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none of the drug. In tabulating his results, eleven
of the treated cases are shown to be completely
relieved, while only six in the control group are so
designated. In those treated with the chemical,
only two are listed as unrelieved, while this desig-
nation is applied to ten in the other group.

The modus operandi of the substance has been
explained by British and Belgian observers on the
basis of restoration of the cellular carbohydrate
metabolism of the allergic individual. Whether or
not this hypothesis is correct, there is one reassur-
ing fact that stands out prominently in all of the
reports reviewed. It is the absence of any untoward
effect except a moderate amount of pain at the site
of injection, and many of the patients were infants
who received the same dose as an adult.

It is necessary to carry out the routine allergic
investigations even if treatment by this substance
is contemplated and its use does not preclude a
thorough physical investigation. Routine stool ex-
amination for the presence of parasites has been
stressed and positive findings have been reported
more often in the case of the allergic than the
non-allergic. Elimination of parasites must be ac-
complished before the specific medication (ethylene
disulphonate) is started.

From available statistics, ethylene disulphonate
appears to be worthy of a trial in all severe allergic
conditions. We are especially impressed by its po-
tentialities in intractable allergy, in multiple sen-
sitivities, especially to the basic foods, and cer-
tainly where a doubt exists in the doctor's mind
about strict adherence to his instructions for die-
tetic or other mandatory routine.



1. Wasson, V. P.: Archives of Pedialr
517, Sept., 1943.



New York, 60:511-



ON THE IMPORTANCE OF MALARIA AS A
CAUSE OF FALSE POSITIVE SERO-
LOGIC REACTIONS

It is obvious that reporting to a person that he
or she has syphilis, when this is not true, is doing
that person a very serious injustice and injury.



From numerous studies it has been shown that
yaws, leprosy, infectious mononucleosis and malaria
are diseases in which positive serologic tests for
syphilis can be frequently expected. In occasional
instances other conditions; e.g., pneumonia, vacci-
nia, measles and other acute febrile diseases give
rise to false positive tests.

Since yaws and leprosy are extremely infrequent
diseases in the United States infectious mononu-
cleosis and malaria will be the chief causes of
biologic false positive serologic recations. Both of
these diseases are common and often are present in
a subclinical state.

Latent malaria may produce positive tests easily
mistaken for latent syphilis and the distinction be-
tween the two conditions not always easy. In a
review of all the cases of naturally occurring ma-
laria seen at a U. S. Marine Hospital between July,
1936, and July, 1940, the following facts were
established. 1

Total cases of malaria 64

Total cases with positive serologic tests 19

Cases diagnoses as syphilis 7

Cases probably due to syphilis 4

Cases with false positive serologic reactions 8

A 20-year-old white boy's Kahn reaction was 3
plus. Wassermann strongly positive. On June 28th
(three days after admission) he had a chill and a
t. of 40.2° C. A blood smear showed tertian ma-
laria. Treatment with quinine was begun.

On 7/1 Kahn — 3 plus; Wassermann — strongly positive
7/8 Kahn negative; Wassermann — negative
7/12 " " " "

7/19 "

Prior to the development of the chill this patient
was considered syphilitic and would have been
treated as such had he not fortunately developed
clinical malaria. A smear had not been taken in
this case prior to the chill so that it cannot be
stated that he had no evidence of malaria prior to
onset of chill. It is the writer's belief that he had
chronic malaria, the only manifestation of which
were the positive serologic tests.

The longest period of positivitv of serologic re-
actions with quinine therapy was 18 days after
the last chill. This occurred in only one case. The
other cases all had negative reactions within a
period of 10 days following the last chill.

It would then appear that if one allows a month
to elapse following malarial infection, the serologic
reactions should certainly have become negative,
assuming that adequate therapy has been given.

In this very week this case came to my atten-
tion: A young man, after being given a report of
'positive blood." was discharged from the Army,
probably from some other cause. He went home,
told his story to a physician and requested treat-
ment. This physician found no evidence of syph-

1. T. R. Dawber, in Annuls Internal Med., Oct.



SOUTHERN MEDICINE & SURGERY



February, 1944



ilis, blood or otherwise, and declined to give treat-
ment. The young man went to another doctor,
with the same result.

Then he wrote the letter. He was much per-
turbed. Possibly his mind may never be at rest
again.

The fact should never be lost sight of that a
positive Wasserman or Kahn reaction is not in-
fallible proof of syphilis.



