Document Type: 
Document Number (FOIA) /ESDN (CREST): 
Release Decision: 
Original Classification: 
Document Page Count: 
Document Creation Date: 
December 14, 2016
Document Release Date: 
February 26, 2002
Sequence Number: 
Case Number: 
Publication Date: 
January 29, 1951
Content Type: 
PDF icon CIA-RDP80-00926A003000050013-1.pdf18.69 MB
COUNTRY ApproveOWk2 dM'NOD1188 ; ffl&p ~ , ,1Q 6 40C(~,3 00050013-1 CENTRAL INTELLIGENCE AGENCY ~'~~ REPORT NO INFORMATION REPORT CD NO. China/Czechoslovakia/Poland/USSR 2'5X1 A CASE I I 25X1 A DATE DISTR. 2 q Jan 1951 SUBJECT Subscribers to Transactions American Academy of NO. OF PAGES Ophthalmology and Otolaryngology PLACE ACQUIRED DATE ACQUIRED BY SOURCE DATE OF INFORMATION 25X1A NO. OF ENCLS. (LISTED BELOW) SUPPLEMENT TO REPORT NO. 25X1X The foil owing-is a list of individuals and institutions in China, Czechoslovakia, Poland and the USSR now subscribing to, F_ I 25X1 regularly receiving, the Transactions American Academy of Ophthalmology and Otolaryngology: Dr Louis WS Chang The Methodist Hospital Fatshan, Via Canton Kwangtung, China Lekarske Knihkupectvi Sokolska 31 Praha II - Czechoslovakia Glowna Biblioteka Lekarska Prof Dr Antonin Precechtel Chocimska 22 Otolaryngologicka Klinika Warszawa, Poland Karlovy University Prague II Vseobecna nemocnice USSR Moskva/l97ul, Kominterna Czechoslovakia 3 Knigoobmen Gosudarstvennoj Biblioteki SSSR imeni Lenina Orbis - Newsagency Sect. of International Exchange of the Stalinova 46, Praha XII All-Union Lenin Library Czechoslovakia USSR ZA-vailable on loan from the CIA Library is the November-December 1950 issue of Transactions American Academy of Ophthalmology and Otolaryngology.7 25X1A CLASSIFICATION CONFIDENTIAL/US OFFICIALS ONLY Approved or Release - _ - IUMUOUU13-11 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 r;ONFICENilAL OFFICIALS ONLY THIS IS AN ENCLOSURE I DO NOT DETACH TRANSACTIONS AMERICAN ACADEMY Of OPHTHALMOLOGY and OTOLARYNGOLOGY NOVEMBER - DECEMBER 1950 'T j WEI LIB ARY Printed bimonthly, February, April, June, August, October, and December, by the Douglas Printing Company, 109 North 18th Street, Omaha 2, Nebraska, for the American Academy of Ophthalmology and Otolaryngology. Editorial and business office, 100 First Avenue Building, Rochester, Minnesota. Subscription price $5.00 yearly to members, $10.00 yearly to non-members. Entered as Second-Class Matter November 28, 1938, at the Post Office at Omaha, Neb., under Act of March 8, 1879. ANNUAL MEETING OCTOBER 14-19, 1951, CHICAGO 25X1A Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP8Q-00926A003000050013-1 new topical therapy SULFAMYLON - 4-aminomethylbenzene- sulfonamide, a new sulfonamide compound which is not inhibited by para-aminobenzoic acid - effectively controls upper respiratory, ocular and wound infections. Sulfarnylon is bactericidal for a wide range of gram negative and gram positive- bacteria including anaerobes (gas gangrene). Applied topically by swab, instillation, irrigation, atomizer or wet dressings. Sulfamylon hydrochloride available in I per cent solution, bottles of 1 fl. oz. and 8 fl. oz. Also in combination of 100 cc. vials of 5 per cent solution with vial of Streptomycin sulfate 20,000 units. I Sulfamylon EFFECTIVE TOPICAL ANTIBACTERIAL 1 INC. NewNew YORK, WINUTgI, OM. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 ~ 7"N Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 a and for INC. SHURON OPTICAL Co., a N. Y. for Christmas-1"' ' ' ? ll the months to come t Genev Established in 1864 Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Authentic Instruments for Otorhinolaryngology Specialists in all fields of medicine look to Pilling for new and important in- struments to facilitate therapeutic pro- cedures and enhance diagnostic skill. Since 1814, leading surgeons and physicians have consulted Pilling- confident that Pilling craftsmen would create to their specifications precisely the instruments they desired. Of special interest to the otolaryngolo- gist is the Hollender Pharyngoscope, drawn in situ above. Designed for use in both diagnosis and treatment, this pharyngoscope is long enough for all HOLLENDER PHARYNGOSCOPE $445.00, BATTERY CORD $4.00 oral cavities ... provides a wide, unob structed view of the nasopharynx. Place- ment is comparatively simple and retention is comfortable for long periods of time. Preliminary anesthesia is only occasionally required. Direct or indirect illumination may be used. Shown with the Hollender Pharyngo- scope is the Hartmann Extra-Long Punch, supplied with circular, oval or tri- angular bite. These punches feature the, built-on basket for retaining punched- out tissue. The lumen of the pharyngo-. scope permits their ready passage. Order instruments direct from weeve 1 . JPI anal 9002 OW9 3451 WALNUT STREET Philadelphia PILLING FOR PERFECTION in surgical instruments Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANSACTIONS - NOVEMBER - DECEMBER, 1950 III TABLE OF CONTENTS THE OCULAR FINDINGS OF INTRACRANIAL TUMOR: A STUDY OF 358 CASES.. . MANOUSOS ANGEL PETROIIELOS, M.D., Ann Arbor, Mich. BY INVITATION PAGE 89 and JOHN WOODWORTH HENDERSON, M.D., Ann Arbor, Mich. NEMATODE ENDOPIITHALMITIS ........................................ 99 HELENOR CAMPBELL WILDER, Washington, D. C. TIIE CONTAMINATION OF OPERATIVE WOUNDS WITH COTTON FIBRILS AND TALC ........................................ 110 L. R. DuszvNsKI, M.D., New York, N. Y. BY INVITATION ? MALIGNANT LYMPIIOMA OF TIIE UVEAL TR.ACT ........................... 116 EDMOND L. COOPER, M.D., Detroit, Mich. and JOHN L. RIKER, M.D., Alpena, Mich. BY INVITATION A CONCEPT OF ALLERGY AS AUTONOMIC DYSFUNCTION SUGGESTED AS AN IMPROVED WORKING HYPOTHESIS ................................. 123 HENRY L. WILLIAMS, M.D., Rochester, Minn. DIFFUSE EXTERNAL OTITIS: ITS PATHOLOGY AND TREATMENT .............. 147 BEN H. SENTURTA, M.D., St. Louis, Mo. IN MEMORIAM ..................................................... 160 COUNCIL MINUTES .................................................. 161 ANNUAL BUSINESS MEETING ......................................... 170 COMMITTEE REPORTS ................................................ 179 INDUSTRIAL OPHTHALMOLOGY MEDICAL CIVIL DEFENSE: THE BACKGROUND ........................ 191 ANDREW C. Ivy, M.D., Chicago, 111. DISASTER STRIKES-WHAT HAPPENS? ............................. 193 COL. VICTOR A. BYRNES (MC), Randolph Field, Texas EMERGENCY EYE CARE IN DISASTER: THE LAYMAN WIIO PRECEDES Us. 202 HEDwIG S. KuHN, M.D., Hammond, Ind. NEWS NOTES ...................................................... XXV POSITIONS AVAILABLE ............................................. XXIX DIRECTORY OF OPIITIIALMOLOGIC AND OTOLARYNGOLOGIC SOCIETIES ........ XXX HEARING AIDS ACCEPTED BY COUNCIL ON PHYSICAL MEDICINE OF THE AMERICAN MEDICAL ASSOCIATION ...................... XXXVIII Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 in acute lar.rn(I)otracheal bronchitis prompt response with 7 erramrcin 'dN~ ,Jhil. 1I~. INFECTING 1 TOTAL ADMINIS- CONDITION ORGANISM TREATED DOSE, GM. 1 AND RESULT bronchitis in 24 hours, Recovery Case report taken from Herrell, W E.; Heilman, F. R., and JVellman, E E.: Ann. New York Acad. Sc. 53:448 (Sept. 15) 1950. CRYSTALLINE er rarnycin CHLORIDE jjQ I?aj idl}? Absorbed "... produces significant continuous blood levels when 250 mg. are given every six hours."1 Well Tolerated "... side-effects have not constituted a problem in therapy."' Uosu1;e:On the basis of findings obtained in over 150 lead- ing medical research centers, 2 Gm. daily by mouth in divided doses q. 6 h. is suggested for most acute infections. Sup1-lied: 250 mg. capsules, bottles of 16 and 100; 100 mg. capsules, bottles of 25 and 100; 50 mg. capsules, bottles of 25 and 100. 1. Welch, II.; Hendricks, F. D.; Price, C. W., and Randall, W. A.: J. It. Ph. A. (Sc. Ed.) 39:185 (Apr.) 1950. /p~.zy ^ ACHAS. /L/ll)LOfIC ~~[hGSCO/2 2. Knight, V.: New York State J. Med. l\\ (vJ 50:2173 (Sept. 15) 1950. AS. PFIZER PFIZER V? CO., INC. Brooklyn 6, N. Y Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 R 9hrdW S71 ERE VlSPARA1OR ? ? ? the Preferred. Instrument for Investigation and Visual Training of. 0 . 1 Accommodation and Convergence Suppressions and Suspensions of Vision ? Amplitude and Facility of Accommodation Stereopsis Many Other Functions and Skills All the functions of the ordinary stereoscope plus many others are combined in the AO Renshaw Stereo Disparator. In this im- proved diagnostic and training instrument variable guides permit movement and setting of targets to maintain the correct re- lationship between accommodation and convergence, regard- less of the distance between the stereograms and the lenses. The targets follow definite paths, stimulating accommodation and convergence together, as normally at various seeing dis- tances. Abnormal patterns of viewing may also be provided for in the instrument by placing emphasis either upon accom- modation or convergence. Representing a significant advance in stereoscopic diagnosis and training, the AO Stereo Disparator OTHER ADVANTAGES OF THE STEREO DISPARATOR Simple adjustment of instrument to patient Wide range of prism effect with- out use cf auxiliary prisms , Rapid, simultaneous adjustment of desired target separations Adequate range of adjustment to compensate for vertical imbalances Adequate range for stimulating demands on accommodation Calibrated central scale for indi- catina accommodation demand is unusually effective in producing efficient binocular vision. Arrange today for a demonstration at any AO Branch Office. proved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Lloyd STEREO CAMPIMETER ... the Campimeter that permits complete plotting of both central and paracentral fields under stereoscopic fixation In many cases showing impairment of vision it is important to make full ce t l d n ra an para- central field studies. The "angled mirror septum" in the AO Lloyd Stereo Campimeter permits field testing up to 47? nasally, 35? temporally, 30? upward, and 30? downward. Even when central scotomata are present in either or both eyes, single binocular fixation is readily maintained. Lenses compensate for the. distance from the chart to the eye, thus avoiding accommodation on the part of the patient. Illumination of test chart and fixation chart is exceptionally even. More and more professional men are demanding the simplicity of operation, accuracy, and versatility of application available only in the AO Lloyd Stereo Campimeter. You too will find it more than worthwhile to ask your AO Representative for further details. Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 How the Paredrine Technique' in refraction saves the physician time and trouble Ophthalmic Solution Paredrine Hydrobromide* 1% with Boric Acid *hydroxyamphetamine hydrobromide, B.K.P. Advantages : 1. requires only a minimum number of instillations 2. helps achieve rapid cycloplegia 3. permits accurate refraction 4. assures a quick return of accommodation The `Paredrine Technique' in refraction saves the physician time and trouble and spares the patient prolonged visual disability. In the words of Harrison,, it "has the advantage of maximum action with minimum duration." With children, the whole procedure can be carried out at the office; and the greatly reduced amount of atropine required for satisfactory cycloplegia lessens the probability of toxic side effects. Smith, Kline & French Laboratories, Phila. 1. Harrison, W.J.: Ocular Therapeutics, Springfield, Ill., Charles C Thomas. Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 MEDIA ,c ~'+ ern r *r r ~^^ m '~ mm ~ i mp m u~. r, ru PLEASANT- EFFICIEp1 r rc -sacra rc~a ue "S Y-6 S icnt c c zd clinical Data scat o .. 1 1 I I I I -Also MALLON DIVISION - Makers of RECTALGAN Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 For the Modern E. N. T. Specialist Send for descriptive folder il- lustrating and describing new Imperial treatment unit com- plete, consisting of hydraulic chair designed to accommo- date Proetz treatment, adjust- able stool, and cabinet with enclosed rotary pump (with footswitch), recessed suction and pressure irrigating bottles, stainless steel trays, one spe- cial drawer to accommodate Bard-Parker liquid sterilizer, and National cautery and transilluminator. Finish-White Enamel, Cream White, Brown and Maroon (solid colors), with upholstery (black, brown and maroon) on chair and stool. C. M. SORENSEN CO., Inc. Factory, General Office and Showroom 403 EAST 62nd ST. NEW YORK 21, N. Y. o o,, ARTIFICIAL iex The Making and Fitting of Artificial Eyes Are A Specialty with us-Not A Sideline THE FINEST IN ARTIFICIAL EYES OF PLASTIC AND GLASS MADE TO ORDER AND STOCK ? Mail order selection service ? Our technicians travel to most principal cities ? Trained technicians to fit artificial eyes to all motility implants Write as if you have any artificial eye problems with your patients CHICAGO DETROIT CLEVELAND KANSAS CITY MINNEAPOLIS NEW ORLEANS ST. LOUIS S E R V I N G T H E P R O F E S S I O N SINCE 1 8 5 1 NEW YORK BALTIMORE BOSTON BUFFALO PHILADELPHIA PITTSBURGH WASHINGTON Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 SIMPLE TEST PROVES INSTANTLY PHILIP MORRIS ARE LESS IRRITATING Now you can confirm for yourself, Doctor, the results of the published studies* With proof so conclusive ... with your own personal experience added to the published studies* ... would it not be good practice to suggest PHILIP MORRIS to your patients who smoke? ... light up a PHILIP MORRIS Take a puff -DON'T INHALE. Just s-l-o-w-1-y let the smoke come through your nose. AND NOW... 2 ... light up your present brand DON'T INHALE. Just take a puff and s-l-o-w-1-y let the smoke come through your nose. Notice that bite, that sting? Quite a difference from PHILIP MORRIS! PHILIP MORRIS Philip Morris & Co., Ltd., Inc., 100 Park Avenue, New York 17, N. Y. *Proc. Soc. Exp. Biol, and Med., 1934, 32, 241-245; N. Y. State Journ. Med., Vol, 35, 6-1-35, No. 11, 590-592, I,amyngoscope, Feb. 1935, Vol. XLV, No. 2, 149-154; Laryngoscope, Jan. 1937, Vol. XLVII, No. 1, 58-60 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANSACTIONS - NOVEMBER -DECEMBER, 1950 XI RADM For the Treatment of Nasopharyngeal Lymphoid Tissue The original monel metal radium applicator was designed by Radium Chemical Company according to specifications of Otolaryngologists with nearly 25 years experience in radiation therapy of the nasopharynx. This applicator is offered to the medical profession for one purpose only - the treatment of hyperplastic lymphoid tissue at the orifice of the eustachian tube or in the fossa of Rosenmuller, which cannot be removed surgically. Approximately 1,400 of these applicators have been supplied to spe- cialists in the United States by Radium Chemical Company. Published medical papers indicate that radiation in conjunction with antibiotics, systemically or locally, often relieves the symptoms due to the presence of hyperplastic lymphoid tissue. Extensive research covering a period of many years has established the proper time factor for the 0.3 millimeter monel metal radium applicator. All important reports from clinics and specialists have been based on the monel metal applicator of the exact dimensions furnished by Radium Chemical Company. No changes will be made in these specifications unless they are re- quested by medical authorities, and then only after intensive clinical research. The physician using a monel metal radium applicator from this Com- pany can expect the same favorable results as reported in the medical literature. RADIUM CHEMICAL CO., INC. 570 Lexington Ave., New York 22, N. Y. MORE THAN 35 YEARS CONTINUOUS SERVICE TO THE MEDICAL PROFESSION Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Chronic Asthmatic A W FIEN she feels an attack corning on, she simply reaches into her purse, takes out the Aerohalor? and takes three or four inhalations of a bronchodilating powder called NORISODRINE Sulfate. The bronchospasm ends quickly. This take-it-with-you therapy is effective against both mild and severe asthma, has restored many chronic asthmatics to normal activity. Proved by clinical investiga Lion, 1, 2 NOIIISODRINE has relatively low toxicity. Few side-effects result when the drug is properly used and, when they do, are usually minor. Before prescribing NORISODRINE, however. please write for literature which discusses dosage and precautions. NORISODRINE Sulfate powder 10% and 25% is supplied in multiple-dose Aerohalor* Cartridges, packaged three to an air-tight vial. Acrohalor is prescribed separately. Abbott Laboratories, ~_14- Nor th Chicago, Illinois. *'rrade Mark for Abbott Sifter Cartrid,o f'>Abbott's Powder Inhaler Krasn Iv, , A. C L.(949), T1 a a ala Inhtlona o1 1- (3', 41T Dlhydroxyphenyll-2-Isopropyl- aminoetanol (Norisodrine Sulfate Dust), J. Allorgy, 2'.'. 0:111, March. 2, irrasno, L. R., Grossman, nd Ivy, A. C. (1948), The Inhalation of Norisodrine Sulfate Dust, science. 108:478, Oct. 29. NORISOORINES0If3te Powder (ISOPROPYLARTERENOL SULFATE, ABBOTT) Always Ready for Use when the Need Arises Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 INE NATURAL vtS -Approved For Release 2002/07/24: CIA-RDP80-00 B 003000050013-1 "o, Natural Seeing Habits dictated the design of this Bifocal Lens . The bifocal wearer finds in Panoptik a lens designed to let him see naturally.. . not a lens which requires readjustment of his seeing habits. That's because the Panoptik is designed to natural seeing habits ... the segment is widest at the level of natural reading ... its optical center is at this same level . . . corners are round to match the round pupils of the eye. Panoptik is the bifocal lens easiest to get used to . . . the bifocal lens that gives natural youthful vision with comfort, In Soft-Lite, too # ~ F # ? 2 ,y F _ x9 ? ? 1 ~ ? t F F ?#F?'F # FF ? k#F 1 # h5 { F# # ? _ 4 ~ M tle bifocal legs M,j Wlil prides {? F F ? ~ F d y ; ~ iF F e ? idest# ossible reading area F ?~? ~,`~FF.t ?; { ~~? a 2 p s s ~ # ~ ~ ?~,tr~a#q~r # ~E cs?a?c? w th FleestFencroachmentt y #?F F??~#sq~h~~~r??F~~ra?a~?~~?ti?+ ?>H? ~~? F~i~Fa?~s;~ ,~?. ~a~qp? ? d~f $~ i i ? Y~.?