Epidemic of aseptic meningitis due to Leptospira pomona

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be occurring in one plane of the body while little change is observed in other planes. CLINICAL USE OF THE PROTEIN-BOUND IODINE DETERMINATION IN A GENERAL HOSPITAL. Philip K. Bondy, M.D. and Bernard L. Hallman, M.D. (From the Department of Medicine, Emory University School of Medicine, Atlanta, Ga.) The development of a simple method (Barker and Humphrey) for the PBI determination has made this test available for routine hospital practice. The method has been used for over 1,700 determinations in the past year. Normal values fall between 3.4 and 7.8 mcgm./lOO ml. of serum. The value is elevated in hyperthyroidism and after the injection of iodine-containing compounds. It is depressed in hypothroidism. It is particularly useful in the diagnosis of cases (e.g., heart disease, fever, anxiety and psychosis) in which the BMR is misleading. In certain patients the diagnosis can be made only by use of the PBI. Antithyroid medication causes an immediate fall of the PBI, with a slower fall of the BMR. The PBI therefore confirms the adequacy of antithyroid dosages but does not indicate that the metabolism has returned to normal. The clinical disadvantages of the PBI arise chiefly from falsely elevated levels caused by contamination. After pyelograms the PBI is elevated for one to two months; gallbladder dyes cause a spurious elevation for up to six months. The PBI has proved to be a valuable addition to the diagnostic armamentarium. USE OF ACTH AND CORTISONE IN THE PREPARATION OF PATIENTS FOR OPERATIVE STRESS. Laurence H. Kyle, M.D., William P. Walsh, M.D. and Paul D. Doolan, M.D. (From the Department of Medicine, Georgetown University School of Medicine, Washington, D. C.) One patient with panhypopituitarism, prepared with testosterone and given large amounts of cortical hormone at the time of craniotomy, tolerated the operation well and demonstrated an adequate but brief catabolic response. Another patient with pituitary insufficiency was given ACTH for eight days prior to abdominal exploration. Although there occurred marked eosinopenia and a moderate rise in urinary 17-ketosteroids, there was no appreciable increase in urinary nitrogen excretion during ACTH therapy or following surgery. One patient with Addison’s disease complicated by pregnancy underwent a normal uneventful delivery after treatment with cortisone and NOVEMBER,

1951

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hormone. In one patient with due to hyperinsulinism the administration of ACTH for four days before operation was associated with a rise of blood sugar to normal levels and a significant decrease in blood glutathione levels. These patients are presented as examples of the value of hormonal therapy in such conditions as permit logical application on the basis of sound physiologic facts. ELECTROENCEPHALOGRAPHIC ABNORMALITIESIN PATIENTSWITH LIVER DISEASE.Robert A. Wise, M.D., Robert D. Westphal, M.D. and Peter E. Kellawuy, Ph.D. (From Baylor University College of Medicine, Department of Medicine, Houston, Tex.) This study was undertaken to determine if the electroencephalogram would reveal evidence of liver dysfunction that was not evident clinically, It is not unknown for severe liver cell destruction to come to the doctor’s attention because of mental symptoms, without jaundice. Electroencephalograms were made in twenty-two cases at the height of their jaundice and repeated when either the liver function tests improved or when the clinical states improved. Eight of eleven cases of cirrhosis showed definite abnormality, three were questionably abnormal, and these eIectroencephalographic ahnormalities remained about constant in spite of clinical and laboratory improvement. Two of six cases of viral hepatitis were definitely abnormal, one clearing with recovery and the other persisting; three of the six were normal and one of the six was borderline. One case of cardiac cirrhosis was normal. Two cases of odstructive jaundice were normal. One of two cases of fatty liver was abnormal and the other borderline. This work shows that bilirubin elevation is not a factor in causation of electroencephalographic abnormalities; that when the sensorium is grossly abnormal, the electroencephalogram is also; that when the patient’s sensorium is clear, the electroencephalogram may be abnormal; and that no single liver function test can be correlated with the electroencephalogram. EPIDEMIC OF ASEPTIC MENINGITIS DUE TO LEPTOSPIRA POMONA. Morris Schaefer, M.D. (From the Communicable Disease Center, Virus and Rickettsia Section, Montgomery, Ala.) This report, to our knowledge the first of its kind in the United States, deals with an epidemic of Ieptospirosis wherein aseptic meningitis