HUMAN BEHAVIOUR

James K. Hall, M.D., Editor, Richmond, Va.



ILLITERACY AND WARFARE

Killing one's fellow-human has become one of
the high arts. The illiterate may kill any other
animal than man and do the killing thoroughly and
well. But the unlearned man is not permitted to
kill his enemy in warfare. The American soldier
must be able to read and to write, otherwise he
cannot be commissioned to indulge in human
slaughter. The reason for the necessity of literacy
in the soldier is that killing in warfare is now per-
formed by science. Now the soldier merely oper-
ates the machinery that does the killing. The illit-
erate may be able to manipulate rather complicated
machinery in war and in peace; but most of the
instruction in the mechanisms utilized in killing
and in destroying property in warfare is proffered
in printed language, and the illiterate neither reads
nor writes any language. Because the illiterate is
helpless in the interpretation of written and of
printed words, the most robust and valorous and
ambitious young man must first acquaint himself
with letters if he aspires to the reputation got
sometimes at the mouth of the flaming cannon.

Modern Mars refuses admission to his battalion
all those who are defective or diseased in structure
or infirm in attributes; nor can the god of war
instruct the young man how to twang the bow and
to interpose the shield against the darts of the
enemy unless the young man can understand the
meaning both of the- printed and the spoken word.

It was not so in more distant days. No type-
writers and no pens and no telephones were made
use of during the long siege of ancient Troy.
Achilles moved the Greeks and struck terror to the
heart of the lovely wife of Hector by his death-
defying spoken words. Mahomet, the prophet and
the founder of a mighty empire, remained unable,
did he not? to read either the morning or the even-
ing paper. And the brave, appealing Joan of Arc
was illiterate and probably additionally handi-
capped by hallucinosis. Yet she still lives as no
mean figure in the art of war.



An illiterate has been defined somewhat techni-
cally as a person ten years of age or older who
cannot write in any language. We pay great defer-
ence to written and to printed language — and also
to spoken words. But man speaks, even if his lips
are immobile, and if he forms no words. Man in-
sists upon expressing himself, unless he is engaged
in repressing his ideas.

Forever and always man is wondering whether
to say it nakedly, as he thinks it; to repress it en-
tirely; or to modify it by paint and mask so that
when released his idea may be neither recognized
nor understood. One of the purposes of the use of
language is to conceal thought or to cover up igno-
rance. Warfare has always made use of language
either to inform or to deceive. The modern soldier
must be as able to interpret printed words as to
identify and to use the military mechanisms.

In the ancient Commonwealth of Virginia more
than 28,000 drafted young men have been refused
admission into the armed service because of illit-
eracy. Almost enough men to constitute two divi-
sions are kept out of the army because they cannot
properly interpret typed and written words. In
their stead many fathers of children have been
taken into the service; and the father of children,
however valiant, is an expensive soldier. In the
county in Virginia in which I write these words a
Negro father of eleven children has lately been
taken into the army. His services will cost the
public treasury almost $200.00 a month in compen-
sation to him and in guardianship of his family.

If the state would have its young men to do
the killing incidental to warfare, it must first give
them adequate instruction in the art of making and
of interpreting visible words. The man who would
aspire to kill his fellow-man with some degree of
artistry must first develop some appreciation of
linguistics. Even an enemy might object to being
killed by an illiterate. I am unwilling to enter upon
a discussion of the relationship between illiteracy
and ignorance. The usual assumption is that the
two words illiterate and ignorant are practically
synonymous. But I have known keen-minded indi-
viduals who could not read and write.

The educational processes may be too firmly
founded upon the belief that all learning must
come through the printed page. We would be much
more validly educated if less of our learning were
derived from printed words. The arts and the
crafts are almost completely neglected by the
schools. Yet they possess pedagogical worth as well
as economic value. We still have little understand-
ing of the educational process. Not infrequently
much more would be learned if words, printed or
spoken, were not used at all.



February, 1944



SOUTHERN MEDICINE &■ SURGERY



RHINO-OTO-LARYNGOLOGY SURGICAL OBSERVATIONS



Clay W. Evatt, M.D., Editor, Charleston, S. C.



CONTROL OF NASAL HEMORRHAGE

Almost everyone has seen epistaxis continue
despite skilful postnasal and antenasal packing.
I have seen several such hemorrhages stopped by
the intravenous administration of a solution of
oxalic acid. 1 This phenomenon has not been ex-
plained. This chemical has not been found to be
toxic when administered properly and in no way
endangers the status of the patient. It appears
that contraindications to its use are essential hy-
pertension, peripheral vascular disease, thrombo-
angiitis obliterans and allied conditions. If the
hemorrhage in any given case is deemed more im-
portant than any of these conditions, its use should
still be considered.