~ # '~SiF F ~`F 4!F #'~F~{y#~ iF3jy ~.? #~i~i3'Sk Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 A COMPLETE TREATMENT ROOM IN A SMALL AREA The dimensions in the above photograph are 5' 9" along one wall and 4' 2" along the other. In this area, conveniently arranged, is everything needed to make a complete examination. However, it need not be con- fined to this limited space. The complete absence of piping and wiring is especially noticeable. A number of other arrangements will be furnished on request. Treatment Stand: Covered with stainless steel. Contains: air regulator with gauge, tubing, cutoff and air filter; nosopharyngoscope rheostat; push button' cautery transformer and rheostat; transilluminator complete with rheostat, cord, handle, lamps, antrum and frontal tips; seven metal drawers on fiber runners and one large drawer for towels, waste container; bakelite covered work table; space for six spray bottles, twelve solution bottles, shelf bor cotton jars; pocket for history card or prescription blanks; and a spray bottle heater; the whole presents an attractive appearance and will not tarnish and is easy to keep clean. Price complete without glassware $185.00. Without air but with electrical equipment $155.00. With air equipment only $140.00. Without either air or electrical equipment $110.00. Chair: Can be placed in horizontal position, will not tip in this position- raised and lowered by large hand wheel; paper covered headrest removable; locked with foot-pedal; bakelite armrests removable. Back locks rigidly in any position. As shown in brown. $130.00. Turning Chair: By adding a footrest and the necessary handles this chair can be used for turning tests. All the additional equipment is easily and quickly removable. Add. $25.00. Combined Suction and Cuspidor: This is an entirely new piece of equipment. It was designed to eliminate the cost of installing a separate suction. The apparatus is 12" wide and projects 131/4" from the wall. The flushing rim and the suction is furnished with a vacuum breaker and should meet all plumbing requirements. Stop and trap not furnished. Available in ivory, green and white. Price $80.00. Ceiling Light: A telescopic light attached to the ceiling. May also be attached to base board in back of chair. Available in 4, 5, 6 and 7 ft. (extended). 4 ft. $15.50 (add one dollar per ft.). Light Shield: Takes an ordinary 100 watt lamp. Will not burst; spot can easily be rotated. $5.00. Stool: A soft upholstered stool with easy running ball bearing stem casters. $20.00. Stool with back, $26.00. All Prices are F.O.B. Los Angeles, Calif. Surgical - Mechanical - Research Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 for rapid easy adjustment to any treatment position A Ritter ENT Motor Chair adds more time to your professional day. Patients are treated in less time ...with less fatigue. This precision-built Ritter Chair raises or lowers to any desired position. You merely exert slight toe pressure on a conveniently located pedal. Patients are moved quickly, quietly and with no vibration to the desired position. A motor-operated hydraulic mechanism does the trick. Easily and quickly adjusted from sitting to supine position, you are able to examine or treat while comfortably seated or standing. Patients enjoy the comfort of the wide foam rubber seat and the exclusive compensating back. The Ritter ENT Motor Chair can be pre-set to accommodate 90% of your patients. Ask your surgical dealer,for a demonstration of the time and energy-saving features of the A RITTER SURGICAL CUSPIDOR A Ritter Surgical Cuspidor, completely redesigned provides greater efficiency at . , I effective vacuum volume control maintained with a fingertip regulator at the aspirator handle. Use Ritter ENT Motor Chair. instantly positions Ritter ENT Motor. Chair... any aspirator ved F Re a e 2002/07/24~??l ~~1 P80- 6 0300 modern equip ~RITiE~K doctor's-office. I I ROCHESTER 3, N.Y. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANSACTIONS - NOVEMBER - DECEMBER, 1950 Corneal Contact Lenses Their Advantages and Disadvantages Write for Brochure 0:!!! ~ I - Za rv i, a 49 EAST 51st STREET ? NEW YORK, Manufacturers of all types of Contact Lenses BRANCHES IN PHILADELPHIA ........ MONTREAL ........ LONDON JOHANNESBURG ... SHANGHAI ? Are you AWL one of the thousands of Eye Specialists who have prescribed more than 150,000 KEYSTONE Home Training Services? NEW Features: New Plastic Stereoscope - attrac- tive, lighter in weight, warp proof, permanently accurate. New Manual for Patients has easily understood directions; rec- ord form gives the doctor a quick check on progress. New Guide for Doctors is a most comprehensive and direct technical manual on home-training orthoptic procedures. drew Compact Package takes only half the previous space; easily car- ried by patient from home to office. SOLD ONLY ON PRESCRIPTION. Carried in Stock by Most Optical Supply Houses. If so, you will be glad to know that New Services are now ready for your prescription, at your optical supply house. For strabismus and chiroscopic drawing. Widely prescribed for asthenopia after refraction, and for discomfort due to near-point work. Many eye special- ists use them routinely for: Adjustment to Bifocals. Esophoria and Exophoria. Premature Presbyopia. Low accommodative Amplitude in younger patients. Slowness in Changing Fixation from far-point to near-point. Diffi- culty in Accepting Rx. Ciliary Spasm. Faulty Stereopsis. Write for circular - or for the new Doctor's Guide (no charge). KEYSTONE VIEW CO.,Meadville,Pa. PIONEERS IN VISUAL TRAINING EQUIPMENT Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANSACTIONS - NOVEMBER - DECEMBER, 1950 XVII A New Vacuum Unit for Cataract Extraction with an Improved Erisophake By OSCAR B. NUGENT, M.D. Chicago Producing an even, constant vacuum that can be set at any desired level up to 65 centimeters of mercury, this new little pump unit with its improved erisophake assembly provides the ophthalmic surgeon with a dependable instrument precisely controlled for utmost delicacy and effec- tiveness of application. The motor at}d rotary pump are wholly enclosed, silent and vibrationless; built for long, care-free service, they require little attention other than occasional oiling. The motor has an automatic thermal overload protector. The entire unit stands only 6x14x11" high. A-4 - Nugent Cataract Vacuum Unit - Self-contained in a cast alumi- num housing with smooth, attractive, easy to keep clean, Crystal Gray finish. For operation on 110 volts, 60 cycles, AC, complete with erisophake described below, each ................................................ $129.75 IMPROVED NUGENT-GREEN-DIMITRY ERISOPHAKE A- 14 - This improved erisophake permits greater ease of application and more perfect manipulation in extraction procedures than formerly. It makes use of the Dimitry shallow suction cup, and has Nugent 's oral vacuum control valve-most simple, efficient means of control of vacuum during cataract extraction. Hand- piece and oral valve are gold plated. Erisophake, valve and tubing only. . $24.75 Since 1895 Instrument JY)ueller Ma kers to an the and Profession 320-340 S. HONORE STREET CHICAGO 12, ILLINOIS Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 THROAT SPECIALISTS REPORT ON 30-DAY TEST OF CAMEL SMOKERS... Yes, these were the findings of throat specialists after a total of 2,470 weekly examinations of the throats of hundreds of men and women MY DOCTOR'S REPORT ('ONFIRMGr) WIaAT I WMI_W FROM THE START-CAMELS AGREE WITH MY THROAT. AND I LIKE CAMELS RICH, FULL FLAVOR! is .one of hundreds, coast to coast Who made, , the 3A Day; 'est of Cui ei Mildness under the;oliwrve tion of thr"soar spec alists TRANSACTIONS - NOVEMBER - DECEMBER, 1950 who smoked Camels -and only Camels - for 30 consecutive days. Yes, doctors smoke for pleasure, tool In a nationwide survey, three independent research organizations asked 113,597 doctors what cigarette they smoked. The brand named most was Camel. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 01 WIDE ate the extent t d i ll r emons ons ustrat The i ANGLE of the fields of view (2d) available to higher myopes and hyperopes. It is E immediately discernible that the wearer v I of a strong minus lens has a much IEW larger field of view than a high hyper- ope. (The myope must, however, learn to view objects within a narrower angle.) The 14 D. myope has a field of view through a 25 mm. aperture Myodisc lens that is 37% larger than the field of view enjoyed by the 14 D. hyperope wearing a 38 mm. diameter lens. The diagrams stress the im- portance of placing lenses of higher power as close to the eyes as possible if the patient is to have a maximum field of view. Many years of research have resulted in Benson cataract lenses that provide maximum field of view without the use of aspherie surfaces. Myopes appreciate the saving in weight and the im- proved appearance that results from carefully computed, perfect Benson made Myodisc lenses. Interpreting your prescription into glasses that DO what YOU want them to do for the patient is our specialtyl N. P. BENSON OPTICAL COMPANY Since 1913 MAIN OFFICE AND LABORATORY: MINNEAPOLIS, MINN. Branch Laboratories in Principal Cities of Upper Midwest New Color Slide LIBRARIES OF THE EYE from the private collections of recognized experts Series I. Anterior Segment Photographs II. Anterior Segment Photographs Ill. Retinal Color Photographs IV. Gonioscopic Color Photographs All by H. Saul Sugar, M.D., Detroit V. Retinal Color Photographs from the collection of the late Robert Von Der Heydt, M.D., Chicago VI. Original Ophthalmological Photomicrographie Slides by Julius Weber, New York Write for booklet listing each slide. Literature also available on lighting systems and complete camera units for photographing the eye. BARNETT Optical Laboratories 1218 Pratt Blvd., Chicago 26, III. REFRACTION DIFFICULTIES A monograph by Clarence A. Veasey, Jr., M.D. Send order with remittance to W. L. BENEDICT, M.D. 100 First Avenue Building Rochester, Minn. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 50/1000 Fine Gold. You prescribe "New Jersey Optical" with complete confidence. NEW JERSEY OPTICAL CO. ? IRVINGTON, N. J. THE NEW YORK POLYCLINIC MEDICAL SCHOOL AND HOSPITAL (ORGANIZED 1881) (The Pioneer Post-Graduate Medical Institution in America) EYE, EAR, NOSE AND THROAT A combined full-time course covering an academic year (9 months). It consists of attendance at clinics; witnessing operations; lectures; demonstration of cases and cadaver demonstra- tions; operative eye? ear, nose and throat on cadaver; head and neck dissection (cadaver); clinical and cadaver demonstrations in bronchoscopy, laryngeal surgery and surgery for facial palsy; refraction; radiology; pathology, bacteriology and embryology; physiology; neuro-anatomy; anesthesia; physical medicine; allergy; examination of patients pre-operatively and follow-up post-operatively in the wards and clinics. Also refresher courses (3 months). For information address MEDICAL EXECUTIVE OFFICER: 345 West 50th St., NEW YORK 19, N. Y. _ito EQ INSTRUMENTS used by HENRY M. GOODYEAR, M.D. Cincinnati, Ohio, for INTRANASAL SINUS SURGERY A. 5418 'Elevator and Curette, DUNNING ........$ 6.00 B. 5712 `,Perforator, Antrurn, BISHOP 7.50 C. 5775 *Double Curette, PRATT 7.50 D. 5970 *Forceps, Nasal, GRUEN- WALD: Size 3 through cutting ....... each 29.50 E. 5971 *Forceps, Nasal, WEIL: cup shaped ........ 29.50 F. 6054 Punch, HAJEK- KOFLER: downward . 37.50 G. 6060 *Handle, Universal .. 29.50 H. 6071 Punch, Antrum, WAGNER: forward.. 26.50 K. 6076 Punch, Intranasal, STORZ: right or left, each 25.00 Designates STAINLESS STEEL STORZ INSTRUMENT COMPANY Quality Frames and We have always produced but one mountings line - the finest - in which crafts- manship, quality and inherent worth of Superb are backed by invariable guarantee of ' EAR U 1- OUR NEW NOSE CATALOG SE NT UPON R St. Louis 10, Missouri Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 . Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANSACTIONS AMERICAN ACADEMY of OPHTHALMOLOGY and OTOLARYNGOLOGY SCIENTIFIC PAPERS READ AT FIFTY-FIFTH ANNUAL SESSION CHICAGO, ILLINOIS October 8-13, 1950 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 EDITORIAL BOARD WILLIAM L. BENEDICT, M.D., Editor in Chief, Rochester, Minnesota W. HOWARD MORRISON, M.D., Associate Editor, Omaha, Nebraska HENRY L. WILLIAMS, M.D., Associate Editor, Rochester, Minnesota THE BOARD OF SECRETARIES PRINTED IN OMAHA, NEBRASKA Sy DOUGLAS PRINTING COMPANY Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 American Academy of Ophthalmology and Otolaryngology THE COUNCIL - 1950 President J. Mackenzie Brown, Los Angeles, Calif --------- ........................................................????---'-?President-Elect Derrick Vail, Chicago, Ill- ----------- ------------------------------------------------------------------------ --------- Vice-President Edwin B. Dunphy, Boston, Mass. ..................................... ?---??-?????'---?"-""?__??-S First Second Vice-President Kenneth L. Craft, Indianapolis, Ind------------------------------------------------- ?--?-???-- ............Third Vice-President James Mason Baird, Atlanta, Ga ................................................... ... ?? Alan C. Woods, Baltimore, Md .....................................Past President, Senior Member of Council Carl H. McCaskey, Indianapolis, Ind . ........ .................................................................... Past President Past President Conrad Berens, New York, N. Y ....................................................................................... Executive Secretary-Treasurer William L. Benedict, Rochester, Minn..... {Editor and Business Manager of the TRANSACTIONS Algernon B. Reese, New York, N. Y ......................................... Secretary for Ophthalmology James H. Maxwell, Ann Arbor, Mich----------------------------------------------Secretary for Otolaryngology A. D. Ruedemann, Detroit, Mich .............................Secretary for Instruction in Ophthalmology Secretary for Instruction in Dean M. Lierle, Iowa City, Iowa ...............................?-?-? ? - - - - - . . - -. Otolaryngology and Maxillofacial Surgery Secretary for Home Study Courses Lawrence R. Boies, Minneapolis, Minn ................................. ..........................................Secretary for Public Relations Erling W. Hansen, Minneapolis, Minn. ...................................Councillor Thomas D. Allen, Chicago, Ill ................................................................. Fletcher D. Woodward, Charlottesville, Va .............................................................................Councillor ..........Councillor Archie D. McCannel, Minot, N. D .................................................................................. C. Stewart Nash, Rochester, N. Y. ._...................................................................................... Councillor COUNCIL COMMITTEES EXECUTIVE, RESEARCH AND FINANCE J. Mackenzie Brown, Chairman Alan C. Woods Derrick Vail Carl H. McCaskey Thomas D. Allen Conrad Berens William L. Benedict RESEARCH AND FINANCE Research (Subcommittee fFExecutive, and Alan C. Woods, Chairman J. Mackenzie Brown William L. Benedict BOARD OF COUNCILLORS Thomas D. Allen, Chairman Fletcher D. Woodward C. Stewart Nash Archie D. McCannel BOARD OF SECRETARIES William L. Benedict, Chairman Algernon B. Reese Dean M. Lierle James H. Maxwell Lawrence R. Boies A. D, Ruedemann Erling W. Hansen ACTIVITIES Thomas D. Allen, Chairman Fletcher D. Woodward Derrick Vail Archie D. McCannel Edwin B. Dunphy C. Stewart Nash JUDICIAL J, Mackenzie Brown, Chairman Thomas D. Allen Archie D. McCannel Fletcher D. Woodward C. Stewart Nash PROGRAM J. Mackenzie Brown, Chairman John R. Lindsay, Chicago General Chairman on Arrangements Derrick Vail James H. Maxwell Edwin B. Dunphy A. D. Ruedemann Thomas D. Allen Dean M. Lierle William L. Benedict Lawrence R. Boies Algernon B. Reese Erling W. Hansen Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 STANDING COMMITTEES ADVISORY COMMITTEE TO THE REGISTRIES PREVENTION OF BLINDNESS OF PATHOLOGY Ralph I. Lloyd, M.D., Chairman ----- .-.Brooklyn, N: Y. Brittain F. Payne, M.D., Chairman, New York, N. Y. Lawrence T. Post, M.D- ------------------ St. Louis, Mo. Col. J. E. Ash, M.C., Ret. ............Washington, D. C. Alan C. Woods, M.D. .......... --- Baltimore, Md. William L. Benedict, M.D. _-- --- Rochester Minn . Brig. Gen. Raymond O. Dart, M. C. , Andrew A. E Washington, D. C. N. Y Edmund P. Fowler, Jr , kb------------ New New York, ' N. Y. Jonas S. Friedenwald, M.D- ------------Baltimore, Md. Hugh G. Grady, M.D- -----.--..----..... Washington, D. C. Stacy Guild, Ph.D. ----------------- -------------- Baltimore, Md. Lyman H. Heine, M.D.......... .............. Fremont, Neb. Michael J. Hogan, M.D. . San ........Francisco, Calif. Paul H. Holinger, M.D. ___ ........... ---------- Chicago, Ill. John E. L. Keyes, M.D- ---------- Cleveland, Ohio A. Edward Maumenee, M.D.....San Francisco, Calif. John S. McGavic, M.D------- ...- Phoenixville, Pa. Bernard J. McMahon M D St L i M , ................. . . ou s, o. Algernon B. Reese, M.D. ---------------- New York, N. Y. Theodore E. Sanders, M.D. ------------St. Louis, Mo. LeRoy A. Schall, M.D. Mass. Herman Z. Semenov, M.D. -. BeverlyB Hills, Calif. Georgiana Dvorak Theobald, M.D., Oak Park, Ill. Frederick H. Verhoeff, M.LI- ---------- Brookline, Mass. Helenor Campbell Wilder ------...---Washington, D. C. CONSERVATION OF HEARING Executive Committee Dean M. Lierle, M.D., Chairman ,...-.Iowa City, Iowa Gordon Berry, M.D- ------------------------Worcester, Mass. Lawrence R. Boles, M.D. ............Minneapolis, Minn. Norton Canfield, M.D---------------------New Haven, Conn. George M. Coates, M.D. ........ ........... Philadelphia, Pa. William E. Grove, M.D .....................Milwaukee, Wis. Gordon D. Hoople, M.D. ................Syracuse, N. Y. Howard P. HouseM.D - ------------Los Angeles. Calif. Marvin F. Jones, M.D- ---------- --------- New York, N. Y. Charles E. Kinney, M.D. Cleveland, Ohio Julius Lempert, M.D.: ................... New York, N. Y. Carl H. McCaskey, M.D-----------------Indianapolis, Ind. Marion R. Mobley, M.D ------------- --Florence, S. C. Harris P. Mosher MD-----------------Marblehead, Mass. Werner Mueller, 111. .............. ......Boston, Mass. C. Stewart Nash, M.D- --------------------Rochester, N. Y. George E. Shambaugh, Jr., M.D.------------ Chicago, Ill. Consultants Raymond Carhart, Ph.D- _.__---------------- -Evanston , Ill. Eva Thompson Carson ----------------------------Glenview, Ill. Howard Carter, B.S- -------------------------- --Chicago, Ill. Stacy Guild, Ph.D. -----------------Baltimore, Md. Scott N. Reger, Ph.D. .-_--_------------- Iowa City, Iowa PAN-AMERICAN RELATIONS IN OTOLARYNGOLOGY C. L. Jackson, M.D., Chairman --------Philadelphia, Pa. Norton Canfield, M.D.. ....... Haven, Conn C. Furstenber . g, M.D. .... ........ Ann Arbor, Mich. Paul H. Holinger, M.D . ............... Chicago, Ill. Gordon B. New, M.D- ----_---_----------Rochester, Minn. Theodore E. Walsh, M.D- --------------------St. Louis, Mo. SCIENTIFIC EXHIBIT Kenneth L. Roper, M.D., Chairman-------Chicago, Ill. STANDARDIZATION OF TONOMETERS Jonas S. Friedenwald, M.D., Chairman Baltimore, Md. Francis Heed Adler, M.D- -----------------Philadelphia, Pa. Dry0 e Harrington,, M.D-- -------------------.Boston, Mass. Peter C. Krotifeld, M.D. -__ San Francisco, Calif. ------- -..-....Chicago, III. John M. McLean, M.D .....................New York R , Y. Adolph Posner, M.D - .----New York, N. Y, Algernon B. Reese, M.D..--..-..--------- New York, N. Y. Robert N. Shaffer, M.D. _----_.----San Francisco, Calif. STUDY OF AUDIO-VISUAL INSTRUCTION Dean M. Lierle, M.D., Chairman ....Iowa City, Iowa W. L. Benedict, M.D., ex officio-- ---.