Showing papers in "JAMA Internal Medicine in 1965"

Childhood and Society.

Abstract: Erik Eriksen is a remarkable individual. He has no college degrees yet is Professor of Human Development at Harvard University. He came to psychology via art, which explains why the reader will find him painting contexts and backgrounds rather than stating dull facts and concepts. He has been a training psychoanalyst for many years as well as a perceptive observer of cultural and social settings and their effect on growing up. This is not just a book on childhood. It is a panorama of our society. Anxiety in young children, apathy in American Indians, confusion in veterans of war, and arrogance in young Nazis are scrutinized under the psychoanalytic magnifying glass. The material is well written and devoid of technical jargon. The theme of the volume is that it is human to have a long childhood which will leave a lifelong residue of emotional immaturity in man. Primitive groups and

The Thyroid Gland.

Abstract: The rapid growth of knowledge in recent years concerning the physiology and biochemistry of the thyroid hormones and the pathogenesis and treatment of thyroid diseases has no doubt been responsible for the recent spate of books dealing with these subjects. Among the most comprehensive and stimulating of these is The Thyroid Gland . This two volume presentation is comprised of 28 chapters by an international aggregation of 36 contributors, each an acknowledged authority in the field with which he deals. The books are edited by Rosalind Pitt-Rivers and W. R. Trotter, who are themselves distinguished authorities in basic and clinical thyroidology. This expertise and scholarship is reflected in the comprehensive manner in which the subjects are usually discussed and in the extensive bibliographies which accompany them. Volume 1 is concerned principally with the structure and function of the thyroid gland, the peripheral metabolism, and the metabolic effects of thyroid hormones.

The Self and the Object World.

Abstract: This volume is the second monograph to be published by the Journal of the American Psychoanalytic Association and deals with the ubiquitous problems of identity. Identity is defined as the ability to experience one's self as something that has continuity, uniqueness, and sameness. The vicissitudes of identity have been assessed by other authors, but they have never integrated this data into orthodox psychoanalytic theory. The author brings this theme within the mainstream of psychoanalysis. Dr. Jacobson is a brilliant clinician and is able to articulate her ideas with simplicity. She graphically harmonizes object relations, psychosexual development, and ego maturation and its role in the development of self. She redefines such basic assumptions as infantile narcissism, masochism, the distinction between ego and self, and self and object representations. She traces the development of identity from the early infantile period to the postadolescent period. To illustrate her concept she discusses her theories

Games People Play—The Psychology of Human Relationships.

Abstract: These games are quite familiar One has seen people play them and has been a participant in some It was merely that one called them by other names In this context, a game is a set of interpersonal moves or maneuvers made by one, or both, individuals in contact For example, one of the simplest games: Salesman: "This one is better but you cannot afford it" Housewife: "That's the one I'll take" The ploy is obvious: the salesman, depending upon the child in the woman, sets up a condition that implies a reduction in her status—presumably Mrs So-and-so can afford it The adult response obviously would be to buy the item she can afford Thus the aim of a game may be manipulation, desire for gain, self-justification, vindication, expiation or guilt, alleviation or self-exculpation, revenge, malice or reassurance, self-abasement, or any of the hundreds of intentions The objective may also

Introduction to the Work of Melanie Klein.

Abstract: This volume is based on a series of lectures given by Mrs. Segal at the London Institute of Psychoanalysis. The purpose of the text was to introduce psychiatric trainees to Melanie Klein's contributions. The author presents a brilliant and cogent analysis of Melanie Klein's remarkable contributions. The study of adult neurotics led Freud to discoveries about childhood and infancy. Melanie Klein, in her work with children, was led to the discovery that the Oedipal theme and superego occurred at a much earlier age than Freud had suspected. In attempting to illuminate the early roots of these complexes, Klein formulated two earlier positions: the paranoid-schizoid position and the depressive position. These two positions are phases of our psychological development and occur during the oral mode of communication. The paranoid-schizoid position, which occurs in the first four months of the infant's development, is characterized by his relationship to part objects (breasts) and

Methacholine Aerosol As Test For Bronchial Asthma

Abstract: THE DIAGNOSIS of bronchial asthma can ordinarily be made with assurance by employing the standard criteria of history, physical examination, and the demonstration of reversible airway obstruction. 1 Occasionally, the diagnosis of asthma is suspected from the history, but the physical examination is normal, and spirometry shows no airway obstruction at the time of the evaluation. When it is not possible for the physician to observe the patient during an acute episode, the diagnosis cannot be made with certainty. Consequently, a test for bronchial asthma is needed. More than 20 years ago Dautrebande and Philpott 2 and Tiffeneau 3 demonstrated that the asthmatic patient is much more sensitive than normal persons to the bronchoconstrictive effects of histamine and cholinergic agents. This increased response has since been amply confirmed and has been used many times to investigate the pathophysiology and pathogenesis of the disease. 4-17 Tiffeneau 18,19 has suggested that

Diagnosis of cushing's syndrome; single dose dexamethasone suppression test.

