Walsh McDermott

Absence of indicators of the influence of its physicians on a society's health: Impact of physician care on society

There are no established indicators for measuring the influence of its private physicians on a societys health. For a brief period the age-adjusted death rate, an important indicator of the public health effort, also served to reflect a portion of the influence of the personal physician system. Particular medical interventions could be linked to specific sites in the pathogenesis of microbial disease in a way not yet permitted by the available knowledge of the common nonmicrobial diseases. Our national allocations for health cannot be made rationally until we develop indicators for measuring incremental investments in either system, but especially for the personal physician system. For death rates per se fail to accurately reflect the workings of this system which is concerned primarily with prolonging effective life by preserving or restoring function in an individual person.

Toxicity of streptomycin

Abstract The administration of streptomycin by the intramuscular route in a daily dose between 1 and 3 Gm. is well tolerated for a one or two-week period by most individuals. With the single exception of vestibular dysfunction the same close regimens are well tolerated by most individuals for periods as long as four months. Although daily doses larger than 3 Gm. are apparently well tolerated by some individuals for short periods of time, it is probable that 3 Gm. represents the upper limit of the safe daily dose. The histamine reaction, irritation at the site of injection and possibly the sustained febrile reactions are not caused by streptomycin but by impurities which are removable with refinements in the process of manufacture. All of the other manifestations of toxicity which have been observed after the use of impure streptomycin have also occurred during the administration of highly purified preparations of the drug. The toxicity of streptomycin is sufficiently low to justify the use of the drug in serious or potentially serious infections. Conversely, the incidence of toxicity, notably vestibular dysfunction, is sufficiently high after several or more weeks of therapy, that the drug should not be used for infections with a generally favorable prognosis such as. minimal pulmonary tuberculosis or chronic brucellosis.

EFFECTS OF ADRENOCORTICOTROPIC HORMONE AND CORTISONE IN PATIENTS WITH TUBERCULOSIS

In the early reports on the administration of adrenocorticotropic hormone and cortisone to patients with various disease states, there were described a number of effects, the reproduction of which might conceivably alter the course of infections in man. Among these effects were defervescence, decrease in edema and inflammation, change in antibody production, and alteration in the state of hypersensitivity to bacterial products. Clinical evidence of such effects was provided by Finland, Kass and Ingbar (1) who showed that adrenocorticotropic hormone may effect striking alterations in the course of pneumococcal and primary atypical pneumonia. Moreover, equally striking changes were observed by Freeman and his coworkers in two patients with pulmonary tuberculosis (2). The modification of response to infection, by an agent which presumablv acts solely upon the host, thus presents an opportunity for further evaluation of the participation of host mechanisms in tuberculous disease. There are relatively few forms of tuberculosis in humans appropriate for such a study. A serious form of progressive disease, with a reasonably predictable course, is necessary. It is desirable to avoid reliance upon chest roentgenograms as the sole means of evaluating changes in a tuberculous lesion. In this situation, the extent of viable tissue within a lesion must be determined by a procedure which is highly subjective before proper evaluation

Special articleAbsence of indicators of the influence of its physicians on a society's health: Impact of physician care on society

There are no established indicators for measuring the influence of its private physicians on a societys health. For a brief period the age-adjusted death rate, an important indicator of the public health effort, also served to reflect a portion of the influence of the personal physician system. Particular medical interventions could be linked to specific sites in the pathogenesis of microbial disease in a way not yet permitted by the available knowledge of the common nonmicrobial diseases. Our national allocations for health cannot be made rationally until we develop indicators for measuring incremental investments in either system, but especially for the personal physician system. For death rates per se fail to accurately reflect the workings of this system which is concerned primarily with prolonging effective life by preserving or restoring function in an individual person.

Aureomycin in typhus and brucellosis

Abstract The administration of aureomycin ∗ ∗The aureomycin used in this investigation was supplied through the courtesy of Doctor Benjamin Carey, Director, Lederle Laboratories Division, American Cyanamid Company, Pearl River, New York. to eleven patients with typhus (presumably murine) was followed in every instance by prompt defervescence and complete recovery. No instances of relapse were observed despite the fact that in seven cases the total period of antimicrobial therapy was limited to forty-eight hours or less. In four patients with acute brucellosis, one of whom had meningo-encephalitis, a similar prompt disappearance of the manifestations of the infection occurred soon after the start of aureomycin therapy.

Absorption and Excretion of Terramycin in Humans Comparison with Aureomycin and Chloramphenicol.

Summary A study has been made of the absorption, distribution, and urinary excretion of terramycin, aureomycin, and chloramphenicol in humans. The determinations of absorption and excretion of aureomycin and chloramphenicol following a single oral dose of drug were made in the same subjects. All 3 drugs were readily absorbed after oral administration. The maximum serum concentrations attained after oral doses of 50 mg per kilo were 25 to 50 μg per ml for chloramphenicol, 12 to 16 μg per ml for terramycin, and 3.3 to 12.5 μg per ml for aureomycin. Reasonably high serum concentrations of all 3 drugs were maintained with daily doses of 50 to 100 mg per kilo by mouth. Measurable concentrations of the compounds were obtained in the cerebrospinal fluid and in other body fluids when sufficiently large doses of the drugs had been administered. Urinary excretion of the 3 substances in biologically active form was similar, and high concentrations of drug were attained in the urine.

THE PROGNOSIS OF SYPHILITIC AORTIC INSUFFICIENCY

Excerpt The course of syphilitic aortic insufficiency is generally believed to be rapidly progressive.1, 2, 3, 4, 5, 6Death from cardiac failure is said to occur 12 to 36 months after the discovery...

Education and General Medical Care

Medical education needs to take into account the features of general medical care. Educators should stress the physicians capacity to come to appropriate decisions in the use of diagnostic tests and in referral and should attempt to inculcate the habit of thoroughness. The economics of present-day medical education may undermine its capacity to educate properly for general medical care. Adequate teaching of the discriminating use of diagnostic and therapeutic methods could be promoted directly through research in medical practice. Such research can be carried out despite economic constraints on research in medical schools if the right thinking is applied to important problems.

STREPTOBACILLUS MONILIFORMIS AS A CAUSE OF SUBACUTE BACTERIAL ENDOCARDITIS: REPORT OF A CASE TREATED WITH PENICILLIN

Excerpt Human infections with theStreptobacillus moniliformishave occurred either following a rat bite,1or as epidemics of so-called Haverhill fever, presumably due to infected milk.2Regardless of ...

Patterns of Health and Disease Among the Navahos

Community patterns of our Indian citizens range from ordinary American communities to ways of life more comparable with those seen in parts of Asia or South America. In each type the disease picture can be expected to be different and the ways of dealing with it must necessarily be somewhat dif ferent. The Navaho tribe is the largest Indian tribe, a group whose ways of life perhaps differ the most from the rest of the United States. The broad principles revealed in an analysis of Navaho health are applicable to other tribes, although the particular health situation of another tribe would depend on the circumstances of its tribal life.