--Rochester, Minn. James H. Maxwell, M.D- ------------Ann Arbor, Mich. Algernon B. Reese, M.D- ------------New York, N. Y. A. D. Ruedemann, M.D- -------------------- Detroit, Mich. Representatives of the Academy to : ADVISORY COMMITTEE TO THE EYE HEALTH COMMITTEE OF THE AMERICAN STUDENT HEALTH ASSOCIATION Lawrence T. Post, M.D. ............__--St. Louis, Mo. AMERICAN ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE M. Elliott Randolph, M.D----------- _--.-Baltimore, Md. AMERICAN BOARD OF OPHTHALMOLOGY Algernon B. Reese, M.D. ................New York, N.Y. Frederick C. Corderses, M.D.......-.San Francisco, Calif. Robert J. Mast, M.D. .._..........--Indianapolis,Ind. Derrick T. Vail, M.D--------- ............. ---_-Chicago, Ill. AMERICAN BOARD OF OTOLARYNGOLOGY Carl H. McCaskey, M.D-----------------Indianapolis, Ind. William E. Grove, M.D- --------------------Milwaukee, Wis. AMERICAN COLLEGE OF SURGEONS BOARD OF GOVERNORS H. Marshall Taylor, M.D. ---------...Jacksonville, Fla. John P. Lordan, M.D- ----------------Beverly Hills, Calif. Conrad Berens, M.D. ....................New York, N. Y. AMERICAN COMMITTEE ON OPTICS AND VISUAL PHYSIOLOGY Alfred Cowan, M.D........... ------- Philadelphia, Pa. Kenneth C. Swan, M.D. . Portland, Ore. Frederick C. Cordes, M.D. ------ ..San Francisco, Calif. AMERICAN ORTHOPTIC COUNCIL Kenneth C. Swan, M.D -------------- ---------Portland, Ore. George D. os enbader,IM.D...-SaWashington, , D. AMERICAN SOCIETY OF CLINICAL PATHOLOGISTS CONSULTATIVE PANEL ON TUMOR TERMINOLOGY John S. McGavic, M.D- -------------------- Bryn Mawr, Pa. HELMHOLTZ CENTENARY COMMITTEE F. Bruce Fralick, M.D;, Chairman, Ann Arbor, Mich. Nelson Miles Black, M.D- ------------------------Miami, Fla. Frank E. Burch, M.D----------------------- -St. Paul, Minn. Herman Elwyn, M.D. ------------------- New York, - N. Y. W. H. Luedde, M.D. ---------------------- -St. Louis, Mo. Albert C. Snell, M.D. --------------------.Rochester, N. Y. JOINT COMMITTEE ON INDUSTRIAL OPHTHALMOLOGY Edmund B. Spaeth, M.D- ---------------- Philadelphia , Pa. John B. Hitz, M.D----------- ----------------- Milwaukee, Wis. Col. Victor A. Byrnes, M.C. --- Randolph Field, Texas Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 THE OCULAR FINDINGS OF INTRACRANIAL TUMOR A Study of 358 Cases MANOUSOS ANGEL PETROIIELOS, M.D. BY INVITATION and JOHN WOODWORTII HENDERSON, M.D. ANN ARBOR, MICII. THE diagnosis and successful local- ization of intracranial neoplasms should ideally be the result of close cooperation between the neurosurgeon, the neurolo- gist and the ophthalmologist. Such a re- lationship has been enjoyed at the Uni- versity Hospital of the University of Michigan, where the neurosurgery and neurology departments routinely refer the great majority of their suspected cases of intracranial pathology for oph- thalmologic consultation. There has thus been afforded a somewhat unique op- portunity to establish a proper back- ground upon which the neurologist or neurosurgeon may rely in reaching his diagnosis. It is the purpose of this paper to at- tempt an evaluation of the signs of in- tracranial neoplasm which are encoun- tered by the ophthalmologist from the standpoint of their significance in diag- nosis. A total of 358 cases will be presented. Of these 344 were operated upon and the pathologic diagnosis confirmed by microscopic study. The remaining 14 cases were those in which the diagnosis was within the limits of certainty but in which it was felt surgery would not be advantageous. The latter instances From the department of ophthalmology, University of Michigan Medical School. Dr. Petrohelos holds the position of John E. Weeks Scholar in Ophthal- mology, and Dr. Henderson that of Walter R. Parker Scholar in Ophthalmology. Presented at the Fifty-Fifth Annual Session of the American Academy of Ophthalmology and Otolaryn- gology, Oct. 8-13, 1950, Chicago, Ill. fell mainly under the heading of pinea- loma. The original series of records was selected by the Division of Medical Sta- tistics to include representative series of each major diagnostic group, either by location or by type of tumor. These were tabulated according to ophthalmo- logic findings. The individual findings were then analyzed according to tumor location, as will be noted from the ac- companying tables. Thus the series pre- sented does not claim to embrace the to- tal number of cases observed during a given period of time, nor does it attempt to include all the cases of any one tu- mor type during such an interval. Prac- tically all of the records studied were of patients seen within the past ten years. Where a particular finding was not noted for a tumor location, it has been omitted from the appropriate table. The final selection of cases whose completeness warranted their inclusion in this study is presented in table I ac- cording to location of the tumor. Those instances listed as "diffuse" involvement were cases in which the tumor involved more than two major areas. The re- maining subdivisions of the table are self explanatory. This grouping does not claim any significance with regard to the relative incidence of brain tumor by local sites. The ocular findings to be analyzed are (1) papilledema, (2) optic atrophy, (3) visual field changes, (4) pupillary abnormalities, and (5) disorders of ocular motility. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TABLE I PAPILLEDEMA TRANS. AMER. ACAD. OF O. & 0. NUMBER OF CASES NUMBER WITH PAPILLEDEMA PER- CENTAGE BILAT- UNI- ERAL LATERAL Frontal lobe T l 66 30 45.4 29 1 empora lobe P i t l l b 29 15 51.7 15 ar e a o e O i it l l 25 13 52.0 13 cc p a obe F 5 4 80.0 4 rontoparietal TemporOparietal 18 17 9 50.0 _ 7 2 Parieto-occipital 11 10 88.8 10 - Frontotemporal 7 9 81.8 9 - Cerebellum 3 42.9 ' 3 - Pi l l 58 44 76.2 44 nea g and Third ventricle 16 7 10 62.5 _ 10 - Lateral ventricle 5 71.7 5 - F th i 9 7 77.7 6 1 our ventr cle P d d 16 12 75 0 12 ons an me ulla 6 5 83 3 Midbrain and pons 10 6 . 5 Posterior fossa 5 4 60.0 5 1 Corpus callosum Bas l li 5 2 80.0 40.0 4 2 _ a gang a Ce b ll i 5 3 60.0 3 _ re e opont ne angle Diff 6 5 83.3 5 use O i i 10 7 70.0 _ 7 pt c ch asm and nerve 9 5 55 5 _ 3 Pituitary and cranio- . 2 pharyngioma 11 1 9 1 1 Sphenoidal wing . - meningiorna 7 4 57.1 3 1 Totals 358 213 59.5 205 8 TABLE II OPTIC ATROPHY PRIMARY ATROPHY BILATERAL UNILATERAL Frontal 2 Occipital - Frontoparictal - Cerebellum 1 Pineal 1 Third ventricle - Lateral ventricle - Fourth ventricle Basal ganglia _ Diffuse _ Optic chiasm and nerve. 2 Sphenoidal wing meningioma - Pituitary and cranio- pharyngioma 3 Midbrain and pons 1 Cerebellopontine angle -- Foster Kennedy syndrome f ? Early Foster Kennedy syndrome M. A. PETROHELOS AND J. W. HENDERSON SECONDARY ATROPHY BILATERAL UNILATERAL Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TABLE III VISUAL FIELD FINDINGS ,t O a 0 a 0 -F d .O. V 0 8 a d F W 4 a wa xF a y d a z U y z zw o 0 ac0~ ~ wx Frontal 40 2 - 1 7 1 Temporal 16 9 - 5 1 - Parictal 22 5 - 1 - Occipital 5 3 - 2 Frontoparietal 14 1 - 1 1 - Temporoparietal 9 5 2 Parieto-occipital 8 4 - 2 Frontotemporal 5 - - 0 Cerebellum 23 1 1 - - Pineal gland 10 1 2 Third ventricle 4 - - - 1 - Lateral ventricle 7 1 1 1 4 Fourth ventricle 10 -- - - 3 Pons and medulla 6 - - - - 1 Midbrain and pons 8 - - Posterior fossa 3 -- - Corpus callosum 5 1 - Basal ganglia 2 - - Cerebellopontine angle 4 - - 1 - Diffuse 7 2 1 1 1 Optic chiasm and nerve Pituitary and cranio- 8 - - - 2 (uni- lateral) pharyngioma Sphenoidal wing 9 - - . meningioma 6 - OCULAR FINDINGS OF INTRACRANIAL TUMOR The incidence of papilledema was 59.5 per cent, this finding being reported in 213 of the 358 cases. Where the tumors could be classified as located above the tentorium, papilledema was evident in 53.3 per cent (137 out of a total of 257 cases). Those located sub- tentorially showed papilledema in 76 out of 101 cases, an incidence of 75.2 per cent. Papilledema was reported to be bi- lateral in 205 of the 213 individuals. In only 14 cases was there a difference in amount of elevation of the nerve head between the two eyes sufficient to war- rant its mention in the hospital records. The incidence of optic atrophy was 12 per cent among the cases studied. There were 25 instances in which the optic nerve changes were classified as secondary atrophy. Those diagnosed as. primary optic atrophy totaled 17 cases. In both types of atrophy the greater number showed changes in both eyes. The findings by location of the tumor are given in table II. The visual field findings are listed in table III. A visual field examination was performed in 231 of the 358 cases. Changes in the fields of vision were re- corded in 104 of the 231 examinations,. or in slightly less than half. The specific findings for each group of tumors may- be noted in the table. Almost without exception there were positive visual field findings in certain cases regardless. )f tumor location. Although too few. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 92 M. A. PETROHELOS AND J. W. HENDERSON cases were found to warrant inclusion in the table, the incidence of improve- ment of the visual fields after surgery was small. It was noted according to further perimetry or to report in the records in only 3 cases. The poor LOCATION OF TUMOR , Frontal Temporal Occipital Temporoparietal Frontotemporal Cerebellum Third ventricle Fourth ventricle Pons and medulla Corpus callosum Basal ganglia Cerebellopontine angle Diffuse o r A zN - C a o TRANS. AMER. ACAD. OF O. & O. prognosis of many of the patients un- doubtedly is reflected in this finding. Anisocoria was the only pupillary ab- normality thought reliable enough for inclusion in this report. This was men- tioned in 42 of the records, an incidence of 12 per cent. The lateralization of the pupillary size was unfortunately not mentioned in many cases. The larger pupil was on the same side as the tumor in 13 instances, as compared with 6 cases in which it was contralateral to the lesion. Table IV lists the cases in de- tail. The movements of the eyes were found to be affected in a fairly large number of the cases studied. Defects of conjugate movement were noted in 20 cases of the group. These are listed in table V. Most of these instances oc- curred in patients in whom the location of the tumor was such as to involve the pathways for ocular movement, either in the frontal lobe or in the brain stem, with particular emphasis upon the group of pineal tumors. niopharyngioma 1 A lack of uniformity of classifica- - - Sphenoidal wing tion as well as inadequate description meningioma 1 - - of particular cases. in detail makes the evaluation of nystagmus in this series most difficult. However, it will be UPWARD GAZE PALSY LATERAL GAZE PALSY MISCEL- LANEOUS TOTAL CASES Frontal Temporal 1 (weakness 2 Cerebellum Pineal 1 8 all directions) Diffuse 1 Optic chiasm and nerve 1 - 1 Pituitary and craniopharyngioma 1 - 1 Sphenoid wing meningioma 1 - 1 Midbrain and pons 1 (upward 2 and downward gaze) Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 ,.Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Nov.-DEC. OCULAR FINDINGS OF INTRACRANIAL TUMOR 93 1950 TABLE VI NYSTAGMUS MIXED HORI- ZONTAL AND MISCEL- "central" Temporal -- 1 Occipital - 1 Cerebellum 1 11 1 "ocular" 20 Pineal 1 1 2 Lateral ventricle - 1 - 1 Fourth ventricle -- 3 1 - 4 Pons and medulla - 3 3 Diffuse - - 1 - 1 Cerebellopontine angle - - 2 - 2 noted from table VI that the major- ity of the cases were those in which coordinative mechanism of the cere- bellum, the brain stem; or the motor pathways was likely to be involved. The incidence of nystagmus for the series was 10.9 per cent. Individual muscle palsies occurred in 46 cases of the group. The ab- ducens nerve or nerves were involved in 35, the oculomotor partially affected in 11, and the trochlear in only 2 patients. Several other cases could not 'be listed in this way. These included paralysis of convergence and complete ophthalmo- plegias and may be found in table VII. TABLE VII EXTRAOCULAR MUSCLE PALSIES LOCATION OF TUMOR 6TH PALSY 3RD PALSY 4TP1 PALSY Temporal 2 1 compl. Frontoparietal 1 - Temporoparietal 2 1 inc. Cerebellum 8 5 inc. Pineal 5 1 inc. Lateral ventricle 1 Fourth ventricle 2 1 inc. Pons and medulla 3 Midbrain and pons 1 - Basal ganglia 2 1 Diffuse 2 - Optic nerve and chiasm 2 Pituitary and cranio- pharyngioma 1 Sphenoidal wing - meningioma 1 TOTAL MISCELLANEOUS CASES 1 ext, ophthal- moplegia O.U. 3 1 compl. ophth- almoplcgia O.U. 3 3 2 convergence palsy 13 6 1 ? convergence palsy 2 convergence palsy Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANS. AMER. ACAD. OF 0. & 0. DISCUSSION The incidence of papilledema found for this series of cases is distinctly low- er than that reported in other articles. Van Wagenen8 found in a series of 145 verified cases of intracranial tumor that over 88 per cent developed papilledema. Critchleyl has reported brain tumor to be associated with papilledema in over 80 per cent of cases. The 59.5 per cent incidence in the present series seems low by comparison. Truly comparable figures are not available, since the high- er figures are given for series of tu- mors in children, or for consecutive cases over a relatively short period of time. The closest comparison could be made with the report of Paton,6 who found that papilledera occurred in 80 per cent of intracranial tumors in a se- ries of 252'cases. The discrepancy between the findings of the present series and those of previ- ous articles appears to be a direct re- flection of the remarkable advances made in the diagnosis and treatment of brain tumors during the past several decades. The reports cited above all ap- peared prior to the period. covered by the cases herein reported. With the di- agnostic aids of electroencephalography, ventriculography, and arteriography, fewer cases of intracranial tumor are now allowed to progress to the stage where papilledema becomes visible to the ophthalmoscope. The higher percentage (75.2 per cent) in the present report for tumors arising in the posterior fossa of the skull is much nearer to comparable figures in the literature. The papers of Critchley,I of Newman,5 and of others report a high incidence of papilledema for tu- mors of the brain in children. It is true that the greater percentage of brain tu- mors in childhood are of the subten- torial variety. This closer correlation of reports for papilledema between sub- tentorial tumors for different age groups appears to reflect the earlier and more severe interference with the circulation of the cerebrospinal fluid with resulting internal hydrocephalus. The preponderance of bilateral pa- pilledema in this series serves to verify the statement of Duke-Elder,3 who writes that in the great majority of cases the degree of edema is equal in the two eyes and that a greater amount of swelling in one optic nerve head. is not of lateralizing value. As would be expected, the majority of the cases of primary optic atrophy occurred where the direct action of the tumor was exerted upon the optic nerve, the optic chiasm or the optic tract. At least 13 out of the 17 instances of such atrophy could. be so classified if one were to include the frontal, fronto- parietal, optic chiasm and nerve, sphe- noidal wing meningioma, and pituitary groups. All of the tumors so listed are also much less likely to produce papil- ledeina until very late in their course. Nineteen of the 25 instances of secon- dary optic atrophy occurred in cases in which the ventricular system could be easily involved, and thus papilledema occurs early, to be followed by a post- papilledema type of atrophic change. The small number of cases evidencing the Foster Kennedy syndrome should be mentioned. None occurred in purely frontal lobe lesions, but two instances were found in more extensive tumor involvements classified as frontoparietal. The third case was found with a sphe- noidal wing meningioma. The fourth instance was equivocal and occurred in a case with a tumor of the lateral ven- tricle. It will be seen from table III that the most frequent visual field findings were homonymous hemianopsia and periph- eral constriction. There were 35 in- stances of homonymous hemianopsia in the 231 examinations performed, or slightly over 15 per cent. As would be Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Nov.-DEC. OCULAR FINDINGS OF INTRACRANIAL TUMOR 95 1950 expected on anatomic grounds, the ma- jority of such findings occurred in cases with involvement of the cerebral hemis- pheres. Although recorded in too few cases to be of great significance, the relative occurrence of macular sparing as compared with macular splitting should be mentioned. There is certainly no indication in the table to support the classic view that macular splitting is more apt to occur with involvement of the optic tract. On the other hand, the finding of sparing of the macula ex- clusively in the tumors of the hemis- pheres may have some relative value. It will be noted that the majority of such cases are recorded for locations where the optic radiations could be involved. Therefore it would be logical to assume that the fixation reflex pathways, the corticotectal tracts2 which lie just out- side the radiations, would also be in- volved. This would lend support to the view of Verhoeff,9 who believes that sparing of the macula may be the result of faulty fixation. The finding of quadrantanopsia is not indicative of temporal lobe involvement in this series of cases. A study of the table appears to support the view of Walsh,10 who states, "An homonymous quadrant defect in the visual fields sug- gests involvement of the dorsal or ven- tral band respectively in the optic radia- tion, and such an involvement may be in the temporal lobe." There was only 1 case in this series in which quadrantan- opsia occurred in a proved temporal lobe tumor. On the other hand, there were 9 of the group which showed a homonymous hernianopsia. Mention should be made of the speci- ficity of the finding of bitemporal hemi- anopsia in localizing tumors to the chi- asmal region. This can be verified from table III. It is important to note that not one single instance of bitemporal hemianopsia was recorded which could logically be due to dilatation of the third ventricle, although 54 patients with sub- tentorial tumors were examined by per- imetric methods. There were 56 cases in which either hemianopsia or quadrantanopsia oc- curred. Thus, field findings of localiz- ing value were present in slightly over 25 per cent of the cases in which a peri- metric examination was performed. The value of examining the fields of vision in any case suspected of harboring a brain tumor therefore should be evi- dent. The finding of anisocoria in a case of suspected brain tumor is said to have little localizing value, according to Walsh.10 That inequality of the pupils with irritative cortical phenomena can occur has been borne out by Penfield and Erickson.? However, certain of the cases listed in the table could well have been unrecognized instances of Hor- ner's syndrome. It will be noted that in the frontal, temporal and temporoparie- tal tumors, the larger pupil was most often to the side of the tumor, but the number of cases is too small to warrant any definite conclusions. The small total number of conjugate palsies (5.6 per cent for the series) in- dicates how infrequently such a finding occurs. The greater number of upward gaze palsies in tumors of the pineal gland shows a distinct localizing value. Downward pressure exerted by a pine- aloma affects the more superficial tectal layers of the midbrain early. It has been shown experimentally that the cortico- tectal fibers which reach the roof of the midbrain are those having to do with vertical movement.