After extensive primary or secondary hemor-
rhage a patient may be a candidate for transfu-
sion.

For the patient whose condition after operation
would be endangered by any type of thrombosis
this substance is contraindicated.

As a prophylactic 2 c.c. (0.1% sol.) may be given
one to one-half hour prior to operation, followed
by the same amount immediately afterward.

In cases of profuse hemorrhage 3 to 5 c.c. intra-
venously, followed in one-half hour by 2 c.c, is to
be given intramuscularlv, with the addition of 2
c.c. at hourlv intervals for three doses if the hem-
orrhage does not stop.

Its action is almost immediate, and one adequate
dose will persist in its activity for several hours.
It contains no alkaloids or proteins, and side effects
are not to be expected.

It is economical, easily administered, nontoxic
and efficient.

All I know about oxalic acid is that it is sup-
posed to be poisonous, it is used as a bleaching
agent, rhubarb is said to contain it; and sodium
oxalate is placed in tubes into which blood is to be
collected for certain tests, the purpose being to
cause the calcium in the blood to unite with the
oxalate radical, forming insoluble calcium oxalate,
which precipitates from the blood and so makes it
incapable of clotting.

This measure is put before you for what it is
Worth. The sponsor comes from a first-clas school
and publishes in a first-class journal.

Write him for a reprint.

I. \V. F. IIulsc. Cleveland, in Arch, of Otolaryngology, June,



OF THE STATF

DAVIS HOSPITAL
Statesville



K the German arm* wounds of the cyebal lare sutur-
ed in layers, in some of which sterilized women's hair is
used. — Australian & New Zealand J. of Surf;.



PTOSIS OR PROLAPSE OF THE KIDNEY

The eight kidney is more subject to displace-
ment than the left. Downward displacement is apt
to produce kinking of the ureter and so, obstruc-
tion to the flow of urine from the kidney to the
bladder, and the consequent collecting of urine in
the pelvis under pressure tends to destroy the kid-
ney substance.

There may be prolapse when standing or sitting,
and the kidney return to its proper position when
the patient is lying down, this often relieving the
obstruction. Where there is pain from the ob-
struction this may also relieve the pain, due to the
fact that the obstruction is relieved and the urine
which has collected in the kidney pelvis will drain
down into the bladder.

The hydronephrotic kidney may be very large,
an enormous amount of urine collecting in the
kidney during the day and draining out at night,
although in some cases the kidney pelvis remains
over-distended for long periods of time. The drain-
age of large collections of hydronephrotic urine ex-
plains the unusual amount of urine passed by some
patients at night.

Any pain complained of in the side may indicate
renal trouble especially on the right side.

With the patient lying on a table on the left
side a loose kidney can sometimes be felt by gentle
palpation. With the patient standing a kidney can
be felt fairly well and, since this causes the pro-
lapse to become more pronounced, it may be asso-
ciated with the characteristic pain of ptosis of the
kidney.

Undue mobility of the kidney is caused by ab-
sorption of the fat pad in which the kidney lies,
due to disease, sickness, or possibly to injury; laxitv
of the abdominal walls from any cause; congenital
absence of the peritoneal support of the kidneys;
ptosis of the other abdominal viscera; repeated
jars and jolts as from jumping or falling from a
distance.

I know a test pilot who says that he and others
in his profession have ptosis of the kidneys. As
they pull out of a dive there is a tremendous down-
ward pull upon all the abdominal viscera. Doubt-
less, also, the rough riding in jeeps and tanks over
rough terrain would tend to produce ptosis of either
or both kidneys.

Usually the kidneys are more mobile in women
and ptosis is far more frequent in women. The
greater frequency of this mobility and prolapse of
the right kidney is explained thus:



SOUTHERN MEDICINE & SURGERY



February, 1944



1. The heavy liver, moving with respiration, con-
stantly pounds on the right kidney.

2. The right renal artery is the longer and this
gives the right kidney more latitude of move-
ment.

3. The right kidney is naturally a little lower
than the left and so more exposed to the ap-
plication of force.

Pain in the kidney region may be mild or se-
vere, sometimes agonizing. Nausea and vomiting
sometimes occur. The continued pain and dragging
sensation cause extreme nervousness in many cases.