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American Federation for Clinical Research

was the predominant clinical feature. Sporadic cases of this type of infection (swineherd’s disease) have been recognized and reported abroad on many occasions. The outbreak occurred in a rural area in southern Alabama and involved about fifty of approximately eighty people, mostly adolescents and young adults, who had been in swimming in a commonly frequented swimming hole, on July 4, 1950. A dead hog was reported to have been seen in the creek previously. Within several days to two weeks these individuals began to come down in rapid succession with fever, headache, nausea, myalgia, arthralgia and stiff necks and backs. In some, conjunctivitis was prominent and in a few transient maculopapular rashes were observed. None had jaundice. Spinal fluid findings in about six examined were compatible with the clinical signs of aseptic meningitis. From twenty-two of these patients paired serum specimens were obtained and tested against all of the available viral and rickettsial antigens, with negative results. However, the majority showed marked rises in antibody titers against L. Pomona and less significant ones against other leptospira strains. Controls of similar age and locality distribution, but not ill at this period, were negative.

AUREOMYCIN AND TERRAMYCIN IN TREATMENT OF AMEBIC COLITIS.Eugene Brown, M.D., E. Xafiier Burson, M.D. and John C. Ransmeier, M.D. (From the Department of Medicine, Emory University School of Medicine, Atlanta, Ga.) Aureomycin was used in four patients with amebic colitis and in three asymptomatic cyst passers. Terramycin was administered to five patients with colitis and to two cyst passers. The dosage in most cases was 0.75 gm. orally every six hours for ten days. The stools usually became free of amebas on the third or fourth day of treatment, with subsidence of diarrhea and cramping. Proctoscopy revealed rapid healing of lesions in the rectosigmoid. One amebic colitis patient relapsed a month after treatment elsewhere with aureomycin 1.5 gm. daily for one week. He was retreated with aureomycin 23.5 gm. in eight days. Another relapse occurred two months later but responded to a course of 31 gm. in ten days. The patient was free of symptoms and amebas when reexamined six and one-half months later. Ten patients were observed from three and

one-half to fourteen months following treatment. Except for the case described above, stools remained negative for E. histolytica. Giardia lamblia and H. nana, however, were not eliminated. The remaining four patients had negative stools five, fourteen, fifteen and thirty days after treatment. Long remissions can be achieved in most patients with amebic colitis by aureomycin OI and cysts are readily terramycin therapy, eliminated. We have as yet observed no relapse after administering 3 gm. of either drug daily for ten days.

LABORATORY AND CLINICALSTUDIESON TERRAMYCIN. Ellard M. Tow, M.D. and Daniel E. (From the Department of Jenkins, M.D. Medicine, Baylor University College of Medicine, Houston, Tex.) Fifty patients with infections of varied etiology were treated with terramycin. The in vitro sensitivity of the etiologic agents to terramycin was correlated with the therapeutic results. The response of infections due to gram-negative bacilli, lymphogranuloma venereum, granuloma inguinale and intestinal amebiasis was comparable to that obtained with aureomycin therapy. Occasionally relapses occurred following cessation of terramycin therapy in grampositive coccal infections. Staphylococci and streptococci frequently persisted in cultures of the sputum and urine during terramycin therapy. When a leukocytosis was associated with infection due to terramycin-sensitive organisms, the leukocyte count usually returned to normal precipitously after the institution of therapy. A transient relative increase in eosinophils was frequently noted during the administration of the antimicrobial agent.

SPECIFIC ANTISERUM AGAINST ERYTHROCYTES FROM SICKLE CELL ANEMIA; ITS USE FOR DIFFERENTIATIONOF SICKLE CELL ANEMIA FROM SICKLE CELL TRAIT. Rose G. Schneider, Ph.D. and William C. Levin, M.D. (From the Department of Internal Medicine, University of Texas, Medical Branch, Galveston, Tex.) Washed erythrocytes from two individuals with sickle cell anemia were injected into rabbits, and the resulting antisera were absorbed with erythrocytes of the appropriate blood group and type. The antiserum was tested against erythrocyte suspensions from twenty-four individuals with sickle cell anemia, thirty-two with sickle cell trait and 148 normal individuals. The erythrocyte suspensions from all of the AMERICAN

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