inThe Journal Research Articles

Self-Examination Kit

To the Editor:— My whimsical turn of mind compels me to write a letter to the editor, prompted by the unintentional humor of the Question and Answer section inThe Journal, Feb. 18. Colleague Burt of Milford Center, Ohio, questions you in the cheerful confusion of our do-it-yourself age about the possibility of spreading wholesale across the face of the land a self-examination kit for Papanicolaou-minded women of today. May I call your attention to the interesting sequence of events which was evoked by the paragraph on Penny Cancer Kit in the February, 1955, issue of Today's Health? It was stated hopefully, A home kit costing only a penny offers a promising aid for drastic reduction of deaths from cancer of the cervix, second most common type of female cancer. This seemingly innocuous, but spectacular, proposal was promptly seized upon by W. B. McCunniff who, to fill up space in

Radiologic Estimation of Heart Volume

To the Editor:— An article on radiologic estimation of heart volume, by Dr. John S. Hanson, appeared inThe Journal( 176: 16 [April 8] 1961). The estimation of heart volume, of course, is no more accurate than the accuracy of the heart diameters used in its measurement. This involves the 3 measurements mentioned by the author: The broad diameter requires the accurate location of the juncture of the pulmonary conus with the left ventricle. This cannot be done with an ordinary chest film and can only be done accurately with the contrapulsatile motion demonstrable by fluoroscopy. The long diameter also has innate inaccuracies since it involves measurement of the pericardial fat pad in many cases, and its upper origin at the juncture of the superior vena cava with the right atrium can only be estimated. The greastest horizontal depth of the cardiac shadow is the third diameter

Osteoporosis and Multiple Myeloma

To the Editor:— I was concerned about the answer to M.D., Illinois to his question about osteoporosis inThe Journal, March 18, p. 1038. From the letter of inquiry I had the impression that the osteoporosis was limited to, or at least more severe in, the 11th and 12th thoracic vertebrae. Perhaps a more thorough differential diagnosis had already been undertaken and was not elaborated in the the letter; however, I would like to point out that multiple myeloma occasionally appears as a diffuse osteoporosis, particularly in the spine. If it has not already been done, I feel this patient should have several additional studies, including Bence-Jones protein, serum protein electroporesis, serum calcium and inorganic phosphorous, and alkaline and acid phosphatase studies.

Herpes Zoster

<h3>To the Editor:—</h3> There is a statement in the article by Drs. Yaffee and Greenberg inThe Journal(<b>175:</b>1009 [March 18] 1961) which is not quite correct. The authors state: "The site of the original 3 lesions was in the lower abdomen in the distribution of L-4 and L-5 dermatomes." Dermatomes are in the lower part of the thigh, foreleg, and foot.

Commercial Contraceptive Jellies and Creams

<h3>To the Editor:—</h3> The printing of the article "In Vitro Assessment of Commercial Contraceptive Jellies and Creams" (JAMA<b>176</b>:427 [May 6] 1961) is an all-time low in medical journalism inThe Journal. If the AMA must resort to printing articles of this type, I hopefully suggest that the time has come forThe Journalto close its printing doors. Yours for better medical literature.

Legalized Abortion in Eastern Europe

To the Editor:— The increased use of legalized abortion in Eastern Europe recently reported inThe Journal( 175 :1149 [April 1] 1961) has no medical justification. Better management of the complications of obstetrics has nullified the traditional indications for therapeutic abortion. Well-regulated clinics and well-trained physicians in increasing numbers are consigning interruption of pregnancy, with craniotomy on the living child, to the limbo of discarded, destructive obstetrical operations. As for the compelling socioeconomic reasons, one wonders how members of a profession dedicated to the saving of human life can be induced to cooperate in such a diabolical program. One of the most important precepts of the World Health Organization is, will maintain the utmost respect for human life from the time of conception; even under threat, I will not use my medical knowledge contrary to the laws of humanity. Surely these countries can find better ways of relieving social

Thesaurosis Caused by Hair Spray

To the Editor:— In an editorial inThe Journal, Nov. 5, 1960, entitled Dangerous Dusts and Furtive Fumes—`New' and Resurrected, pulmonary thesaurosis, believed due to hair spray, is referred to as a new but definitely established clinical entity. It should be made clear to readers ofThe Journalthat the concept of pulmonary thesaurosis is not proven, and that studies by the FDA and others do not confirm its existence. Bergmann and his co-authors originally described pulmonary thesaurosis in a report covering 2 patients in whom x-rays revealed slowly resolving hilar node enlargement and reticulated pulmonary densities. A third possible case was reported in Great Britain. In one subject, a scalene node biopsy showed epithelioid cells containing periodic acid-Schiff stain-positive granules. Both patients had been users of hair spray. Bergmann also injected 3 guinea pigs subcutaneously with hair-spray solids and reported finding a granulomatous reaction at the injection sites. The

Tuberous Sclerosis

<h3>To the Editor:—</h3> The failure to mention eye findings in Bourneville's disease in the otherwise excellent article by Duvoisin and Vinson inThe Journal(<b>175</b>:869, 1961) indicates that this is both infrequently present and insignificant in the diagnosis of this disease. While it is true that Earl (1932) observed only one case with eye manifestations in 29 cases, Van der Hoeve (1920-1932) was able to collect 26 cases, indicating that eye complications would be much more frequently found if they were looked for. The more or less typical raw-potato—like appearance of these spherical bodies in the vitreous is such that ophthalmoscopic diagnosis is possible. The 3 phakomytoses are easily distinguishable from each other; the only condition giving much differential diagnostic difficulty is hyaloid degeneration of the disc, which, of course, has no systemic manifestations. Since Von Hippel-Lindau's disease is vascular, it is easily ruled out.