Abstract: SOME of the clinical signs and symptoms of Cushing's syndrome are frequently seen in patients who are not taking or producing excessive amounts of glucocorticoids.1It is not surprising, therefore, that Cushing's syndrome, although rarely encountered, is a frequently suspected diagnosis. Because clinical findings alone are frequently not sufficient to confirm or exclude this diagnosis with confidence, laboratory investigations must be performed on many patients in whom the diagnosis is considered.1At present, determination of the plasma concentration of 17-hydroxycorticosteroids (17-OHCS) and the 24-hour urinary excretion of 17-OHCS or 17-ketogenic steroids are commonly employed as screening tests for Cushing's syndrome. Unfortunately, the results of these tests in normal subjects and in obese patients overlap those of patients with Cushing's syndrome.2-4A simple reliable laboratory test for identification of patients with Cushing's syndrome would be advantageous. The purpose of this report is to review our experience with a

Diagnostic Value of Scintillation Scanning of the Liver: Follow-Up of 1,000 Studies

Abstract: FOR 13 YEARS, radioactive colloids have been successfully used for the measurement of hepatic blood flow in man. 32 Labeled dyes, such as rose bengal I 131 have been employed to assess the function of the parenchymal cells of the liver. These techniques have not become widely used, because alterations in liver blood flow occur relatively late in hepatic diseases and because the labeled dye studies convey essentially the same information as the conventional liver function test with sulfobromophthalein (Bromsulphalein). In contrast, the technique of scintillation scanning following injection of these labeled materials has steadily increased in popularity since the first successful demonstration of intrahepatic metastases by Friedell et al in 1957. 15 With this method, the size, shape, and position of the liver can be assessed and focal intrahepatic lesions demonstrated. This diagnostic information cannot be provided by any known radiographic technique. Many authors have reported their results in

Self-Renewal: The Individual and the Innovative Society.

Abstract: In this book the author is for self-development, flexibility, individuality, commitment, courage, and love. He is against tyranny, vested interests, deadwood, inflexibility, moral decay, morbid pessimism—and sin. Moreover, the book deals with some rather general ideas, concepts and abstractions such as "society," "self-knowledge," and "creativity" which are almost innately soporific. In short, it should be pretty dull reading—but it is not. Rather, this very short book is thought-provoking, often very amusing, and continuously interesting. It is reviewed in these pages because so much of what is said has relevance to what is perhaps the most important determinant of the quality of medical care—the continuing self-renewal of the physician. Parts of this long essay deal with the factors which further or impede innovation in society and these comments have application to the problems of adapting our systems of medical education and medical care to fit the changing society they serve. Of

Issue in Evolution.

Abstract: Edited byDaniel B. Stone, MB What fun it would be to peer about in the year 2059 to look and wonder at the effects of Charles Darwin's contribution to human understanding, the monumental theory of evolution which exploded on the complacent world of Victorian England a little over 100 years ago when he published the Origin of the Species . I sang my own paean of praise to him in this journal in the year of 1959 or Darwin 100, as the French might have called it. When I heard of the great hullabaloo and to-do in Chicago, I hoped at least to attend but I never got there. Nonetheless, I did see a television program presented by an omnium-gatherum of brilliant scholars, miscellaneous but very well matched. The scientific and biologic gentry had been lured to appear in Chicago for the occasion under the aegis of Dr. Sol Tax,

Drug-Induced Liver Disease: A Penalty For Progress

Abstract: DRUG-INDUCED hepatic injury, particularly that associated with jaundice, is becoming more frequent because of the increasing use of potent drugs. Nevertheless, its pathogenesis remains mysterious, and its classifications is difficult. Initially, drug-induced hepatic injury followed use of established hepatotoxins as exemplified by diethylene glycol, the vehicle of an early sulfonamide preparation which proved to be a fatal poison.1Subsequently, new disease entities were recognized after patients were exposed to drugs. For instance, intrahepatic cholestasis, then called intrahepatic biliary obstruction, following the administration of organic arsenicals, was reported by Hanger and Gutman.2This led to the appreciation of intrahepatic cholestasis caused by agents other than drugs.3Today, however, confusion about the many hepatic changes associated with drug therapy produces apprehension on the part of the physician when prescribing which sometimes protects the patient but almost as frequently prevents beneficial treatment or causes senseless testing for hepatotoxicity. The

Myxedema; a study of 400 cases.