` It is anatomically difficult to explain the upward gaze palsies noted for the 2 cases of frontal lobe tumor presented in table V. Nystagmus is said to be present in a great majority of cases with cerebellar tumor.10 This statement is substantiated by the present series, where 20 of 58 cases showed this finding, an incidence Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 of 34.5 per cent. As stated earlier in this paper, the lack of uniform classification in the records studied makes further conclusions valueless except to reiterate that the motor connections for ocular movement were probably involved in most of the other cases. The total of 39 cases in which nystagmus was recorded gives an incidence of 10.9 per cent. The much greater incidence of ab- ducens nerve involvement in the cases studied confirms the fact that the sixth cranial nerve is relatively less protected in its long intracranial course. An in- crease in intracranial pressure alone may be enough to implicate this nerve by shifting the position of the brain stem. There is little localizing value from abducens palsy, as may be seen in table VI. A review of the records shows further that the lateralization of the palsy has no significant bearing on de- termining the side of the tumor. The lesser number of oculomotor and troch- lear palsies would indicate either a shorter intracranial course or a more protected position. It will be noted that such ocular palsies occurred in only 13.4 per cent of the total series. The conver- gence palsies noted in the table are diffi- cult to accept unless one assumes that these may have been unrecognized cases of internuclear ophthalmoplegia. SUMMARY AND CONCLUSIONS Ina series of 358 cases of intracranial tumor the following ocular findings were present: 1. The incidence of papilled.ema was 59.5 per cent. Tumors which were above the tentorium presented papilledema in 53.3 per cent of the cases, while the sub- tentorial group had a 75.2 per cent inci- dence. Almost all the cases were bilat- eral. 2. Optic atrophy was found in 12 per cent. The cases with primary optic atrophy were mainly those in which di- TRA\S. AMER. ACAD. OF O. & O. rect involvement of the nerve, chiasm or tract was possible. Those with sec- ondary atrophy occurred. where the tumor could produce an early rise in in- tracranial pressure. 3. Abnormal findings were present in slightly less than half the cases where the visual fields were examined. The findings were of localizing type in slight- ly more than 25 per cent of the cases tested. 4. The statement of Walsh10 that pu- pillary changes are of little localizing value was supported by the present study. Anisocoria occurred in 12 per cent of the series. 5. Defects of conjugate movement occurred in 5.6 per cent of the cases. In- volvement of upward conjugate gaze in pineal tumors appeared to have the greater value for localization. 6. Nystagmus was present in 10.9 per cent of the series. It was a frequent finding in cases of tumor of the cere- bellum. 7. Extraocular muscle palsies were found in 13.4 per cent of the cases. The incidence of abducens, oculomotor and trochlear involvement reflects' their anatomic arrangement. Such palsies were of little value in lateralization. REFERENCES Critchley, M.: Brain tumors in children; their general symptomatology, Brit. J. Child. Dis., 22:251-264 (Oct.-Dec.) 1925. Crosby, E. C. and Henderson, J. W.: The mammalian midbrain and isthmus region: Part II. Fiber connections of the superior colliculus. B. Pathways concerned in automatic eye movements, J. Comp. Neural., 88:53-92 (Feb.) 1948. Duke-Elder, W. S.: Text-Book of Oph- thalmology : Vol. III. Diseases of the In- ner Eye, St. Louis, C. V. Mosby Co., 1943, p. 2947. Henderson, J. W.: The anatomic basis for certain reflex and automatic eye move- ments, Am. J. Ophth., 32, Part II: 232-238 (June) 1949. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. OCULAR FINDINGS OF INTRACRANIAL TUMOR 97 1950 5. Newman, E. W.: Ocular signs of intra- cranial disease in children and juveniles a report of 42 cases, Am. J. Ophth., 21:286-292 (March) 1938. ,6. Paton, Leslie: Diseases of the optic nerve: optic neuritis in cerebral tumours and its subsidence after operation, Tr. Ophth. Soc. U. Kingdom, 25:129-162, 1905. 7. Penfield, W. and Erickson, T. C.: Epilep- sy and Cerebal Localization, Springfield, Ill., Charles C Thomas, 1941. 8. van Wagcnen, William P.: The incidence of intracranial tumors without "choked disk" in one year's series of cases, Am. J. M. Sc., 176:346-366 (Sept.) 1928. 9. Verhoeff, F. II.: A new answer to the question of macular sparing, Arch. Oplith., 30 :421-425 (Oct.) 1943. .10.. Walsh, F. B.: Clinical Neuro-ophthal- mology, Baltimore, Williams & Wilkins Co., 1947. DISCUSSION DONALD J. LYLE, M. D., Cincinnati, Ohio: Many conditions affect a statistical study of this nature, especially . in reference to symp- tomatology which is influenced by three chief factors: 1. Stage of involvement 2. Rapidity of involvement 3. Nature of involvement a. By direct pressure of invasion b. By remote production of general bulk x. Through tumor development y. Through production of obstructive hydrocephalus Rapidly growing tumors are usually as- sociated with tumefaction, swelling, or edema, at first intracellular, then cxtracellular, and be- cause of the rapidity of. growth there is less opportunity for compensatory adjustment to the added bulk, both in the neighborhood of the tumor and in remote locations. Local or focal symptoms of intracranial tumors may be confusing and misleading. The oculomotor, trochlear, trigeminal and facial nerves may be stretched by a shifting of the brain and confuse the location of the lesion by their implication. For these reasons, one must pay particular attention to the first symp- toms as later ones may be misleading in their localizing and diagnosing value. One must remember that localizing signs and symptoms may be produced not only by tumors but by vascular lesions of various types, injuries and other conditions. Therefore, the presence of certain symptoms or syndromes, although they may be of localizing value, is not nec- essarily diagnostic of the type of lesion caus- ing them. I believe that the differences between the percentage found by Dr. Petrohelos and Dr. Henderson and those of other investigators lie in the fact that their material as a whole, as they state, was subjected to earlier diag- nosis and treatment. This applies to all of the symptoms they enumerate and describe in which there has been a discrepancy in sta- tistical figures. As to the difference in the amount of papilledema between the two sides, I am in agreement that there is very little. Perhaps in tumors of the middle fossa there may be some dissimilarity of elevation at the disc, but in these cases one may be dealing with direct pressure on the ipsilateral side in the pro- duction of primary optic atrophy and indirect pressure on the contralateral side resulting in papilledema. These cases of Foster Ken- nedy syndrome or Gower -Patton-Kennedy syndrome were not found by the authors, probably because they appear usually in ad- vanced conditions. I am quite sure, however, that they are occasionally found in the average clinical practice. This syndrome is produced by tumors of the base of the frontal lobe, tu- mors of the middle cranial fossa which include hypophyseal adenoma and anterior temporal lobe tumors as well as the meningiomas, craniopharyngiomas and less common neo- plasms. In these cases there is, of course, a difference in elevation as well as in the pallor of the papilla. It is unfortunate that the term used to describe the type of atrophy of the nerve fibers whose cell bodies are in the ganglion cell layer of the retina and whose axons pass out of the eye to form the optic nerve, chiasm and tract is frequently misleading and inaccurate. The term "secondary optic atrophy" simply means that destruction, both physiologic and anatomic, has followed an earlier involvement severe enough to kill the optic nerve, but it does not indicate what or where. If the destructive process occurs remote from the papilla, one might say from its appearance as seen with the ophthalmoscope that primary optic atrophy is present; if it appears at the papilla with the production of gliosis and fibrosis, a secondary optic atrophy is evident. The essayists in this presentation wish secondary optic atrophy to mean atrophy following papilledema. I do not believe that I am helping to clarify the terminology to any great extent, but I would like to suggest the Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 ~J8 M. A. PETROHELOS AND J. W. HENDERSON use of the term "consecutiv. opts atropi~y" to mean optic atrophy following papilledema. This term has been used for this type of optic atrophy by several neurologists. There is very little definite information, but much has been said concerning the sparing and nonsparing of the macula. The authors' view is worth consideration. Homonymous quadrantanopsia is possible if the lesion involves either the dorsal or ventral bands of radiation fibers. The difference be- tween lesions posteriorly where the two bands of radiations course side by side, and in the forward temporal area, where they are sepa- rated by the temporal horn of the lateral ventricle and other structures, is that a post- erior lesion frequently overflows into the ad- joining quadrant fibers, whereas the anterior lesion shows a sharp horizontal line marking the lower boundary of the quandrantanopsia. (This is demonstrated in the charts and cases illustrating the condition.) Although bitemporal hemianopsia resulting from dilatation of the optic recess in the an- terior end of the third ventricle is an infre- quent symptom compared with its production by tumors in the chiasmal region, it does occur. These conditions are not found in the authors' series probably because of the ad- vanced stage, as mentioned above. Pupillary changes have been noted both clinically and experimentally as arising from the stimulation of the (1) basal telencephalon, (2) midline thalamus, (3) subthalamus, and (4) midbrain, as well as from certain cortical areas. I agree with the authors that until further knowledge is forthcoming, anisocoria and indeed other pupillary ab- normalities have merely a conjectural origin and location. I might make a similar statement con- cerning nystagmus, both ocular and vesti- bular. Nystagmus has very little localiz- ing significance save that lesions producing vestibular nystagmus of central origin occur usually in the posterior fossa. Infrequently, a temporal lobe tumor is found with the symp- tom of vestibular nystagmus, which leads me to the conjecture that there might be a vesti- bular cortical center in the temporal lobe ad- jacent to the auditory center. Conjugate deviation of the eyes, usually irritative, sometimes paralytic (that is, par- alysis of lateral gaze), may improve through a compensatory mechanism so that the symp- toms which appear early, mos, frequently not- ed in acute brain conditions, may disappear. Conjugate deviations remain more perman- ent when produced by lesions in the brain stem. If I were to suggest anything in addition to this comprehensive study, it might be to include the symptoms resulting from involve- ment of the trigeminal and facial nerves and their associated connections. Tumors occurring in the middle fossa may produce pain from involvement of the tri- geminal nerves or the gasserian ganglion which occurs in their confluence. The gang- lion is joined with the pons by its sensory root, from which is given off ascending and descending fibers. In addition to the symp- toms of pain, paresthesia and anesthesia with involvement of the trigeminal, trophic lesions are found along its course, especially with serious involvement of the cornea. Pain may also be found as the result of meningeal irritation as the dura and larger vessels are innervated by the trigeminal. Pain and trophic disturbances are therefore of localizing value in the presence of brain tumors. The facial nerve is of great localizing value in intracranial tumors as its involvement points to different areas. 1. A difference between supranuclear and in- franuclear lesions with their flaccidity and involvement of the eyelids is significant. 2. Infranuclear facial paralysis in association with abducens paralysis, the Millard- Gubler syndrome, points to a lesion in the brain stem in the vicinity of the lower pons. I do not believe that exact percentages are authoritative, especially as they concern symp- tomatology. One must remember that he is working with living tissues exposed to various influences and because of the dissimilar factors at hand, they will not necessarily react in the same manner in every instance. However, in a closely studied series such as this, the statistics are of great interest and con- siderable importance. 1. wish to compliment the essayists on this concise and well docu- mented study. DR. HENDERSON: Dr. Petrohelos and I wish to thank Dr. Lyle for his discussion of our paper. It is obviously very difficult in a some- what dry statistical presentation such as ours to include any particulars on individual cases. We hope in the future to be able to carry out the analysis more extensively. Thank you. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANS. AMER.- ACAD. OF O. & O.. FIG. 1-Nematode larva in eosinophilic abscess in vitreous membrane. x400 AFIP Ace. 198761. owl-"I", 01111 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NEMATODE ENDOPHTHALMITIS HELENOR CAMPBELL WILDER WASHINGTON, D. C. ROIFTINE examination of eyes at the Armed Forces Institute of Pathology disclosed a well-defined group in which the clinical histories and pathologic le- sions were strikingly uniform. The eyes, with few exceptions, were from children. In most instances observation of a white papillary reflex by the parents was the first evidence of ocular disease. On ophthalmoscopic examination there was seen behind the lens a pale mass with the blood vessels coursing over it, and a diagnosis of retinoblastoma led to enucleation. Eosinophilic abscesses, sometimes surrounded by epithelioid and giant cells, presented a pathologic picture not accounted for by the more commonly recognized granulomatous lesions of the eye. Special stains failed to demonstrate bacteria, fungi, inclusion bodies, or or- ganisms of any kind. As the lesions re- sembled those seen in helminth infec- tions elsewhere in the body2,3,i4,i5 and those described in the eyes of experi- mental animals,19 it was decided to re- examine specimens exhibiting a sugges- tive inflammatory reaction in the hope of finding the responsible organism. Forty-six eyes, each from a different patient, were selected for this investiga- tion. On the basis of previous micro- scopic examination, diagnoses of en- dophthalmitis, pseudoglioma, and Coats's disease, i.e., external exudative or hem- orrhagic retinitis, had been made. Serial sections were prepared on all available From the Armed Forces Institute of Pathology. Preli'ninary report presented at the Congress of the Pan-American Association of Ophthalmology, Miami Beach. 1950, Presented at the Fifty-Fifth. Annual Session of the American Academy of Ophthalmology and Otolaryn- gology, Oct. 8-13, 1950, Chicago, Ill. material, which in no case was complete since the specimens had been sectioned previously. Notwithstanding this handi- cap, nematode larvae (figs. 1, 2, 3, 4, 5, 6) or their residual hyaline capsules (figs. 6, 7, 8)2,14,15 were found in 24 eyes. In one case examination of over 2300 sections resulted in the discovery of a single larva (fig. 3), the entire worm being contained within 12 sec- tions. In another eye, three larvae were found. In 9 eyes the larvae were exceptional- ly well preserved. These were examined by Dr. B. G. Chitwood,6 who gave the following report: So Far as can be determined on the basis of the material at hand, the specimens are third stage hookworm larvae. No informa- tion as to species has been obtained. However, Ancylostoma sp., Necator sp. and Uncinaria sp. are possibilities. These specimens are the same stage but differ very slightly from Oesophagostomum larvae 24 hours after in- fection, as seen in sections of a pig's esopha- gus shown to us by Dr. D. A. Shark, Zoologi- cal Division, Bureau of Animal Industry. Furthermore, we are unable to distinguish between this specimen and a nematode seen in a pathologic section of a clog kidney. The fact that the larvae in these cases have been recognized as hook- worm does not rule out other nematodes (Strongyloides, Ascaris, etc.) as pos- sible causative agents in endophthal- mitis. During the course of this study an unusual coincidence led for a time to the incrimination of a nematode larva which had nothing to do with the ocular lesion. In those eyes which were sec- tioned in paraffin, filariform larvae, very different in appearance from the Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 , Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 -Nov.-DEC. NEMATODE ENDOPIITHALMITIS 101 9950 FIG. 3-Nematode larva surrounded by eosinophils in vitreous chamber. x220 AFIP Ace. 298563. FIG. 4--Nematode larva in cosinophilic abscess in vitreous cbainhcr. Sar.ial cxctions showed the body partly extended and the tail coiled. A. x350 AFIP Ace. 69623; 11. x400 AFIP Ace. 69623. larvae within the abscesses, were found of the section, it was decided without apparently within the globe. They were question that they were contaminants, all complete, unsectioned larvae and probably deposited by a parasitized fly -were not surrounded by cellular exudate. on the slides while they were drying on As in a fourth case the larva lay on top the warm plate. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 FIG. 5-Degenerated worm surrounded by necrotic eosinophils, epithelioid cells, and giant cells. x400 AFIP Ace. 202593. FIG. 7-Cross section of hyaline capsule surrounding completely degenerated worm. x400 AFIP Ace. 69623. CLINICAL DATA The 24 eyes in which the presence of larvae was established were all from children. The youngest was 3 years of age, the oldest 13, and the majority were of preschool and early school age : 3 through 5 years, 12 patients; 6 through 9 years, 9; 10 through 13 years, TRANS. AMER. ACAD. OF O. & 0. FIG. 6-Nematode larva, tangential section, sur- rounded by hyaline material. x450 AFIP Ace. 285189. FIG. 8-Hyaline capsular fragment in older lesion. x604 AFIP Ace. 79868. 