Tranquility Remembered in Emotion

To the Editor:— In regard to the article inThe Journal, Nov. 5, 1960, p. 1242, and to many articles on the use of tranquilizers: One is apt to become more than a little frustrated. There appears to be a psychological mania for reporting the use of tranquilizers in a semihysterical (conscious or unconcious) manner. In fact, one has the definite impression that many physicians are afflicted with a neurotic compulsion for writing and prescribing tranquilizing drugs. In other words, too many physicians are on a tranquilizer dispensing and writing jag which must be motivated by some insecure feelings about their attempt to help people with emotional problems and their desire to report something. Now I would like to pose a few questions. What does psychoneurotic schizophrenic reaction mean? Why give occasional sedation and psychotherapy at intervals if the tranquilizers were being so helpful? The majority of

Treatment of Heart Failure

To the Editor:— In the article on Treatment of Heart Failure with Emphasis on the Use of inThe Journal, Dec. 24, 1960, Dr. Charles K. Friedberg states: Sooner or later diuretics are indicated in the treatment of all cases of heart failure. Diuretics, given alone, are far more powerful in removing the signs and symptoms of congestive heart failure than digitalis, rest, and restriction of sodium. If a patient with moderately severe, or severe congestive heart failure is given a powerful parenteral diuretic, a striking improvement of cardiac function occurs. The improvement in cardiac function as a result of the diuretics, unaided by digitalis, is so great that the fundamental conclusion must be drawn that the secondary metabolic manifestations, i.e., the accumulation of sodium and water, are far more potent in the production of congestive cardiac insufficiency than the primary system, that is cardiac incompetence itself. Thus, the

Dunlop's Traction

To the Editor:— Congratulations on the modifications ofThe Journalsince your editorship began. I have a minor complaint, however, concerning an article inThe Journal, Feb. 18, 1961, p. 573, entitled Supracondylar Fractures of the Humerus in Children, which concludes that a method of reduction called Dunlop's traction is the procedure of choice. This is, a very informative article and may do a great deal to improve the handling of a somewhat difficult and always potentially dangerous fracture. There are, in the article, some 21 references to Dunlop's traction, and in the references some 18 sources are quoted, but at no time do the authors bother to explain what Dunlop's traction is. I believe that the exact application of such traction is not common knowledge, the original article by Dunlop having appeared in Bone and Joint Surgery , January, 1939, p. 59. When such an otherwise excellent article is presented,

Dental Surgery During Anticoagulant Therapy

To the Editor:— The article by Behrman and Wright inThe Journal, Feb. 11, 1961, p. 483, pleased me and supported the conclusions of my study, that dental surgery can be performed safely while patients are on anticoagulant therapy. Without this timely evidence, the adverse reports from Boston in 1957 might have continued to deter physicians from permitting such treatment. Since the first report, many more patients have undergone dental surgery while under antithrombotic drug treatment. With observance of ordinary precaution and proper selection of patients, the physician and the dentist will have little trouble. The four steps advocated by Behrman and Wright during dental surgery and the follow-up precautions are excellent. It is to be hoped that this report will receive wide distribution among dentists, so that there need be less insistence on the part of the referring physician that the dental surgery is a safe procedure within the

False-Positive Reactions Among Narcotic Addicts

To the Editor:— I have noted the article inThe Journal, Jan. 28, 1961, entitled Biologic False-Positive Reactions for Syphilis Among Narcotic Addicts, in which the following sentence appears: The high proportion of non-reactive TPI tests among narcotic addicts with no history of syphilis and reactive STS provides direct evidence that certain drugs may induce BFP reactions. Unless other possible causes were thoroughly investigated, I wonder whether the conclusion that drugs have been demonstrated to cause biologic false-positive (BFP) reactions is justified. I should think the wording might be changed somewhat as follows: The high proportion of non-reactive TPI tests among narcotic addicts with no history of syphilis and reactive serologic test for syphilis ( STS ) is perhaps explained by the fact that addicts are subject to a number of conditions which are known to cause BFP reactions: viral hepatitis, malaria, and others. It may also be hypothesized that the chronic

Use of Screws in Fractured Neck of Femur

To the Editor:— I noted Dr. William Bickel's comment inThe Journal(Jan. 28, p. 341) on the use of hip screws for the treatment of fractured neck of the femur. I agree with his condemnation of the old type of screw of the Lorenz type in that it would produce distraction on absorption of the fractured area. There is a newly designed hip screw put out by Richards Company which permits retraction and obviates this problem. It also permits active compression of the fracture line. Ordinarily I have had no problem with its use as far as rotating the head of the femur is concerned. In one case I had a little difficulty when it became apparent that the screw was rotating the head. By releasing traction that had been applied to the leg on the fracture table for reduction, this disappeared and we were able to accomplish the