Abstract: MYXEDEMA is a clinical disease entity resulting from failure of the thyroid gland to maintain a daily output of thyroid hormone consistent with health. Since the publication of the report of the committee appointed by the Clinical Society of London to investigate the subject in 1888,1myxedema has been a well recognized disease and numerous reviews and investigations have been published. Despite increasing knowledge of the physiology of the thyroid gland and the continuous development of better means of investigating thyroid function, myxedema has frequently remained undiagnosed. This probably is the result of the wide variety of presenting symptoms, some of which have been considered rather vague or nonspecific. It is particularly so in old people, as myxedema develops so slowly that its manifestations are often mistaken for those of aging. The tendency to look for the "classic" symptoms and signs of a full-blown case of myxedema is probably

Hallux Valgus, Allied Deformities of the Forefoot and Metatarsalgia.

Abstract: A rapid perusal of the rheumatologic and orthopedic literature will reveal many articles about various hand problems. Much less has been written about the foot, in particular the forefoot. In this lengthy monograph, Dr. Kelikian, a Chicago orthopedist, attempts to remedy this lack. Being an orthopedist, he naturally spends much time on operative repair of foot problems. But his sections on functional anatomy, clinical features, and related problems, as well as his definition of the somewhat confusing terminology can be read with interest by all physicians, particularly those especially interested in arthritis and other affections of the musculoskeletal system. Not only does the reader obtain a clearer understanding of the all too common problems of the forefoot, but he will be in a better position intelligently to advise the patient. With much justification, Kelikian attacks modern styles of footwear as a major cause, or at least aggravator, of hallux valgus

Symptom of restless legs.

Abstract: BY A SERIES of publications 1-9 beginning in 1944, Ekbom has revived interest in "the syndrome of restless legs" which, although first described in 1685, 10 had been almost completely neglected in the medical literature. As he defines it, the clinical features are straightforward and easily recognized. Patients with the condition complain of discomfort in the legs and sometimes the thighs as well. The discomfort is usually described as having an aching, crawling, or restless quality. The distinctive feature is that it commences when the legs are immobile and that it is lessened when they are moved, with more lasting relief being given if the patient walks about. Manifestations are often worse when the patient is in bed at night. Many possible etiologic factors have been reported, but in essence the cause or causes of the condition remain unknown and the results of treatment are variable. Material and Procedure The

Night Comes to the Cumberlands—A Biography of a Depressed Area.

Abstract: Recreation, Leisure and Politics . By Arnold W. Green. Price, $5.95. Pp 193. McGraw-Hill Publishing Co., 330 W 42nd St, New York, NY 10036, 1964. Michael Harrington's The Other America appeared in 1962 as a reaction to Galbraith's The Affluent Society . Harrington gave facts and figures on poverty in present day, midcentury American, ie, in the country at large. Harrington's objective apparently was not to disprove what Galbraith said but to point out that Galbraith omitted areas so huge that his description of society was a distortion— a picture of a highly select small sample— better classified as a group than a society. The Affluent Society can be said to be a view with a magnifying glass of a rich portion of the tapestry that is America. The first book under review, Caudill's Night Comes to the Cumberlands , has similarly been held to be a view with a magnifying glass over

The Diagnostic Value of Angiographic Observations in Polyarteritis Nodosa: A Case of Multiple Aneurysms in the Visceral Organs

Abstract: The protean clinical manifestations of polyarteritis nodosa reflect the underlying multiple organ involvement and frequently present a diagnostic challenge. The pathological lesion of the classic type occurs in the medium and smaller sized muscular arteries and represents a necrotizing inflammatory change.1,2Lacking knowledge of a specific etiologic agent, the diagnosis rests largely on clinical awareness and suspicion and ultimately on a biopsy specimen of the characteristic vascular lesion. Multiple aneurysm formation in the small and medium sized arteries is a feature of the pathological spectrum and when demonstrated is characteristic of the disease.3The lesion is encountered in the vessels of the abdominal viscera, namely, kidney, liver, and spleen. Angiography affords a simple and safe method of demonstrating these lesions in vivo, and thus may help confirm the suspected clinical diagnosis. In view of the vascular nature of this disease it is surprising more attention has not been