2. Fourteen of the eyes were from girls, 10 from boys. Twenty-one of the pa- tients were white and 3 colored. The specimens included 16 right eyes, 6 left, and 2 with side unspecified. In 2 in- stances lesions in the remaining eye in- dicated bilateral involvement. Although the majority of the patients were from Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. 1950 NEMATODE ENDOPHTHALMITIS 103 GEOGRAPHIC DISTRIBUTION the southeastern United States, they were by no means limited to this region (see map). It must -be taken into con- sideration, however, that the children from northern and western states may have lived in or visited other localities. A preoperative diagnosis of retinoblas- toma had been made in 20 instances, pseudoglioma in 3, and in 1 in which the inflammatory reaction was particu- larly fulminating the clinical diagnosis was panophthalmitis. Anderson' ob- served that glioma (retinoblastoma) was the usual clinical diagnosis in oph- thalmomyiasis when the larvae were located subretinally. Neither helminth infection nor any systemic disease was mentioned in the records of 20 patients. One had a history of old nematode in- fection. One child was cachectic, one had frontal headaches at the time of onset of ocular symptoms, and another, con- tinued ocular pain and visual loss fol- lowing meningitis eight years before enucleation. Usually there were no clinical signs of local inflammation. In addition to the 24 proved cases, there were 22 which were believed, on the basis of a similar pathologic picture, to be probable nematode endophthalmitis although larvae were not found. In gen- eral the clinical pattern and geographic distribution closely paralleled those of the proved cases, although 3 patients were adults and 1 was from as far west as the state of Washington. HISTOPATHOLOGIC OBSERVATIONS On microscopic examination, an in- flammatory membrane was generally seen in the funnel of the detached retina, but it rarely involved the ciliary body (figs. 9, 10). In most, although not all, instances the anterior segment was com- paratively free from evidences of in- flammation. Cataract, however, was an occasional complication, and sometimes the posterior capsule was perforated, possibly by the larvae. Retinal, sub retinal and vitreous hemorrhages were often present. Serous exudate usually occupied the subretinal space. The most characteristic lesion was the eosinophilic abscess with a center in Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANS. AMER. ACAD. OF O. & O. 1'T6. 9-Site of larva in retinal fold indicated by arrow. Delicate vitreous memhrane? Subretinal se- rous exudate. Retinal detachment. No involvement of anterior segment. x4 AFTP Ace. 201971. FIG. 10-Site of larva in vitreous membrane in- dicated by arrow. Subretinal serous exudate. Retinal detachment. No involvement of anterior segment. x4 AFIP Ace. 198761. which the cytoplasmic granules tended to become basophilic as a result of necrosis (fig. 11). Surrounding the ab- scesses were epithelioid cells, occasion- ally with giant cells (fig. 5), and in- flammatory granulation tissue infiltrated by eosinophils, lymphocytes, and plasma cells which, frequently were multi- nucleated, some having as many as five or six nuclei. There was considerable variation in the relative number of these cells in different lesions, apparently de- pending on duration and on the stage of disintegration of the larvae. Poly- mofphonuclear leukocytes were not con- spicuous except in very early cases. The eosinophilic abscesses were dis- tributed on the underside of the retina, in retinal folds (fig. 9) and in the vitre- ous membrane (fig. 10). They also marked the sites of entrance of the larvae from the choroidal vessels, in- volving the inner layers of the choroid and breaking through Bruch's mem- brane (fig. 12). In many eyes they were found only on serial sectioning. Al- though it was in the abscesses that the larvae were located, every abscess did not contain a worm. This corresponds to the experience of O'Connor and Hulse,15 who in a study of the general- ized lesions of filariasis observed the organisms in all stages of degeneration in abscesses, and who concluded that failure to find them on serial sectioning was an indication that the filariae which had provoked the characteristic reaction had completely disintegrated. Intra- ocular lesions were not included in their investigation. In eyes studied for the present report the older lesions had undergone fibrosis but retained their tubercle-like pattern, and many of them still contained fragments of hyaline cap- sule (fig. 13). In case of long standing inflammation, granulation tissue and hemorrhage were replaced by dense fibrous membranes. Scars, which un- doubtedly marked the tracks of the larvae, passed from the inner layers of the choroid and through the retina, in- terrupting Bruch's membrane and often forming chorioretinal adhesions (fig. 14). In a few cases calcium deposits were seen in the lens and retinal folds and a little bone formation in the cho- roid, features which might well add to the difficulty of x-ray differentiation from retinoblastoma. Cholesterin slits (fig. 15), masses of mononuclear cells, and even "ghost cells" beneath the retina had sometimes led to a diagnosis of Coats's disease. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. NEMATODE ENDOPITTIIALMITIS 105 1950 FIG. 11-Eosinophilic abscess surrounded by cpithelioid cells and by inflammatory granu- lation tissue. Note hyaline fragment. x125 AFIP Ace. 79868. FIG. 12-Eosinophilic abscess destroying the inner laver of the choroid and interrupting Bruch's membrane. x48 AFIP Ace. 132401. DISCUSSION The chance occurrence of nematode larvae within the eye in nematodiasis is well known. There are excellent re- views in the literature of the reported cases of intraocular nematodes,4,8,13 most of which have been filaria, par- ticularly Onchocerca volvulus7 and, less often, Wuchereria bancrofti and Filaria loa. Generally these parasites have been observed clinically in the anterior cham- ber, and nearly all the patients were Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 106 HELENOR C. WILDER FIG. 13--Older lesion undergoing fibrosis. Note hyaline fragment. x125 79868. FIG. 14-Scar of entrance of the larva from the choroid, through the retina into the vitreous. x48 AFIP Ace. 293903. from tropical regions.16,17 Four reported cases are of particular interest either be- cause of type of worm or geographic distribution. Sen and Ghose18 removed a worm identified as Gnathostoma spinigerum from the surface of the iris in the eye of a Siamese. Although there had been recurrent iritis and hemor- rhages in the retina and vitreous, re- covery was uneventful except for the development of optic atrophy. Jones, Jordan and Sullivan" reported the case Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO0300005001107 1OV.-DEC. NEMATODE ENDOPHTHALMITIS 1950 of a 42 year old white woman who lived on the West Coast, the last 5 years in Portland. She had never been in the tropics. An adult type of round worm measuring 9 mm. and thought to be W. bancrofti was observed in the anterior chamber but unfortunately was lost on removal so that positive identification was impossible. Hosford, Stewart and Sugarman'2 removed 6 worms of The- lazia californiensis from within the eye of a 35 year old man. No further trouble infection. The larval parasites gain en- try to the host by one of two possible routes - through the skin or through the mouth.3'9 If they enter through the skin, they reach the right heart by way of the venous circulation whence they are carried through the lung to the left heart and so through the carotid, oph- thalmic and ciliary arteries into the eye. If they enter by the mouth, they are probably transported directly to the in- testine. They may then penetrate the FIG. 15--Subretinal mass of inflammatory tissue and organized hemorrhage with cholesterin slits in this case of nematode endophthalmitis (see figures 4 and 7) led to a diagnosis of Coats's disease. x125 AFIP Ace. 69623. was experienced. Calhoun4 observed a living Ascaris larva in the eye of an 8 year old Georgia boy. The larva in- creased in size during a period of five weeks, after which it died and was com- pletely absorbed. Iridocyclitis and sec- ondary glaucoma, which were present in the early stages of the infection, sub- sided. In nematode endophthalmitis as seen in the cases from the Institute the loca- tion of the lesion indicates blood-borne intestinal wall and be carried by the venous circulation to the right heart and thence reach the eye by the same route as if they had entered through the skin. In either case migration through the lung, demonstrated by Fullerborn10 and others, readily accounts for their pres- ence in the eye. Choroidal lesions indi- cate that the metastases are generally to the choroid, as in neoplasms, rather than to the retina, and that the larvae reach the retina and vitreous by direct Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANS. AMER. ACAD. OF O. & O. invasion. Further proof of this was the case of Heathy l in which a larva was seen leaving a choroidal vessel by per- forating its wall. Cataract associated with hookworm disease has been ac- credited to anemia, toxemia, or a com- bination of the two by Calhoun.s He did not observe intraocular larvae clinically, and the eyes did. not come to micro- scopic examination. He regarded retinal hemorrhages as the result of toxins, whereas Fiillebornt? thought it possible that they resulted from larval emboli. SUM MARY Forty-six cases which had been di- agnosed pathologically as pseudoglioma, Coats's disease, and endophthalmitis, and which showed similar inflammatory reactions, were the subject of special study. With few exceptions the 46 pa- tients were children, the greatest num- ber from the southeastern United States. In most cases a clinical diagnosis of retinoblastoma had preceded enuclea- tion. Nematode larvae or their residual hyaline capsules were found in 24 eyes. In 22 others the characteristic reaction justified a tentative diagnosis of nema- tode endophthalmitis. In no instance was a parasite found in the original rou- tine sections. Serial sections were neces- sary to demonstrate the larvae in every case. In 9 eyes the larvae were excep- tionally well preserved and were identi- fied by Dr. B. G. Chitwood as those of hookworm. The exact species remains to be identified. CONCLUSION The finding of intraocular larvae by serial sectioning and the identification of the specific pathologic reaction that they evoke has led to the conclusion that nematodes play an important and hitherto unrecognized role in blindness in children, and particularly in the pro- duction of pseudoglioma and Coats's disease in the United States of America. ACKNOWLEDGMENT Recognition is given to Dr. Georgiana Dvorak-Theobald, who, in 1947, on the basis of a lesion similar to those re- ported here, suggested the possibility of helminthiasis as a cause of intraocular eosinophilia ; to Lt. Colonel Thomas Carlyle Jones, V.C., USA, who pointed out the resemblance of the ocular lesion to that commonly caused by helminths in other organs of animals; to Dr. Hen- ry Rappaport, Armed Forces Institute of Pathology, whose experience in ex- amining serial sections of an appendix riddled with lesions and finding only one nematode larva encouraged me in a seemingly endless search ; to Dr. B. G. Chitwood, nematologist and Associate Professor of Biology, Catholic Universi- ty, Washington, D. C., who contributed many hours to the identification of the parasite ; to Mr. Lawrence P. Ambrogi, Chief of Laboratories, Armed Forces Institute of Pathology, and his staff, particularly Sgt. Evelyn F. Ballou and Mrs. Aileen Sevier, whose tireless ef- forts in preparing serial sections made this study possible. REFERENCES 1. Anderson, William Banks : Ophthalmo- tnyiasis : a review of the literature and a report of a case of ophthalmomyiasis in- terna posterior, Ani. J. Ophth., 18:699- 705, 1935. 2. Ash, J. E. and Spitz, Sophie: Pathology of Tropical Diseases: An Atlas, Philadel- phia and London, W. B. Saunders Co., 1945, chapters 14 and 15. 3. Belding, D. L.:- Textbook of Clinical Parasitology, Section TII, New York, D. Appleton-Century, 1942. 4. Calhoun, F. Phinizy : Intra-ocular inva- sion by the larva of the ascaris : report of a case with unusual complications, Arch. Ophth., 18:963-970, 1937. 5. : Eye complications caused by hookworm disease, with special reference to the formation of cataracts, J.A.M.A., 59:1075-1079 (Sept. 21) 1912. 6. Chitwood, B. G. and Chitwood, M. B.: An Introduction to Ncmatology, Balti- more, IVlomnncntal Print_ng Co, 1937. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. 1950 7. Clark, William B.: Ocular onchocerciasis especially in children, Mrs. Wilder has done in Guatemala : Onchocerca volvulus, Tr. us a great service. I am sure you all realize Am. Ophth. Soc., 45:461-501, 1947. the tedious effort required to examine serial 8. Duke-Elder, W. S.: Text-Book of Oph- sections of 46 eyes. Since over 50 per cent thalmology, St. Louis, C. V. Mosby Co., of the eyes selected. for study because they 1941, vol. 3, chap. 41. showed a particular pattern of cellular re- 9. Faust, E. C.: The Phasmid Nematode action yielded positive evidence of parasites, Parasites of Man. In Human Helmin- this long search was well rewarded. thology, ed. 3, Philadelphia, Lea & Febi- ger, 1949, chaps. 15 and 16. During what we would like to continue call- 10. Fiilleborn, F.: Untersuchungen fiber den ing the last war I noticed that we could al- Infektionsweg bei Strongyloidcs and most always find intestinal parasites in non- Ankylostomum and (lie Biologic dieser allergic soldiers with an eo:,inophilia of over Parasiten, Arch. I. Schiffs- u. Tropen- 6 per cent. Although some of these soldiers hyg., Beih., 18:182-236, 1914. also had choroiditis, the possible causal re- 11. Heath, P.: Personal communication. lationship did not occur to us. 12. Hosford, G. N., Stewart, M. A. and Sugarman, E. I.: Eye worm (Thelazia During the past two years, I have observed californiensis) infection in nian, Arch. a man who has had intestinal worms, eosino- Ophth., 27:1165-1170 (June) 1942. philia of 11 per cent, and recurrent attacks of 13. Jones, Lester T., Jordan, Lewis W. and mild paramacular choroiditis with multiple Sullivan, Nicholas P.: Intraocular nema- retinal hemorrhages. While no other cause tode worms : report of a case and review could be found, neither his internist nor I of the literature, Arch. Ophth., 20:1006- know how to prove or disprove a causal re- 1012 (Dec.) 1938. lationship. Mrs. Wilder's report makes it 14. O'Connor, F. W.: Researches in the seem desirable to look for and eradicate in- Western Pacific. Research Memoirs of testinal parasites in such cases, as two of the the London School of Tropical Medicine, 46 eyes were from adults. London, J. C. Phelp & Son, 1923, vol. 4. We are especially interested these days in 15. O'Connor, F. W. and Hulse, C. R.: Some unraveling the mysteries of retrolental fib- pathological changes associated with roplasia. In so doing, attention has been Wuchereria (Filaria) bancrofti infection, focused on other conditions which produce Tr. Roy. Soc. Trop. Med. & Hyg., 25: the pseudoglioma or leukocoria reflex. This 445-454 (May) 1932. endophthalmitis due to nematode infection 16. Puig Solanes, M., Fontes, A. and Quiroz, explains some cases which we have been J. A.: Investigacibn oftalmol6gica on la classifying as Coats's disease or as metastatic zona oncocercosa de Chiapas, Salub. y. retinitis accompanying the exanthematous dis- asist. (no. 10), 2:69-96 (July-Aug.) 1945. eases of childhood. This is real progress. 17. Scott, J. Graham : Onchocerciasis : a study of ocular complications in 342 African hookworm infection and malaria have cases, Am. J. Ophth., 28:624-635, 1945. been the two greatest obstacles to the eco- 18. Sen, K. and Ghose, N.: Ocular gnathosto- nomic development of the Southern States. miasis, Brit. J. Ophth., 29:618-626 (Dec.) Measures to combat them have been rather 1945. half-hearted. Perhaps the fear that children 19. Suyeuiori, S.: On pathological changes in may lose eyes because they are infested with the eye during the incipient stage of in- worms will stimulate a more vigorous fight fection with Ascaris (experimental study), against this common menace to the public The Taiwan Igakkai Zasshi, 239:1, 1925. health. If so, Mrs. Wilder's report will be more valuable than ever. I have a feeling that DISCUSSION more parasitic diseases of the eye will he demonstrated in the near future. JOHN S. McGAvic, M. D., Bryn Mawr, Pa.: In bringing to our attention the fact that nema- It has been a pleasure to discuss Mrs. Wild- tode infection can cause cndophthalmitis, er's excellent report. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 THE CONTAMINATION OF OPERATIVE WOUNDS WITH COTTON FIBRILS AND TALC L. R. DUSZYNSKI, M.D. NEW YORK, N. Y. GERMAN2 emphasized that cotton or talc foreign bodies frequently escape detection in routine methods of histo- logic examination but can be easily dem- onstrated with polarized light. Routine microscopic sections of globes operated upon for glaucoma and subsequently enucleated were examined with a pola- roid microscope. Photomicrographs with polarized light show the location of the foreign bodies. Routine photomicrographs demonstrate the tissue reaction present in the for- eign body field. The relationship be- tween foreign body and tissue reaction can be compared by examining the same field with both technics' (figs. 1 through 8). Table I indicates the relative inci- dence of such material in routine sec- tions of previously operated upon glau- comatous globes. While the number of specimens in each group is too small to permit statistical analysis, the low per- centage in simple iridectomy would lead one to suspect that some factor sepa- rates it as an individual group. This fac- tor is probably the minimal operative manipulation in this procedure, i.e., in the absence of bleeding, sponges are not introduced into the operative field and instrument technic limits contamination from glove talc. Tissue reaction is dependent upon the site and nature of the foreign body.4 'The morphologic and optical properties Presented at the Fifty-Fifth Annual Session of the American Academy of Ophthalmology and Otolaryn. gology, Oct. 8-13, 1950, Chicago, Ill. of the material demonstrated in the polaroid photomicrographs is that of cotton or talc. The tissue reaction to each of these materials is fibroblastic and proliferative. Many observers have described this reaction in clinical and experimental studies. 