at Camp Lewis, extensive subcutaneous and interstitial emphysema has occurred in nine patients as a complication of bronchopneumonia. The clinical picture of this emphysema, extending up over the neck, face and scalp, and down over the chest and trunk to the pelvis, and even to the external genitalia, is of such rarity and interest that the cases are here reported. Spontaneous pneumothorax has developed in two patients having extensive bronchopneumonia. That there is a relationship between these two conditions and that they are produced by similar pathologic processes has seemed likely. One case, in fact, presented, at different times, both of these complications. In this paper we are presenting an explanation of the mechanics of these unusual complications. In each instance, the diagnosis of our cases of bronchopneumonia has been corroborated by roentgenography, and, in fatal cases, by necropsy. Early in the