The Effect of Caffeine on Free Fatty Acids: A Preliminary Report

Abstract: THE PHYSIOLOGIC effects of coffee are due entirely to its caffeine content. Following its oral administration it is rapidly absorbed and its effects are almost immediately apparent. Coffee is one of the most common beverages utilized in this and many other countries. The amount consumed by the average individual approximates three cups a day; many coffee drinkers exceed this figure, some consuming as many as ten to 15 cups a day. The average amount of caffeine contained in the usual percolator type of coffee is approximately 150 mg per cup, while "instant coffee" contains approximately 80 to 90 mg and decaffeinated coffee contains about 15 to 25 mg per cup. 1 Other beverages, such as cola drink, 2 contain from 46 to 53 mg per 12 ounce bottle. The pharmacologic effects of caffeine are fairly well known; these include an increase in the excitability of the nervous system, in alertness,

Multiple Organism Septicemia in Acute Leukemia: Analysis of 54 Episodes

Abstract: ORGANISMS of low pathogenicity often cause serious infections in patients with acute leukemia. Septicemia is a major problem and often proves fatal. Although usually only one organism is recovered from the blood, the isolation of multiple organisms is not infrequent. We have reviewed our experience with 54 episodes of multiple organism septicemia in 52 patients with acute leukemia. Methods Four hundred twenty patients with acute leukemia were admitted to the National Institutes of Health from October 1953 to August 31, 1963. The clinical records and autopsy protocols of these patients were examined. Patients were included in the study if more than one organism was grown from their blood in a single culture or from separate cultures during any two-week period, but not if they contained obvious contaminants such as Staphylococcus albus , diphtheroids, α-hemolytic Streptococcus or group D Streptococcus . Postmortem heart blood cultures were not included unless a morphologically consistent site

Blue rubber bleb nevus.

Abstract: The descriptive designation, "blue rubber bleb nevus," was applied to the following case because it satisfied the criteria of multiple, wide-lumened hemangiomas of the skin and gastrointestinal tract, as enumerated by William Bean. A relationship between hemangiomas of the skin and hemangiomas of the internal organs is said to have been first described in 1860 by Gascoyan, 1 but did not receive much clinical attention until the next century. Bean, in his comprehensive text, 2 recorded a typical case of such an association describing the unique features and naming the complex "blue rubber bleb nevi" of the skin and gastrointestinal tract. Since that time only three case reports 3-5 have appeared under this title, two of them in the dermatological literature. In one of these examples 3 the lesions were characteristic but examination failed to disclose any internal lesions. Berlyne 4 demonstrated a mode of inheritance resembling a mendelian dominant

Cytomegalovirus Infection After Renal Transplantation

Abstract: CHARACTERISTIC basophilic intranuclear inclusion body-containing cells morphologically compatible with viral infection were observed in autopsy lung specimens from 15 of 32 patients treated at this center by means of organ transplantation. 1 These inclusions have been demonstrated in the brains of two patients and in an additional ten cases other histologic evidence of viral CNS infection was present. 2 In three patients the inclusion body-containing cells were also disseminated to the lymph nodes, liver, pancreas, parathyroid, and salivary glands. 1 In addition, a segment of donor ureter resected 228 days posttransplant because of stricture also contained these inclusions. 3 It is the purpose of this communication to report the isolation and identification of a viral agent from the lungs of three patients who died following renal homotransplantation. Methods Tissue Culture. —Specimens of lung obtained at autopsy were ground to approximately a 10% suspension in tissue culture medium. This consisted of Eagle's minimal essential medium

Methyltestosterone, related steroids, and liver function.