Traction upon the gastro-intestinal tract may
cause gas on the stomach or indigestion, possibly
enough obstruction of the duodenum to give pro-
nounced symptoms. Traction on the bile ducts
may produce symptoms. Rotation with torsion of
the vessels might cause hematuria and if long-con-
tinued, serious renal lesions.

Traction and an angulation of the ureter causes
intermittent obstruction, which later may be con-
tinuous. Hydronephrosis may result with degen-
eration of the kidney substance with great impair-
ment of the function of the right kidney. Such a
kidney is more subject to infections.

In undertaking the diagnosis the following ex-
amination should be made:

1. A cystoscopic examination, with ureteral
catheterization.

2. Collection of specimen of urine from each
kidnev. Measurements of the urine drawn off
from each kidney pelvis.

3. An x-ray picture made with catheters in place
aids greatly in locating calculi. This should
be done before the pelvis is injected for
pyelogram.

4. A pyelogram shows position, shape and size
of the kidney pelvis, and often yields other
valuable information in regard to tumors and
other conditions of the kidney.

5. With the patient standing or lying an x-ray
picture of the kidneys with the radiopaque
solution still in the renal pelvis will demon-
strate just how far the kidnevs come down.

Among the pathological conditions causing pro-
lapse of the right kidney are:

1. Nephroptosis.

2. Aberrant blood vessels.

3. Calculi. (It must be remembered that some
calculi are sometimes non-opaque).

4. Infections of the kidney pelvis or the ureter
or the kidney itself.

5. Spasms of the ureter.

6. Congenital stenosis of the ureter, especially
at the uretero-pelvic junction.

7. Abdominal tumors pressing on the ureter.

8. Inflammatory conditions about the cecum and
appendix, causing pressure on the ureter or



even obstruction from combined pressure and
inflammation.
9. Tumors of the cecum and ascending colon.

10. Back pressure from prostatic obstruction.

11. Back pressure from bladder hypertrophy,
especially where there is obstruction to the
urethra, such as in prostatic disease or other
similar conditions.

12. Fibrous bands.

Relief is afforded in some cases by an abdominal
support, with or without a kidney pad.

Our advice to patients who have any great de-
gree of prolapse is that the kidney be anchored in
its proper position. The standard operation gives
good results and recurrences are extremely rare.

Within the past two years in this clinic we have
operated upon patients who had kidney suspensions
as far back as fifteen years ago and some more
recently. These patients were all operated upon
(the second time) for pelvic conditions which had
no relation to the former prolapse of the kidney.
We have found in every instance the kidney had
remained in proper position all these years; and
they all stated that they had no further attacks of
trouble such as they had had before the kidney
was fixed in the correct position.

I feel that patients may be reassured about this
operation since many of them have been told that
recurrences are the rule rather than the exception.
Recurrences in our experience have been almost
nil.



Duke Psychiatrist to Have Charge of Charlotte
Mental Hygiene Clinic

Dr. R. Burke Suitt, new psychiatrist of the Charlotte
Mental Hygiene Clinic, by an arrangement perfected in
January, now conducts two Mental Hygiene clinics each
month in Charlotte.

Dr. Suitt, a native of North Carolina, attended Trinity
College and the St. Louis College of Arts and Sciences. He
was graduated from the St. Louis School of Medicine in
1932 ; was instructor in psychiatry at Henry Phipps Psych-
iatric Clinic of Johns Hopkins School of Medicine; asso-
ciate in neuro-psychiatry at Duke LTniversity, and assisting
neuro-psychiatrist at Duke Hospital since the opening of
the department in 1940. In July, 1942, he joined the 65th
General Hospital as psychiatrist and served there until re-
leased from military duty late in 1943.

He is a Fellow, American Medical Society; a Diplomate,
American Board of Psychiatry and Neurology; a member
of American Association for the Advancement of Science,
International League Against Epilepsy, Southern Medical
Association, Allied Regional Societies, Tri-State Medical
Association, American Psychiatric Association, National
Committee for Mental Hygiene, Association for Mental
Deficiencv, and Southern Psychiatric Association.



Diabetes — In families with a predisposition to the dis-
ease starchy food and sugar should be restricted by way
of prevention. — Christian.



Diabetes. — Only the unusual case requires the care of a
specialist. — Christian.