Purchase of Mount Vernon

To the Editor:— Our attention has been called to a statement inThe Journal, Feb. 11, under the caption, Purchase of Mount It is stated that Dr. Newell was instrumental in the Government's purchase of Mount Vernon for agricultural purposes. This is a misleading statement, the error of which should be obvious to many of your readers, but which could be confusing to many others. The enclosed page from our official handbook contains a concise statement, identifying the Association and reporting its ownership status. The Mount Vernon Ladies' Association was founded in 1853 by Miss Ann Pamela Cunningham, of South Carolina, for the purpose of acquiring the home of George Washington and holding it in trust as a national shrine. Under the guidance of Miss Cunningham, Vice-Regents in each state of the Union enlisted support and raised funds for the purchase of Mount Vernon. In 1858 an agreement was

Maximum Permissible Dose

<h3>To the Editor:—</h3> The title of my contribution inThe Journal, Jan. 21, p. 227, does not put the emphasis where I wish to have it put. Since your headline writer seems to have missed my point, I assume that I did not make the point clearly enough, and I am now apprehensive, lest those who read the essay also misunderstand it. I was talking about fear of injury to oneself by irradiation, not about the degree of hazard encountered in industry. I was trying to dispel the growing conviction of hazard in occupations in which film badges are used to eliminate hazards. I was trying to undo an evil that I am partly responsible for, as a member of the National Committee on Radiation Protection. The effect of radiation, diminishing as the exposure is made smaller, becomes unobservable for a certain range of exposures, but is presumed to continue

The New Fertility Testing Tape

To Editor:— InThe Journal, April 16, 1960, p. 744, Drs. Doyle, Evers, and Sapit report on The New Fertility Testing Tape, stating that a paper tape impregnated with glucose oxidase and a peroxidase will turn from pink to blue in presence of glucose. In cervical mucus, glucose is alleged to be derived partly from follicular fluid, although possibility of some glucose being derived from glycolysis within fundus and cervix is postulated. They recommend use of a special vaginal applicator to hold testing paper. If, after 3 minutes in vagina, it turns blue, woman is presumed to be in the fertile phase of menstrual cycle. Based on such assumptions, Fertility Testor Company recently placed large advertisements in Los Angeles Times insinuating that this technique would serve as an accurate method for contraception as well as conception,

The Labeling of Prescriptions

To the Editor:— InThe Journal(Jan. 14, p. 164) is a letter from Dr. Havener regarding the labeling of prescriptions with the name of the drug. While Dr. Havener seems to be a proponent of this procedure, your readers should not be left with the impression that there are no disadvantages to labeling prescriptions in the manner suggested. The two examples cited asreducing the possibiity of errorare equally subject to the argument thatthe possibility of error is increased. Patients should not be expected to be acquainted with the many similarities in drug names. A patient might think the name of a drug is the same as one previously causing an unfavorable response, with the result that the prescriber is led to another preparation less effective. Dosages are also a factor here, and this information may not be on the prescription label. A program that would encourage

Post-Irradiation Fractures

To the Editor:— I wish to commend you on the fine editorial which was published inThe Journal, Jan. 21, page 255, regarding post-irradiation fractures of the femoral neck. The experience of Bickle, Childs, and Porretta at the Mayo Clinic is well recorded and most deserving of attention. The concept that radiation changes are progressive and irreversible is something which is continually being stressed in the literature without any tempering based on clinical experience. Articles such as these emphasize that although the underlying biologic process may be severely impaired, clinical healing and reversibility of the situation can occur. Since many of the patients who show such late radiation injuries have often been cured of cancer, it is important to dispel the pessimism regarding such late injuries. This is not only true of the bone but also applies to many other organ systems where proper surgical or medical care can make

Etiology of Clinical Paralytic Poliomyelitis

To the Editor:— The earliest printed reference to fatal clinical poliomyelitis due to a nonpoliovirus was inThe Journalin 1953 (Steigman, A. J.; Kokko, U. P.; and Silverberg, R. J.: Unusual Virus from Poliomyelitic Spinal Cord, [in Correspondence] 152 :1066 [July 11] 1953). Comments on the multiple viral etiology of clinical paralytic poliomyelitis were made in 1960 in an editorial inThe Journal(Multiple Causes of Paralytic Poliomyelitis, Editorial, 174 :175 [Sept. 10] 1960). The disturbing, inescapable conclusion is that severe and even lethal paralytic poliomyelitis may be due to other enteroviruses. The past and current extent of the problem is unknown, and the risks in the future a matter for conjecture without complacency. The Journalnow carries a valuable contribution on this subject from California (Magoffin, R. L.; Lennette, E. H.; Hollister, A. C.; and Schmidt, N. J.: Etiologic Study of Clinical Paralytic Poliomyelitis, 175 :269 [Jan. 28]