1941: Medicine

Air Raid Shelters in Large Cities.

Now that the United States is at war the possibility of the bombing of large cities must be considered. Experience in England has shown that the herd instinct leads many people to forsake domestic shelters for communal shelters, many of which came to be used as dormitories, so that serious public health problems arise. Over-crowding, insufficient closet accommodation, defective ventilation and lack of cleanliness, as well as dampness, all have to be considered. Regular medical supervision of shelters must be arranged for. Children should be sent into the country when possible as should expectant mothers, the aged, the crippled and the infirm. Arrangements for proper ventilation and heating have to be devised. Suitable shelter wardens are chosen to provide for proper management. A general discussion of the problem in England will be found in the Proceedings of the Royal Society of Medicine, 1941, 34; 125-138.

Cases of open tuberculosis found in shelters should be hospitalized promptly. A close watch should be kept in shelters for lice, fleas, and bed bugs; and shelter wardens should be instructed how to deal with such pests.

The principle of the mask for reducing the risk of droplet infection in shelters is believed to be sound and methods of practically applying it are being considered. Smoking is prohibited in public shelters except where a separate compartment can be set aside for smokers.

Alopecia Following Use of New Antispasmodic Drug (Cyverine Hydrochloride).

Levin and Behrman (J.A.M.A., 1942, 118: 41-43) report a case of a white woman, age 49, who after thirty days treatment with cyverine hydrochloride for intestinal spasm, began to lose hair rapidly from the scalp; this progressed to nearly complete baldness. The drug has been shown by pharmacologists to cause almost complete relaxation of smooth muscle and hence has been used for its antispasmodic effects in pylorospasm and in spastic colon.

Auricular Fibrillation.

In the treatment of auricular fibrillation most clinicians now recommend digitalization and then the continuance of just enough digitalis to keep the pulse rate in the lower seventies. Formerly quinidine was used in order to cause a reversion to normal rhythm. Such reversion was sometimes obtained in younger and middle aged people, more rarely in older people. Many patients, however, show a severe toxic reaction when quinidine is administered and some clinicians now prefer not to use this drug at all. Embolism may occasionally occur in patients with auricular fibrillation whether quinidine is used or not. Some fibrillating patients (even when the pulse is slowed) are sensitive to the feeling of irregularity; this sensitivity can be lessened in many cases by giving a half-grain tablet of phenobarbital three or four times in the twenty-four hours.

Aviation Medicine.

The entrance of the United States into the World War since Japan's attack on Pearl Harbor finds this country far better prepared in aviation medicine than when it entered the World War in 1917. The former war made investigators acquainted with a whole series of questions regarding aviation that demanded answers. Some of the answers were supplied by experience during the war itself but more of them resulted from the experience of commercial aviators during the 20 years that followed the war.

During the former war the task of aviation medicine was to prepare pilots to get the most out of their planes; in the present war it will also be necessary to assist the pilot to get the most out of himself. For a discussion bearing upon the selection of flying personnel, upon protection against the effects of high acceleration, upon oxygen supply for high altitude flying, upon protection against air embolism, upon instruments and accessories and their simplification, upon visual problems and upon fatigue, the article by Captain J. R. Poppen of the U. S. Navy may be consulted (J. Aviation Medicine, 1941, 12: 53-71). The author emphasizes the importance at this time of coordinated concerted effort for fruitful research. A good review of recent progress in aviation medicine will be found in the article by J. F. Fulton (New England J. Med., 1941, 225: 263-268).

Prospective aviators and their physicians should read the volume Fit to Fly by M. C. Grow and H. G. Armstrong (New York, 1941).

Blood-Typing of Soldiers.

It has been suggested that each soldier in the army have his blood tested and that he should carry a metal tab upon which is recorded the blood-type to which he belongs. This knowledge, together with the quick methods of typing by means of rabbit blood now available, would greatly facilitate the use of transfusions in the treatment of war wounds.

Calcium Requirements of the Body.

Recent studies (J. Nutrition, 1941, 21: 577) indicate that the daily calcium requirement of adult human beings is from 9.6 mg. to 10.7 mg. per kilogram of body weight.

The best dietary source of calcium is milk though carrots, fresh lettuce and string beans are also important sources.

Cancer and Other Malignant Tumors.

Knowledge of malignant neoplasms and of the conditions of their growth has been making rapid progress, thanks to intensive research in all countries. The results of treatment of cancer, though far from satisfactory, are far better than they were, thanks especially to earlier diagnosis by physicians and to earlier reporting by patients of suspicious symptoms. For data on the encouraging aspects of cancer control the article by F. E. Adair (Hygeia, 1941, 19: 393-396) should be read, as well as the Honyman Gillespie lecture by R. McWhirter (Edinburgh M. J., 1941, 48: 452-469). Most heartening are the statistics of cured cancer of the breast. Hope is now held out for the treatment of multiple myeloma (malignant bone tumor) through administration of radio-active strontium by mouth.

In Scandinavian countries a form of anaemia (Plummer-Vincent syndrome) develops because of insufficient vitamin intake and may be followed by cancer of the throat. Timely treatment of the anaemia by brewer's yeast and green vegetables is said to prevent the cancerous development.

For a general review of the possibilities of improved therapy for cancer patients and of the experimental work now being done upon cancer the work by Carl Voegtlin (J.A.M.A., 1941, 116: 1491-1497) may be consulted.

The importance of popular education as a factor in the solution of the cancer problem has again been emphasized by J. M. Swan (New York State J. Med., 1941, 41: 1849-1853), and by J. R. McKeldin (Bull. Am. Soc. Control Cancer, 1941, 23: 7-8) (See more below regarding Cancer).

Cirrhosis of the Liver.

We observed at the Johns Hopkins Hospital during the past year an alcoholic patient who gave evidence of liver injury with marked jaundice and with development of ascites at the same time. The jaundice cleared up in a few weeks. The ascites persistently recurred after repeated tapping for several months. He was given a high-protein, high-carbohydrate, low-fat diet and large amounts of Vitamin B-complex, including brewer's yeast by mouth, and liver extract parenterally. While on this regimen the ascites gradually diminished and disappeared and has not recurred after several months even though the patient has resumed the use of alcohol.

Epidemic Myositis.