February, 1944



SOUTHERN MEDICINE & SURGERY



CLINIC

Conducted by

Frederick R. Taylor, B.S., M.D., F.A.C P.,

High Point, N. C.



A 6-yr.-old boy from an orphanage was brought
to me on June 9th, 1925. His chief symptom was
fever. Three months before this he was belieevd
to have had a mild attack of influenza which kept
him in bed 3 days. He seemed well a week later
except for weakness, but then one night had a
violent attack of spasmodic croup, lasting only a
few hours. A week later Dr. H. L. Brockmann saw
him and said his left lung was congested. At that
time his t. went to 104 and stayed there 3 or 4
days. Dr. J. T. Burrus then saw him and prescrib-
ed mustard packs, and his fever was not so high
afterward, he had a cold sweat as soon as he would
get to sleep at night, and by midnight his t. would
get to 100-102, falling some by morning, but reach-
ing normal only by afternoon. No nausea or vom-
iting till the day before I saw him — he was nau-
seated all that day. Then he ate an orange and
had a severe abdominal pain ending with vomiting
the orange. He ate a good breakfast the day I saw
him, without pain. His bowels usually moved nor-
mally, but 3 days before I saw him he passed 2 or
3 spoonfuls of fresh bright blood per rectum. This
seemed to weaken him, and the next day he would
tremble like a leaf when picked up. Never had
any other hemorrhages. No sore throat or cough.
He breathed hard during his night sweats. No
edema. He complained of aching in his calves, and
they would stay cold when his feet were hot. No
headache or earache. He complained of lumbar
pain the night after the rectal hemorrhage, but
never before or since. No urinary symptoms. Uri-
nalysis at hospital negative. Pulse reported very
irregular at night. Rectal examination by Dr.
Brockmann negative.

He had never had typhoid fever, scarlet fever,
diphtheria, malaria, rheumatic fever, chicken-pox,
whooping cough or mumps. He had a mild pneu-
monia the winter before coming to me, a very se-
vere influenza in the epidemic just after he was
born, another mild attack V/ 2 yrs. before I saw
him. The attack the winter before he came to me
seemed mild, but he did not seem to regain his
health. He had measles two years before T saw
him. He had never been vaccinated against any-
thing and had had no operations or serious injuries.
His father died of influenzal pneumonia, his mother
and ] brother were well.

He showed adenoid facies, faucial tonsils moder-
ately enlarged, lingua! tonsil the largest I ever
saw. He was a mouth breather. He showed a gen-
eralized pallor. His neck, chest, abdomen and rec-



turn were negative. His station was normal, gait
slightly ataxic, no knee-jerks unless reinforced —
perhaps due to voluntary fixation. No clonus or
Babinski. Rough tests of sensation gave normal
findings. He had been referred by Dr. Brockmann
for a neurologic examination, and was referred
back to him with a negative neurologic report and
the suggestion that he have a special otologic ex-
amination, an x-ray study of his chest, and perhaps
a gastrointestinal x-ray study after having a ba-
rium enema. To be considered in diagnosis were
a simple post-infectious weakness and possibly epi-
demic encephalitis. His blood findings were nor-
mal including a negative Wassermann test.

The next day his walking got worse, and if he
tried to run fast his feet would tangle. T. 99.6 at
3:00 p. m., though it was said to be usually nor-
mal at that hour, t. record for the preceding 24
hrs.: Noon, 99.4; 3:00 p. m., 98.0; 9:00 p. m.,
97.0; 6:00 a. m., 99.0; 9:00 a. m., 99.4; noon,
99.4. He never complained of headache, but al-
most cried when he would have to walk a little
distance because his legs and ankles ached, though
they showed no tenderness or redness. Knee-jerks
decreased now — absent except with reinforcement
and then very weak. Pupils reacted promptly. A
von Pirquet tuberculin test was negative. An otolo-
gist gave a negative report. Dr. Jean V. Cooke of
St. Louis, who was holding a University of North
Carolina Extension Postgraduate course in Pedia-
trics, saw this boy and advised x-ray study of the
paranasal sinuses, pointing out that hemiplegia
had been attributed to antral infection and cleared
up in two weeks after treating the antra. He
thought the development too slow for epidemic en-
cephalitis. The boy certainly had an infection.
Though he had not had a cold or a cough for 2
months, Dr. Cooke suspected the upper respiratory



Online LibraryGreensboro CollegeSouthern medicine and surgery [serial] (Volume 106 (1944)) → online text (page 11 of 98)