Abstract: JAUNDICE due to methyltestosterone was first reported by Werner in 1947. 1 Subsequently 42 cases of jaundice during methyltestosterone therapy have been reported. 2 Foss and Simpson 2 summarized reported cases and noted that the duration of therapy to the onset of jaundice ranges from eight days to ten months. Studies of liver function, in addition to elevation of serum direct and indirect bilirubin levels, showed abnormal sulfobromophthalein (Bromsulphalein) sodium (BSP) retention, and normal or a slight elevation of the alkaline phosphatase concentration. The flocculation tests and total serum albumin and globulin concentrations were not altered. In most cases the illness is mild with anorexia, malaise, nausea, vomiting, and upper abdominal pain. Pruritus and jaundice subsequently develop with acholic stools and dark yellow urine. There is no fever. These symptoms are of varying intensity and duration. Withdrawal of methyltestosterone results in remission of hepatocellular dysfunction within a few days to

Intracavitary 5-fluorouracil in malignant effusions.

Abstract: ALKYLATING agents have been effective in treatment of effusions into the pleural, pericardial, and peritoneal cavities due to metastatic tumor.1-4Other forms of treatment are also available at the present time and include radioisotopes, x-ray, talc poudrage, and pleurectomy.5-9However, there are certain disadvantages associated with the use of each of these agents or procedures. Mechlorethamine hydrochloride (HN2), one of the nitrogen mustards, frequently causes moderate to severe nausea and vomiting necessitating heavy premedication. Local reactions may occur following intracavitary injection of HN2resulting in reactive effusions which may require emergency paracentesis. The disadvantages of radioactive isotopes are the lack of ready availability, the expense, and the radiation hazard to the patient and personnel. Furthermore, improvement is obtained with alkylating agents or radioisotopes in only 50% to 65% of the patients. Talc poudrage and pleurectomy may be very effective in controlling recurrent effusions but these techniques require thoracic surgery. Therefore

Antimicrobial Therapy of Ratbite Fever: A Review

Abstract: RATBITE fever is an acute illness caused by Streptobacillus moniliformis or Spirillum minus , and characterized by chills, rash, and intermittent or relapsing fever. Arthritis or a local lesion at the bite-site, usually associated with regional lymphadenopathy, may also occur with the onset of other symptoms, depending upon the causative organism involved. Although penicillin is accepted as the treatment of choice for the disease, no agreement can be found in the literature concerning the most desirable dosage and duration of therapy. This paper reports a case of streptobacillary-ratbite fever successfully treated with penicillin. Previous American, Canadian, and British experience with cases in which the causative microorganisms were clearly demonstrated are reviewed, and the therapeutic programs used have been compared with the results achieved in an attempt to determine optimal management with antimicrobials now available. Report of a Case A 38-year-old white male radioisotope laboratory technician was admitted to the medical service

Toxicity and antitumor effect of divided doses of methotrexate.

Abstract: IT IS generally agreed that single daily doses of folic acid antagonists given by mouth for prolonged periods are usually ineffective in the treatment of solid tumors 1-5 Since the successful treatment of women with choriocarcinoma by Li et al and Hertz et al 6-9 with large daily oral, intravenous or intramuscular doses of methotrexate, there has been renewed interest in dosage schedules and routes of administration 10-12 Repeated courses in large oral doses (up to 25 mg for five days), 13 single intravenous injections (25-15 mg/kg), 14 or continuous intra-arterial infusions (50 mg/24 hours) 10 produced objective responses in solid tumors more frequently than previously noted In addition to these clinical observations there has been considerable advance in knowledge of the pharmacology of methotrexate recently It has been reviewed in detail by several authors 15-18 It seemed appropriate to us to attempt to apply this new pharmacologic knowledge to

Tumors of Bone and Soft Tissue.

Abstract: This volume is a multiple-author compilation of the presentations of the Eighth Annual Clinical Conference at the University of Texas M.D. Anderson Hospital and Tumor Institute. Credit is due Dr. Murray Copeland and his committee for assembling a very knowledgeable group of investigators and clinicians, and the publisher for an excellent format, good charts, and above average radiographic and histologic materials. The subject of bone tumors occupies a major portion of the book and is discussed in two panels, one on histogenesis and the other on metastatic lesions; in addition, 13 definitive essays concerning tumors of bone are included in this section. Although the direction of the book depends on the interest of the essayist, the coverage is broad. Topics include: description of various tumors of bone, diagnosis, therapy, and some basic approaches. The portion on tumors of soft tissue is less extensive. It contains one panel on diagnosis and

Psychoanalytic Concepts and the Structural Theory.