1,3,5,11 The photo- micrographs are confirmatory evidence in support of their previous findings and will not be elaborated upon at this time. T A]SLE I THE RELATIVE INCIDENCE OF FOREIGN BODY MATERIAL IN GLAUCOMA SURGERY OPERATION NO. OF SPECIMENS NUMBER POSITIVE PER- CENTAGE Cyclodialysis 37 31 84 Cyclodiathermy 5 5 100 Iridectomy 49 23 47 Iridencleisis 3 3 100 Iridotasis 1 0 0 Posterior sclerotomy 6 5 83 Sclerecto- iridectomy 9 6 67 Trepanation 106 83 78 TOTALS 216 137 73 The frequent presence of foreign bodies in eye surgery is significant in itself, and particularly so when one con- siders the care taken to prevent wound contamination with bacteria. "Physio- logically inert" foreign bodies are not absorbed and do provoke tissue reac- tions. The low grade chronic inflamma- tory response, while apparently innocu- ous, is a hazard, actually and potential- ly. McCormick5 reported a talc gran- uloma occurring fourteen years after muscle surgery. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 _....... __- FIG. 1-Iridectomy. (A) Low power photomicrograph by routine technic. Globe sectioned through lane indicated by identification suture (black), and also passing through operative site. Note giant p cells in tissue below identification suture. (B) Same field viewed by polarized light technic. Note distribution of foreign bodies (white) in the tissue. Compare location of foreign material with dis- tribution of giant cells in (A). (C) Same field viewed by combined nonpolarized and polarized light technics. Note birefrineent material in giant cells. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANS. AMER. ACAD. Oro. & O. FIG. 2-Trepanation. (A) Photomicrograph by polar- ized light technic. Note birefringent material (white) posterior to opening. (B) Same field by routine technic. Note tissue response localized to foreign body material demonstrated in (A). FIG. 3-Cyclodialysis and trepanation. (A) Photo- micrograph by polarized light technic. Note bire- fringent material (white) in tissue above and pos- terior to operative site. (B) Same field by routine technic. Note tissue response and compare cellular reaction to location of foreign bodies demonstrated in (A). SUMMARY Routine sections of globes operated upon for glaucoma and subsequently enucleated were examined with a pola- roid microscope. Photomicrographs demonstrate the presence of foreign bodies and the tissue reaction to them. The morphologic and optical properties of the foreign material are those of cot- ton or talc. FIG. 4-Trepanation with iridectomy. (A) Photo- micrograph by polarized light technic. Note many small foreign bodies (white) in tissue and large con- glomerate foreign body located posteriorly in epi- scleral tissue. (B) Same field by routine technic. Note capsule about large episeleral foreign body demonstrated in (A). The incidence of wound contamina- tion by foreign bodies in glaucoma sur- gery is indicated and the possible sig- nificance thereof is mentioned. REFERENCES 1. Derbyshire, R. C.: Cotton as suture ma- terial, Surg., Gynec. & Obst., 84:31-35, 1947. 2. German, W. M.: Dusting powder granu- lomas following surgery, Surg., Gynec. & Obst., 76:501-507 (April) 1943. 3. Gurtler, E.: Wattefaden in der Vorder- hammcr nach bulbuscr6ffnenden Opera- tionen [Cotton wool threads in the anterior chamber after intraocular operations], Wien. klin. Wchnschr., 61:686-689 (Oct. 21) 1949. 4. Leber, Theodor : On the present position of otir knowledge of inflammation, with especial reference to inflammation of the eye, Tr. Ophth. Soc. U. Kingdom, 12: 1-28, 1892. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. 1950 FIG. 6-High power photomicrograph of specimen in figure 5. Polarized light technic. Note foreign body material (white) in tissues. CONTAMINATION OF OPERATIVE WOUNDS nu tee mc. o e h field by routine technic. Note tissue reaction and compare cellular response in plane of foreign bodies demonstrated in (A). FIG. 5-Trepanation with iridectomy. (A) Photomicrograph by polarized light merous foreign bodies (white) present in tissues. (B) Same N FIG. 7-Same field as in figure 6 by routine technic. One foreign body in focus. Note cellular reaction. The second foreign body lies in another focal plane and cannot be demonstrated simultaneously by this technic. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANS. AMER. ACAD. OF 0. & 0. FIG. 8-Nigh power photomicrograph of specimen in figure 2. Routine technic. Note cellular response in foreign body field. 5. McCormick, G. L., Macaulay, W. L. and Miller, G. E.: Talc granulomas of the eye, Am. J. Ophth., 32:1252-1254 (Sept.) 1949. 6. Meade, William H. and Ochsner, Alton : The :relative value of catgut, silk, linen, and cotton as suture materials, Surgery, 7:485-514 (April) 11940. 7. Meade, William H. and Long, Carroll H. : The use of cotton as a suture material, with particular reference to its clinical ap- plication, J.A.M.A., 117:2140-2143 (Dec. 20) 1941. 8. Orr, Thomas G.: Granulomas caused by surgical silk and cotton Sutures, Arch. Surg., 54:37-40 (Jan.) 1947. 9. Searcy, Harvey B., Carmichael, Emmett B. and Wheelock, Mark C.: Implant ma- terial : the production of fibrous tissue around the fibers of cotton and other for- eign material implanted subcutaneously in rats, South M. J., 37:149-150 (March) 1944. 10. Vail, Derrick: Lint in the anterior cham- ber following intraocular surgery. Pre- sented at the meeting of the American Ophthalmological Society, Hot Springs, Va., June 1950. 11. Wilter, J. A.: Unusual proliferative re- action to suture material, Arch. Surg., 56: 178-185, 1948. DISCUSSION DErtrucx VAIL, M.D., Chicago, Ill.: Like the ghost of Shakespeare's Hamlet, Dr. Duszynski has here unfolded a tale "whose lightest word would harrow up thy soul, Freeze thy young blood, Make thy two eyes, like stars, start from their spheres, Thy knotted and combined locks to part, And each particular hair to stand on end, Like quills upon the fretful porpentine." W. M. German showed in 1943 that bits of cotton and talc embedded in tissue can easily be demonstrated under the microscope by polarized light, standing out like "an electric sign at night." Dr. Duszynski has cleverly adapted this method to a routine study of eyes operated upon for glaucoma and subsequently removed. He reveals the astounding fact that 73 per cent of 216 such eyes contain cotton fibrils and talc and show unmistakedly the injury these foreign bodies produce. Without his method o F study these harmful particles had escaped notice by even the most astute ob- servers. His photomicrographs are more im- pressive and convincing than a thousand words. They sound the tocsin to alert us at once to this dangerous condition and stimulate us to take what measures we can to combat it. At the last meeting of the American Oph- thalmological Society, I introduced the subject of lint or cotton threads in the anterior cham- ber following intraocular surgery and showed Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 . CONTAMINATION OF OPERATIVE WOUNDS 115 voa.-DEC 950 that clinically this condition probably was not find it satisfactory, although not perfect. rare and that these foreign bodies were cap-a- Powder from rubber gloves is another for- ble of producing harmful reactions within the eign body discussed by the essayist. Starch eye in spite of some reports in the i'terature powder has replaced the older magnesium talc to the contrary. I. was alarmed by the enorm- used on hands and rubber gloves, but particles ous amount of lint from gowns, draperies, of starch powder can easily enter the opened towels, and sponges that floated around in the anterior chamber and can irritate the intra- air of the operating room. This lint dust, ocular tissues. This danger can be alleviated stirred up by the slightest move of anyone by irrigating the newly gloved hands in a within the room, or entering or leaving it, stream of, sterile saline just before operating. swirled around and settled tenaciously on ex- However, those of tis who do not wear gloves posed instruments, solutions, sutures and the for intraocular surgery do not have this prob- patient's open eye. In the beam of the strong lem, as pointed out by Dr. Verhoeff in his operating lamp, the lint resembled white discussion of my paper referred to. The as- swarms of dancing midges. The saline for sistants and the scrub nurse, however, do and irrigation of. the anterior chamber sucked into they should be instructed to rinse thoroughly the glass syringe and held tip to the light their gloved hands to wash off all traces of showed a nauseating quantity of minute pieces powder. of. lint, like thread worms, waiting to be in- Instruments should be rinsed in sterile saline jected into the anterior chamber. or dipped in zephiran and wiped with sterilized The investigation of the problem showed pieces of old fine linen just prior to use. The fluid used for irrigation of the anterior that the pieces of free lint were capable of chamber, should be contained in a closed sterile carrying harmful bacteria picked up in the vessel and sucked into the syringe just be- air as it floated about. Ordinary measures to fore using. stop- or reduce the amount of free lint particles Foreign materials of a nature other than were fruitless. In desperation the advice of Dr. lint are occasionally seen in the anterior cham- Ralph M. Tovell of the Hartford (Conn.) her after surgery. These may be pieces of General Hospital was sought. He advised that bbcr ball irrgators or Bell the laundry use a paraffin-base waterproofin-, ru rubber er (from rbits~iof glass from a broken end material called Migasol P. J. (Ciba) upon all of a glass tipped irrigator, pieces of rust and operating room linen not used to absorb moist- scale from plated instruments, oil drops from ure. The use of this material during the last ophthalmic ointment, and bits of cilia. Methods four months at my free lint. has That t there a T there to prevent the introduction of these substances, solved the problem of f f free h while fairly obvious, require more thought. has been a striking decrease in the amount Whan we see an enlarged motion picture of floating around is evidenced by the fact that a cataract extraction, for example, or see what at the end of a day's work in the operating we do when we wear a loupe during the opera- room there is scarcely any lint seen on the tion, or when we examine with the slit lamp mirrors of the overhead operating lamp, an eye newly operated upon, we are struck whereas hitherto a thick layer of it was ob- with horror over the damage we do to the vious. I am, therefore, able to recommend tender tissues of the eyeball by our manipula- to you without reservation this method for tions. This depressing situation is bad enough, prevention of free lint. The method is simple. although perhaps a necessary evil. At least Migasol P. J. is added to the wash wheel after let us take intelligent measures to obviate as the laundry machine is loaded for the last far as possible the damage to an operated eye time. The formula calls for one pint of Miga- produced by things under our control. I shud- sol P. J. for each 100 pounds of linen in the der to think what we would see if we were to wash wheel. Linen used to absorb blood, serum use polarized light in the clinical slit lamp and other body fluids should, of course, not examination of eyes which have been operated be so treated. upon. Cotton sponges are another source of lint I am grateful to Dr. Duszynski for proving that can enter the anterior chamber. The ma- so convincingly in the laboratory what has been trix of the usual cotton sponge is very easily clinically observed, particularly for showing us broken by rolling into the shape generally em- how common this serious problem is, for alert- ployed. Substitutes are used but these arc not ing all of us to its danger, and for bringing entirely satisfactory. Among them are cellu- up this important subject for thought and dis- lose and the compact "felt cotton" used so cussion that may result in far reaching bene- widely by neurosurgeons. I use the latter and fits to our patients. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 MALIGNANT LYMPHOMA OF THE WEAL TRACT I'.DMOND L. Cooei R, M.I). DETROIT, MICII. and ` JOAN L. RIxiR, M.D. ALPENA, MICT.T. BY INVITATION AN interesting diagnostic problem is presented by a case of malignant neo- plasm with ocular manifestations. In the early stages of the disease the lesion was misinterpreted as inflammatory, and it was not until the enucleated eye was examined pathologically that the proper diagnosis was made. The disease from which the patient suffered was of a gen- eral systemic nature; yet for several months the only signs and symptoms were ocular, and for this reason the case should be of interest to ophthalmolo- gists. CASE REPORT The patient was a 27 year old white rnan, who in November 1947 had begun to have pain and blurring of vision in the right eye. He consulted an ophthalmologist who institut- ed treatment for iritis. When after a month the iritis had not improved but continued to progress, he was referred to us. There had been no attack of pain, no redness or blurring of vision in either eye preceding the "inflamma- tory" condition for which he had been receiv- ing treatment. The past history was negative except for two significant events. In 1944, while attending a radar school at Boston, the patient was hospitalized for an illness charac- terized by swelling of the lymphatic structures of the groin, diagnosed "lymphangitis." In the following year, when he was stationed at Okinawa, jaundice and severe headaches were the prominent symptoms in another illness for which he was sent to the hospital. During this time his weight, which on induction to the service had been 199 pounds, dropped to 180, and from then on he had experienced a very gradual but persistent loss of weight. Presented as a Clinicopathologic Case Report at the Fifty-Fifth Annual Session of the American Academy of Ophthalmology and Otolaryngology, Oct. 8-13, 1950, Chicago, III. When the patient was first seen, the left eye was normal and it remained so throughout the course of the illness. Vision with the right eye was 20/25. There was a mild ciliary flush. Slit lamp examination revealed numerous mut- ton-fat keratic precipitates on the corneal endothelium and cells in the aqueous. The iris was thickened but not nodular, and the blood vessels were engorged. The pupil was nmocl- erately dilated, and there were no posterior synechias. The fundus was easily seen. There was considerable edema of lire optic nerve head and the surrounding retina. The retinal veins were moderately engorged and exhibited peri- phlebitic changes. Throughout the fundus, but particularly in the upper temporal quadrant, were numerous retinal hemorrhages. The vitreous was free of hemorrhage. The intra- ocular pressure was 50 mm. Hg (Schiotz). The diagnosis was neuroretinitis, retinal pcripltlebitis and retinal hemorrhage (Eales's disease to be ruled out), iridocyclitis and sec- ondary glaucoma. The patient was admitted to Harper Hospital where paracentesis con- trolled the glaucoma. The inflammatory con- dition of the eye continued unchecked in spite of energetic treatment during the ten days the patient remained in the hospital. The iris became more thickened, and it was im- possible to keep the pupil dilated. Poster- ior synechias developed. Large nodules, 3 or 4 mm. in diameter, began to form in the iris, and the anterior chamber became shallower as the thickening of the iris increased. In general, the appearance of the anterior seg- ment suggested a chronic granulomatous proc- ess, and it was thought that the etiologic factor might prove to he tuberculosis, brucel- losis, Bocck's sarcoid, or one of the other chronic granulomas. While the patient was in the hospital, a thorough survey failed to provide a clue to the etiology. No foci of infection were found. Roentgenograms of the chest were normal. Skin tuberculin and brucellergin tests, the Frei test, blood agglutination tests for tularemia .,nd brucellosis, and smears of the prostatic Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Nov.-DEC. MALIGNANT LYMPHOMA-OF UVEAL TRACT 117 1950 secretion gave no positive information. Kahn test, urinalysis, and routine blood counts were normal. The differential leukocyte count was repeated twice and neither time was it un- usual. The only abnormal finding in the physi- cal examination was moderate bilateral in- guinal lymphadenopathy with no tenderness. Biopsy of an inguinal lymph node was done, and the pathologist's report was "chronic lymphadenitis of undetermined character-no evidence of sarcoidosis." In short, nothing was found to which the iridocyclitis or neuroreti- nitis could be attributed. Following the patient's discharge from the hospital the iridocyclitis progressed. The iris nodules became larger for a time and then gradually grew smaller. Dense posterior synechias and a pupillary membrane formed, so that the fundus could not be examined. In February 1948 vision was reduced to percep- tion of hand movements. The intraocular pressure was subnormal. A course of strep- tomycin therapy was given without any ap- parent effect on the disease. In March, because the eye was hopelessly blind and was rapidly becoming a cosmetic defect, and also because it seemed impossible to establish the correct diagnosis without path- ologic study, the eye was enttcleated. No diffi- .culty was experienced except that dissection of the conjunctiva and isolation of the rectos muscle tendons were hampered by considera- the orbit and the testicle but also to all of the lymph node areas which might constitute potential foci of metastasis, and to the pelvis, abdomen and ntediastinutn. Supervoltage roent- gen rays were employed over all of the areas except the two axillas, where deep roentgen therapy was used. In July 1948, the total leukocyte count was 4,500 and the differential count was normal. In the terminal stages of the illness the other testicle became involved, and there was clear- cut clinical and radiologic evidence of massive involvement of all the deep lymphatic struc- tures of the abdomen, thorax, neck, and head. The patient died in October 1948. Autopsy was not permitted. PATHOLOGIC OBSERVATIONS* The enucleated eye was sent to the Armed Forces Institute of Pathology, and a report received in April 1948 gave the first indication that the lesion was malignant. The conjunctiva, episclera, uveal tract, retinal pigment epithelium, sensory retina and optic nerve were in- filtrated with closely packed cells (figs. 1 and. 2). These sometimes resembled lymphocytes, having small round, deep- ly staining nuclei and scanty cytoplasm ble thickening and brawny induration of the conjunctiva, episcleral tissue, and Tenon's cap- sule. The patient's total leukocyte count dur- ing this hospital stay did not exceed 9,500, and the differential count was normal. During the following six months the pa- tient's condition gradually declined. In May, a painless swelling of the right testicle sud- denly appeared. It was relatively soft and uni- formly smooth with no nodularity, and at- tained the size of a peach. This was the first clinical indication (unless the inguinal lymph- adenopathy can be considered) of generalized disease. The testicle was removed and studied pathologically. At this time the differential blood count was normal. The liver and spleen were palpable and there were no indications of lymphadenopathy. Later the same month a cervical lymph node was removed and studied. The treatment of the eye in the early stages of the disease included all accepted measures, both local and general, for severe uveitis. It FIG 1__1>iffuse infiltration of the sweat tract, retina, was not until June 1948, when the pathologic and epibulbar tissues by tumor cells. x4. AFIP diagnosis of neoplasm in the eye had been Acc. 205905. further confirmed by examination of the tes 'Patbologic reports furnished by Helenor Campbell ticular tumor, that deep roentgen therapy was Wilder, Registry of Ophthalmic Pathology, Armed begun. Irradiation was directed not only to Forces Institute of Pathology, Washington, D. C. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 THA\S. AMER. ACA,. OF O. & O.. FIG. 2-Dense neoplastic infiltration with thickening of the conjunctiva, iris, and ciliary body. x16. AFIP Ace. 205FS05. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 Nov.-DEC. MALIGNANT LYMPHOMA OF UVEAL TRACT 119 1950 6IG. 4-Reticulum fibers surrounding tumor cells in the ciliary body (Wilder reticulum stain). x435 AFIP Ace. 205805. which was not always discernible. More often, however, the cells were larger, with rather abundant, ill-defined cyto- plasm and large, oval or round, vesicu- lar, nucleolated nuclei (fig. 3). These large cells approximated in appearance the cells of the germinal center of lymph follicles. A reticulum stain demonstrat- ed a close association between the retic- ulum fibers and tumor cells in many areas (fig. 4). There were anterior and posterior synechias and a pupillary membrane. The lens showed subcapsu- lar degeneration arid wrinkling of the capsule. The retina was separated and folded in several places, and there was almost total loss of normal. retinal archi- tecture (fig. 5). The diagnosis was lym- phoid tumor, probably metastatic retic- ulum cell sarcoma. The lesion of the inguinal node which was removed when the patient was first hospitalized for treatment of the eye was diagnosed by the Harper Hospital pathologist as chronic lymphadenitis (fig. 6). Following the identification of the ocular neoplasm, a representative slide of this lesion was forwarded to the Armed. Forces Institute of Pathol- FIG. 5--Infiltration of the ehoroid and retina by tumor cells with partial destruction of retinal archi- tecture. x48. AFIP Ace. 205805. FIG. 6-Reactive inguinal lymph node. x76. AFIP Ace. 205805. ogy. The diagnosis of lymphadenitis was concurred in, although it was re- garded as possible that the process rep- resented an inflammatory reaction to adjacent neoplasm. A microscopic slide of the testicle was submitted to the Armed Forces Institute of Pathology. It also revealed malig- nant tumor composed of small cells with scanty cytoplasm and round, deeply staining nuclei (figs. 7 and 8). The tu- mor in the eye more nearly resembled Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 120 E. L. COOPER AND J. L. RIKER TRANS. AMER. ACAD. OF O. & O. FIG. 7-Interstitial invasion of the testicle by tumor cells resembling lymphocytes. x435. AFIP Ace. 205805. reticulum cell sarcoma, although that in the testicle had the appearance of lymphosarcoma. It is not always pos- sible to make a definite differentiation between the two. Cells of reticulum cell sarcoma resemble the large cells in the germinal center of the lymph nodes, whereas a lymphosarcoma is composed of cells resembling the small cells of the node. Both have an origin from un- differentiated cells, and the variation results from the type of differentiation. The cervical lymph node, which was removed after the testicle, was studied elsewhere. The report stated that there was entire loss of normal architecture, the node being invaded by tumor cells similar to those in the eye. COMMENT Lymphoid tumors arising within the eyeball have seldom been described in the literature. In a report of 21 verified cases of lymphoid disease involving the eye and its adnexa, McGavic3 found only one within the globe as against 20 which involved the lids, conjunctiva, or lacrimal gland. In Heath's series2 of 67 ocular lymphomas, the globe was in- volved in only three. Sugarbaker and Craver,4 reporting on 196 cases of lyrn- phosarcoma, stated, "It is logical to sup- pose that lymphosarcoma is a disease which in the majority of cases begins and runs its early course in lymph nodes alone." In most instances of rapidly dis- seminating disease, it is impossible to determine whether a given organic in- volvement is secondary or primary. Lymphoid tissues composed of fol- licles and sinuses do not exist in the eyeball or within the orbit ; nevertheless, lymphoid tumors arising within the or- bit are by no means unknown. They also occur in other locations where lymphoid Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 ,Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. 1950 MALIGNANT LYMPHOMA OF UVEAL TRACT 121 AN-Wii'll".2 #7 FIG. 8-Small tumor cells resembling lymphocytes in the testicle. x655. AFIP Ace. 205805. tissues are not found normally, particu- larly in the skin where they are regarded as arising from undifferentiated cells around blood vessels. Possibly this tu- mor was primary in the eye, but the early episode of inguinal gland enlarge- ment cannot be ignored. According to the pathologic reports from the Armed Forces Institute of Pathology, it more probably represented either metastasis from elsewhere in the body or one man- ifestation of a tumor arising in dissemi- nated lymphatic tissue and from undif- f erentiated cells. As is often the case, an exact classi- fication of the tumor in this instance is impossible; it includes features of both reticulum cell sarcoma and lymphosar- coma. However, all malignant lympho- mas, including Hodgkin's disease and the lymphoid leukemias, are considered manifestations of the same disease' and it is not unusual for them to exhibit a variable pattern in a single patient. The neoplastic process may be represented in one organ as giant follicular lympho- blastoma and in another as lymphosar- coma, or a tumor starting as Hodgkin's disease may terminate as lymphosar- coma, the transition being readily trace- able in successive biopsies. It is impossible to evaluate the causes which may incite lymphoid tissue to malignant growth. The history of our patient presents two episodes, one in 1944, the other in 1945. Although both were interpreted at the time as infec- tious, it cannot be proved or assumed that an inflammatory process preceded the neoplasm. There is no specific hemogram in lymphosarcoma, and usually, when blood changes do occur, they are late in the disease and may be ascribed to radia- tion therapy. The only abnormality in the blood picture was moderately low hemoglobin late in the disease, and at no time did the patient have an. abnormal leukocyte or differential count, although the last test was made only two weeks before his death. It is agreed by most writers that the diagnosis of lymphosarcoma cannot be made clinically but must be established by biopsy. Early in the clinical course even biopsy may show what appears to be a reactive or benign proliferation of lymphoid tissues. Considering the im- portant part played in inflammations by lymphocytes, it is sometimes difficult to evaluate their significance as part of an inflammatory or neoplastic process. As far as treatment is concerned, all lymphomas are radiosensitive but not necessarily radio-curable. Obviously. the earlier treatment is begun, the bet- ter is the chance of cure, but the prog- nosis is usually poor. SUM MARY The malignant lymphoma involving the eye in the case presented was prob- ably either metastatic or part of a wide- ly disseminated lymphoid activity. The ocular process presented, symptoms which simulated typical uveal inflamma- tion, and the proper diagnosis was made only upon pathologic examination of the enucleated eye. In any case of se- vere uveitis with nodular iritis or re- Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 122 E. L. COOPER AND J. L. RIKER tinal hemorrhages for which no cause is found and which does not respond to treatment, it is important to consider the possibility of malignant lymphoid disease. 1. Custer, R. P. and Bernhard, W. G.: The interrelationship of Hodgkin's disease and other lymphatic tumors, Ani. J. M. Sc., 216:625-642 (Dec.) 1948. 2. Heath, Parker: ' Ocular lymphomas, Tr. Am. Ophth. Soc., 46:385-398, 1948. 3. McGavic, J. S.: Lymphumatoid diseases in- volving the eye and its adnexa, Arch. Ophth., 30:179-193 (Aug.) 1943. \ 4. Sugarbaker, Everett D. and Craver, Lloyd F.: Lymphosarcoma : a study of 196 cases with biopsy, J.A.M.A., 115 :17-23 (July 6) ; 112-117 (July 13) 1940. Approved For Release 2002/07/24: CIA-RDP80-00926A00300005,0013-1 ,Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 A CONCEPT OF ALLERGY AS AUTONOMIC DYSFUNCTION SUGGESTED AS AN IMPROVED WORKING HYPOTHESIS HENRY L. WILLIAMS, M.D. ROCHESTER, MINN. IT is important to remember that al- lergy has two aspects, the one clinical, the other immunologic. It is perhaps unfortunate that some allergists in turn- ing from the one to the other aspect appear to insist that treatment of pa- tients shall be carried on along exclu- sively immunologic lines although the diagnosis may have been made entirely on the basis of a practical clinical em- piricism. The allergist in his role as im- munologist has broadened our under- standing of physiologic mechanisms that ? have to do with the organism's in- tolerance to interference from without. The immunologist in assuming the char- acter of clinical allergist, however, often has seemed to be too rigidly insistent on the immunologic dogma that all the clinical manifestations that have become known as the allergies must have an antigen-antibody mechanism as a back- ground of etiology and as a basis for treatment. Relatively recently the value of a clinical approach to many of the problems of allergy has received atten- tion. Study of those factors that alter the threshold beyond which manifesta- tion of allergy occurs, as Carryer24 stat- ed, has proved more fruitful in the care of many patients than has sole depen- dence on, an antigen-antibody type of treatment. Nevertheless, most allergists insist on including an immunologic mechanism in the definition of allergy, although it seems probable that few of them insist on the demonstration of an From the Section on Otolaryngology and Rhinology, Mayo Clinic. Presented at the Fifty-Fifth Annual Session of the American Academy of Ophthalmology and Otolaryn- gology, Oct. 8-13, 1950, Chicago, Ill. antigen-antibody mechanism in making a clinical diagnosis of the condition. I believe that this attempt to play the dual role of scientist and physician without separating the two parts suffi- ciently has caused some of the confusion in regard to the management of allergy. It seems to have been forgotten that the immunologic hypothesis was de- veloped to explain certain syndromes whose confines had previously been laid out not by controlled experiment but on the basis of knowledge gained through observation and experience. Von Pirquet's hypothesis of allergy76 was based on the discovery of hyper- sensitivity in an immunized organism. He, however, considered these two terms to be mutually exclusive. It seemed impossible to him to consider as immune an organism which is protected against a disease, and at the same time is considered reciprocally hypersensi- tive to the same disease. This phenome- non could not be termed a paradox, he stated, because the word "paradox" should be applied only to an exceptional case, whereas the more one entered into this field of inquiry the more "ac- cording to lawness" the phenomenon was recognized to be. He, therefore, sug- gested a "new, general, nonprejudicial word" for the change of condition which the organism accomplishes, per- haps through the agency of an organic, living or lifeless toxin. According to von Pirquet77 all that could be stated with certainty about a hypersensitive organ- ism is that its readiness for reaction is, altered. For this general concept of al- tered reactivity he suggested the ex- Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 124 HENRY L. WILLIAMS pression, "allergic," Von Pirquet showed himself willing to alter details .of the hypothesis as new observations were presented. Some of his followers, however, have not exhibited his intellec- tual adaptability. Carryer stated that internists vitally interested in the problems of allergic disease are keenly aware of the short- comings of a purely immunologic ap- proach. He said, however, that inas- much as the investigative thought over the past four decades has been greatly influenced by those whose background and experience were in the field of im- munology, it was not difficult to under- stand why progress has been directed away from the nonimmunologic aspect of allergic disease. He recommended a critical review of the none too gratify- ing results of current, generally accept- ed and practiced tenets which have shortcomings of considerable magni- tude. DEFINITIONS AND DESCRIPTIONS OF ALLERGY In considering the desirability of sub- stituting a new and more flexible hy- pothesis for the antibody-antigen reac- tion, a review of some representative definitions and descriptions of allergy made by proponents of the immunologic hypotheses may prove useful. Rosten- berg,87 for instance, recently stated, "The best definition for allergy is the following one: `Allergy is an acquired specific alteration in. the capacity to react which is predicated on an antigen- antibody mechanism." " In his opinion failure to include the antigen-antibody reaction has been the major reason for the confusion and lack of clarity which exist concerning the meaning of the word "allergy." He wished it to be clearly understood, however, that in the majority of allergic reactions an anti- gen-antibody mechanism is not demon- strable by conventional technics and in some cases not demonstrable by any TRANS. AM ER ACAD. OF O. $ O. . known technics. This, he stated, does not mean that antibodies do not exist in these states ; it merely means that we do not have as yet an appropriate indicator system to reveal their presence. He di- vided allergy arbitrarily into three im- munologic patterns, the anaphylactic, the bacteria], and the eczematous type. He emphasized that it was important to realize that no clinical condition corre- sponds exactly to any one of the im- munologic patterns listed. Many clinical conditions represent a combination of several of these types and, indeed, he considered that many varieties of al- lergic reaction do not fit into any of the three types given, but there is so lit- tle information about them that they cannot be set up as immunologic or allergic entities. Rostenberg does not give a single in- stance in which he considered that treat- ment of cutaneous allergic disorders by immunologic methods was certainly beneficial. Rostenberg then appears to declare that although factual data in regard to the presence or absence of an antigen- antibody reaction are absent in many of the conditions he considers allergic, conclusions arrived at by extrapolation and inference can be depended on to be correct and that such conclusions will serve to clear up the confusion and lack of clarity which exist concerning allergy. According to Bell,14 however, extrapolation and inference have been the chief causes of the major errors in human thought. On the other hand, Harley44 stated that in his opinion the confusion and lack of clarity in regard to allergy were due to the tendency of allergists to in- vent new and perplexing terminology for phenomena which were fundamen- tally the same. In the present state of our knowledge it seemed to him impos- sible to give an exact definition to the term "allergy." Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. 