Abstract: This is the third monograph to be published by the Journal of the American Psychoanalytic Association . This slim, provocative volume compares the topographical and structural models of the psyche in a clear and coherent style. The authors cogently demonstrate that these two models are contradictory dichotomies which are incompatable with each other. The topographical theory was first presented in Chapter VII of Freud's Interpretation of Dreams . According to the theory, there are three systems of the mind, each of which is characterized by its relationship to consciousness. The system Unconscious (Ucs) comprises those elements which are not accessible to consciousness. The system Preconsciousness (Pcs) includes those elements which are readily accessible to consciousness. Finally, the system Consciousness (Cs) includes whatever is conscious at any given moment. It becomes very apparent that this heuristic model cannot explain the clinically observable data concerning intrapsychic conflict. The structural theory divides the mind into

Electroencephalographic evaluation of uremia. wave frequency evaluations on 40 uremic patients.

Abstract: Introduction THE FOLLOWING study evolved from efforts over one decade to assess the severity of the uremic syndrome Evaluation of the degree of uremia was particularly necessary to determine indications for dialytic therapy When dialysis is used in renal failure for hyperkalemia, evaluation rests on effective and objective guides The level of potassium can be reliably measured in the serum and the effect of increased potassium levels on vital function can be nicely observed in the electrocardiogram Since the introduction of sodium polystyrene sulfonate (Kayexalate) as an effective means of controlling hyperkalemia, however, dialytic therapy is used less frequently with potassium removal as the chief objective If hyperkalemia is controlled and dialysis is to be used for other manifestations of renal insufficiency, evaluation is difficult and subjective to an unfortunate degree Blood chemical measurements are often misleading in reflecting the severity of clinical uremia; no accepted physiologic test for the

Serum creatinine phosphokinase in acute myocardial infarction: diagnostic value.

Abstract: CREATINE phosphokinase (CPK) is an enzyme abundantly present in skeletal and cardiac muscle cells. It catalyzes the phosphorylation of muscle creatine, a reversible reaction requiring adenosine triphosphate (ATP): In 1959 Ebashi et al first utilized the measurement of this enzyme as a diagnostic aid. 1 They determined the serum creatine phosphokinase (SCPK) in patients with muscular disorders and found abnormal elevations in a large percentage of patients with progressive muscular dystrophy of the Duchenne type. Other investigators have since confirmed these findings 2-4 and in addition have enlarged the diagnostic possibilities by finding abnormally high SCPK values in other disorders affecting muscle tissue, such as dermatomyositis 3,4 hypothyroidism, 5 following cardiac surgery, 6 and during acute myocardial infarction. 7-10 Since CPK is so heavily concentrated in muscle, as opposed to other tissues, 11 it possesses a potentially high degree of diagnostic specificity, in contradistinction to the ubiquitous transaminases and dehydrogenases. Therefore, it is surprising that

Digitalis Toxicity: Treatment With Diphenylhydantoin

Abstract: Digitalis toxicity must be considered a serious cardiac emergency when it causes ectopic arrhythmias, conduction defects, and suppression of sinus pacemaking function. It has been estimated that 6% to 20% of patients receiving the glycosides develop digitalis toxicity1,2because of the narrow range that exists between the therapeutic and toxic dose. The therapeutic dose is approximately 60% of the toxic dose.3 There are a number of factors which precipitate digitalis toxicity: (1) overdose, (2) individual idiosyncracy, (3) electrolyte imbalance following potassium loss due to diarrhea or gastric intubation, etc, and (4) calcium administration to the digitalized patient causing a sudden potassium exodus from cardiac muscle.4,5At present, a common precipitating cause of digitalis toxicity is hypokalemia resulting from the use of saluretic drugs in conjunction with digitalis.3,6-9 There is no specific arrhythmia due to digitalis toxicity. When the glycosides are used in excess, or if there is an associated loss

Epidemiology of osteoporosis; sex and race incidence of hip fractures.

Abstract: THE CLINICAL impression that osteoporosis is rare in Negroes has been mentioned in several clinical studies. 1-3 It is difficult to evaluate the influence of race on the incidence of this disease on the basis of clinical experience, since social, economic, and geographic factors determine the type of patient seen in individual institutions. Questions such as the sex, age, and race incidence of a disease usually can be settled only by epidemiologic studies in which the population at risk in each category is known and all the cases in the population sample are diagnosed. Fractures of the hip which result from minimal trauma provide an opportunity to study the epidemiology of osteoporosis, since presumably such fractures are the result of underlying bone abnormalities. In the absence of trauma or evidence for another type of bone disease, osteoporosis can be assumed to be the basis for the increased fragility leading to