1950 The "unitarian theory" which was developed to do away with some of the confusion of terms appears to have gained wide acceptance. As Zinsser, En- ders and Fothergi11120 stated, this con- cept of allergy implies that the injection of an antigen into the tissues of an an- imal will lead to the development of a single antibody capable of producing the various manifestations of antigen- antibody union. This formulation has been further modified so that the vari- ous antibodies are considered to rep- resent varied physicochemical changes in the same globulin. . Kahn50 embraced the unitarian the- ory of allergy, but to the previous con- cepts of cellular immunity suggested by Metschnikoff,67 and the humoral im- munity suggested by von Pirquet,76 he added the concept of the "third type of immunity" or tissue immunity. He re- jected the suggestion that specialized cells would be entrusted with the entire defense of the body, stating that from the standpoint of phylogeny it would be reasonable to suppose that all cells possessed in some measure the ability to defend, themselves against environ- mental stress whether that stress pre- sented itself in the form of invading micro-organisms or some other form. He suggested that immune gamma globulin should be considered to be of two types, one of which is insoluble be- cause it remains fixed in the cell, the other of which is soluble because it is dissolved in the blood serum and con- stitutes the circulating antibody. Kahn also considered that the differences be- tween bacterial allergy and allergy in which circulating antibody can be iden- tified were in degree rather than in kind. Allergy in his opinion is merely an in- stance of hyperimmunity and there are many examples of overaction of a nor- mal physiologic mechanism. In Bronfenbrenner's opinion,16 the accumulated evidence indicates that whenever antigen-antibody reactions occur in vivo there is always a concomi- tant injury to the tissues of the host, as evidenced by both local and general symptoms. It appeared likely to him. that the very mechanism which causes this injury to the host is also instrumen- tal in bringing about such protective ef- fects as the warding off of infection by immobilization of antigen by the anti- body. Basically this injury consists of an inflammatory reaction which is evoked by the physicochemical changes in the enviropment and differs from ordinary inflammation only by its rapid onset and relatively stormy course. This inflammatory process is accompanied by both local and systemic symptoms re- sembling those elicited by the adminis- tration of histamine. Because of this re- semblance and especially because of the highly suggestive experimental demon- stration of the presence of histamine- like substances at the site of antigen- antibody union, he believed that the most widely held view today is that the inflammatory reaction is actually due to the liberation of histamine-like sub- stances from antibody-laden tissues when they come in contact with the spe- cific antigen. Bronfenbrenner'6 also stated that phe- nomena called "immunity" and "an- aphylaxis" are in fact merely different expressions of the same basic process of antigen-antibody union. Difference in the final outcome depends only on the extent and speed of this union and the consequent intensity of the injury to the host. Classical anaphylaxis as ob- served in animals and occasionally in man in his opinion is a laboratory arte- fact. Under natural conditions of expo- sure antigens enter tissues of allergic animals and of human beings much more slowly and in extremely small amounts ; consequently, their union with antibodies is less explosive and the in- jury to the host is much milder than in Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 126 HENRY L. WILLIAMS classical anaphylaxis. The symptoms elicited vary in form depending on the portal of entry, on the amount of antigen on one hand and on the relative local sensitivity of the involved tissues on the other. When so exposed, some indi- viduals respond more easily to such im- munogenic stimulus than others and these individual differences in reactivity seem to be determined by inheritance. The tendency to hyperreact is inherited, not the specific sensitivity itself. A new hypothesis has been suggested by Wiener.116 He stated that experi- mental work in relation to agglutinin and blocking antibody was the first defi- nite demonstration of the incorrectness of the "unitarian hypothesis" of allergy. The evidence presented by his own work indicated that univalent and polyvalent antibodies are distinct entities as shown by the fact that they can be separated by natural means such as placental fil- tration. He pointed out that Witebsky and associates118 partially separated these antibodies by dialysis in cello- phane bags against distilled water. While the agglutinin proved to be asso- ciated principally with the resulting pre- cipitate which contained most of the globulins, the blocking antibody or con- glutinin remained mostly in the super- natant fluid together with the albumin. Wiener offered the following criteria for allergy based on his theory: 1. The normal (nonallergic and non- immune) state is that in which the body contains no induced antibodies specific for the antigen in question. Cognizance is taken, however, of so-called natural or normal antibodies. 2. The immune state is one in which the body has acquired large amounts of antibodies of the blocking type formed in response to the introduction of anti- gen into the body by either natural or artificial means. In this state an excess number of univalent antibodies are free in the plasma and other body fluids. TRANS. AMER, ACAD. OF O. & O. 3. In the allergic state the body con- tains sensitizing (bivalent) antibodies attached to cells, with little or no free univalent antibodies in the body fluids. 4. Hyposensitization is the process of converting the allergic state into the im- mune state by repeated injections of antigen at sufficiently wide intervals to stimulate the production of potent blocking antibodies. This treatment is successful only when the subject achieves an adequate level of free uni- valent antibodies in his or her body fluids. 5. Desensitization consists in the in- jection of progressively increasing doses of specific antigen in rapid succession in order to saturate antibodies attached to body cells. This method, besides be- ing dangerous, is often unsuccessful and the refractory state that ensues is only temporary due to the subsequent production by the body of additional bi- valent antibody. This hypothesis appears to combine Kahn's concept of tissue immunity with the concept of humoral immunity. Wie- ner pointed out a number of problems in immunology, previously unanswer- able, that can be explained in. the light of his new hypothesis. While all these commentators differ considerably among themselves as to what constitutes allergy, they all insist that definition of the term "allergy" must contain a reference to an antigenic mechanism. It is clear from a review of the lit- erature of allergy, however, that the di- agnosis of allergy in the clinic depends not on immunologic tests but on a well- taken history and careful observation of the patient . 4,26,35,47,68,79,104, 108 It is ob- vious that Rostenberg, for instance, in classifying the various dermatologic al- lergies is depending on history and ob- servation, else he would not so carefully point out that in the majority of such Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. 1950 ALLERGY AS AUTONOMIC DYSFUNCTION 127 patients immunologic evidence is unob- tainable. In discussing skin tests in diagnosis of allergy Tuft,104 while insisting that they are of value in diagnosis when they can be obtained, pointed out that as in other laboratory tests the results must be correlated with the history and other clinical findings before an accurate di- agnosis is possible. He found that un- less a positive reaction can be obtained repeatedly, such a reaction cannot be considered specific but must be attribut- ed to faulty technic, contaminated syringes, or irritating extracts. He di- vided all specific positive reactions into (1) nonclinical positive and (2) clin- ical positive. It seems clear that Tuft has made the diagnosis of allergy on the basis of clinical empiricism and merely hoped for confirmatory and possibly more specific information from skin tests. Hansel`'' tacitly admitted. that as a rule the diagnosis of allergy is made from clinical grounds alone whgn he stated that eosinophilia of the nasal se- cretions is the most dependable sin of allergy. The exact role of the cosi ophil in allergy appears to be unknown. eter- sen,75 however, stated that he was able to produce showers of eosinoph is by causing localized tissue anoxia. This finding suggests that eosinophili can hardly be considered an indicator of an antigen- antibody reaction however valu- able it may be as a diagnostic tot for allergy. Fox, Harned and Peluse37 in iscus- sing "borderline" allergy obviously were not considering allergy as ccur- ring only among those patients who gave evidence of an antigen-antibody reac- tion. Physical allergy. Not all all rgists have insisted on an antigen-antibo y hy- pothesis of allergy, however. uke33 stated that in his opinion in only a mi- nority of patients with asthma, hay fe- ver, urticaria, eczema and other mani- festations of allergy can the source of the illness be traced definitely to contact with some material substance to which the patient is sensitive. He found that in the majority of patients, even after a most painstaking effort had. been made through the use of history, physical ex- amination, skin tests and clinical tests, the primary source of the disorder could not be shown to be sensitivity to sub- stances such as pollen, dander, foods, drugs, or vapors. He was astonished to find, on the other hand, that a rather large proportion of patients with allergic conditions are sensitive specifically and solely to the action of a physical agent such as light, heat, cold, or mechanical irritation and indirectly to the action of emotional -perturbation and fatigue. He termed such reactions "ph.ysical allergy." There is a tendency among allergists, however, to deny that "physical allergy" as defined by Duke should be actually considered an allergy. For instance, Bronfenbrenner117 stated that in his ,opinion it is unlikely that any real al- lergy (production of antibodies) to light exists. He remarked that although sev- eral authors have claimed to have suc- ceeded in transferring light sensitivity passively, the lack of proper controls minimizes the significance of such find- ings. In studying physical allergy Swine- ford'?1 stated that in his opinion physi- cal allergy -usually is an associated al- lergic condition and not a primary re- action. It might be pointed out, however, that the evidence he presented indicates that the antigen-antibody reaction is secondary as much as it does that the physical reaction is secondary. Since this is the only paper I have found in the literature purporting to show that physi- cal allergy in some manner is secondary to antigen-antibody allergy, and because there are several reports to the contrary, Approved For Release 2002/Q7/24 : CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 128 HENRY L. WILLIAMS it would appear that Swineford's find- ings need confirmation. Peshkin74 observed that 10 per cent of normal children reacted to skin tests with a variety of allergens. He also found that some of these "immunolog- ically positive" children were later pre- cipitated into acute episodes of clinical allergy by other presumably unrelated conditions, such as acute infections. He suggested that clinical reaction patterns, depending presumably on some other factor than the antigen-antibody mech- anism, needed to be developed before clinical expression of allergy could take place. He termed such nonclinical sen- sitivity para-allergy. Urbach and Gottlieb106 suggested the term "pathergy" to cover both physical and antigen-antibody allergy. Physical allergy was to cover those cases in which an antigen-antibody mechanism could not be demonstrated. It would appear that Peshkin and Urbach and Gottlieb were trying to es- cape from the horns of a dilemma posed by making diagnoses of allergy on a purely empirical basis, while at the same time insisting on the strictest adherence to the antigen-antibody concept of al- lergy in theory. Selye,95 however, reviewed the exten- sive literature that suggests that the or- ganism could develop specific and non- specific crossed resistance to various ir- ritants without an antigen-antibody mechanism, and White114 recently de- fined immunity to include resistance to physical stimuli in which an antigen- antibody mechanism apparently plays no part. INADEQUACY OF THESE HYPOTHESES Since it appears that allergists in general make the diagnosis of an al- lergic condition through history and physical examination, since the physi- cal and immunologic allergies cannot be distinguished from one another by these means, and since the majority of din- TRANS. AMER. ACAD. OF 0. & 0. ical allergies, according to Duke, fall into the group of physical allergies for which clinically significant skin tests are not obtained, does not insistence on the antigen-antibody concept of allergy tend to lead physicians into the error of unnecessarily doing repeated skin tests and treatments with various anti- genic substances in cases in which such tests and such treatment could not be expected to be of clinical benefit? Does not adherence to the antigen- antibody hypothesis tend to concentrate therapeutic attention on attempts at hy- posensitization alone, or at least to meth- ods by which the manufacture of sensi- tizing antibodies can be diminished while increasing the production of block- ing antibody or to methods which tend in some manner to influence antibody formation? Empirically it has been ob- served that attention to general nutri- tional factors, the use of vasodilators, trace minerals and various vitamins as well as psychotherapy have appeared to influence allergic manifestations in in- dividual cases. In cases in which these measures exert a beneficial influence and in cases which are set apart as physical allergy is not the physician at a loss for a reasonable hypothesis on which to base treatment? What can be the reason for this rath- er blind allegiance to the antigen-anti- body hypothesis? It seems to me that this attitude re- sults from three factors. The first is respect to the memory of Clemens von Pirquet. The second is the impression that no adequate hypothesis for allergy is available to replace the antigen-anti- body hypothesis. The third is based on the second and is the impression of many allergists that unless there are some stable reference points to restrain the diagnosis of allergy within reason- able bounds, the tendency to define al- lergy as a distaste for something or oth- er, as in the lay expression "an allergy Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Nov.-DHC. ALLERGY AS AUTONOMIC DYSFUNCTION 129 1950 to work," cannot be successfully com- batted. This seems an entirely reason- able attitude; therefore, let us examine the second factor carefully. It would seem from the increasing acceptance of the unitarian hypothesis of allergy and the work of Cannon and Pacheco,21 Cannon and Sullivan22 and Walsh, Sullivan and Cannon"' that von Pirquet's hypothesis has outlived its usefulness. Thus a different hypothe- sis whose fundamental assumptions are not in conflict with the knowledge gained in the forty years that have passed since von Pirquet. presented his paper seems to be required. According to Bell,14 this is the normal orderly prog- ress of the scientific method of thought. It might be well, therefore, to exam- ine the available data to see whether a foundation can be found. on which a new formulation can be erected that avoids the difficulties of the old. It would appear that the suggestion that allergy may be a form of autonomic dysfunction furnishes such a founda- tion. RELATION OF AUTONOMIC DYSFUNCTION TO ALLERGY The Autonomic System and Functions Cannon20 observed that the sympa- thico-adrenal reaction was one of the mechanisms by which the body tended to restore physiologic equilibrium or homeostasis when it was subjected to stress in either its external or internal environment. Petersen75 further extend- ed the concept of the autonomic system. He stated that while the mechanisms designed to meet the environmental stress are manifold, the vast majority of these reactions are primarily auto- nomic. Phylogenetically, he considered that the various means of autonomic in- tegration must have taken origin in the following order: 1. The primary method, when the or- ganism was unicellular or consisted of a few cells, was chemical and enzymatic. 2. As the organism became more com- plex and a circulatory system developed, substances we call "hormones" were produced which circulate in the fluids of the body. Their prime purpose is to speed autonomic reaction. 3.. The third method evolved when autonomic correlative efforts required not only speed in the processes of in- tegration or restoration of physiologic equilibrium but direction of localization as well. For this purpose the anatomical- ly defined autonomic nervous system, both sympathetic and parasympathetic, developed. Petersen pointed out that these three components of the autonomic system are functionally inseparable; no disturbance can occur in any one element without immediately affecting the other two. He also noted that whatever autonomic al- teration took place was immediately re- flected in the behavior of the peripheral vascular bed, the arterioles, capillaries and venules. These reacted to environ- mental stress in a stereotyped manner, whether the stress arose in the external or the internal environment and wheth- er it was due to physical agents, emo- tional perturbation, the invasion of micro-organisms or of nontoxic protein substances. The existence of this stereotyped vas- cular reaction has received abundant confirmation. By means of the method of Lom- bard,61 observation of the functional re- action of the peripheral vascular bed to stress has enlightened us as to the fun- damental functional changes resulting from the attempts of the organism to re-establish physiologic equilibrium or homeostasis. These were completely ob- scured as long as the pathologist re- stricted his observations to dead, fixed tissues. Ricker and Regendanz,83'84 for in- stance, found that a typical stereotyped Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 130 HENRY L. WILLIAMS vascular reaction was present in inflam- mations of all types, and that an inflam- matory reaction could not take place in tissue in which autonomic denervation had been done. They observed that in mild inflammation there was arteriolar and capillary dilatation with hyperemia. In somewhat more severe inflammation the arterioles were constricted with a slowing and clumping of the formed elements of the blood. In severe inflam- mation they found arteriolar spasm with dilatation of the contiguous capil- lary and venule. According to Oertel,71 they gave convincing answers to criti- cisms of their findings. Carrier23 observed these same periph- eral vascular reactions on exposure of the organism to differing degrees of cold. llrownT8 observed this same type of arteriolar and capillary reaction in Ray- naud's disease. He stated that this re- action represented a disruption of the normal co-ordination between arteriole and capillary. Krogh57 has shown that the capillaries have an independent au- tonomic nerve supply and their caliber constantly changes. He also brought forward evidence indicating that the ar- teriomotor and capillomotor systems are able to respond in opposite directions to the same stimulus. Krogh noted that individuals exhibit a greater or lesser tendency to react to cold. He stated that although hyperreactivity may be a nor- mal tendency in certain individuals, this tendency can reach an abnormal level. Brown also had found that in patients with the vasomotor neuroses the reac- tions to cold were similar to, but more marked than, the reactions of normal individuals and occurred at higher tem- peratures. Mygind and Dederding70 noted the same lack of co-ordination between ar- teriole and capillary in the skin of pa- tients with Mcniere's disease. They con- clude that a similar reaction in the inner TRANS. AMER. ACAD. OF O. & O. ear was the probable cause of the signs and symptoms of this disease. Lewis and Landis59,6o observed the same arteriolar constriction with capillary and venular dilatation in acrocyanosis. Fremont- Smith and his co-workers38 observed complete stasis in all visible capillaries during a chill; this stasis was due to constriction of the terminal arterioles. Parrisius72,73 found lack of co-ordina- tion among arteriole, capillary and venule in the skin of patients who had chronic simple glaucoma and Meniere's disease. Redisch and Pelzer8l and Ken- nedy53 found that while the premonitory symptoms of migraine might be due to vasospasm in larger vessels, the char- acteristic,headache seemed to be due to this stereotyped lack of co-ordination between arteriole and capillary in the vasa vasorum of the involved extra- cranial vessels. A most extensive investigation of the so-called vasomotor neuroses or dys- functions has been made by Muller.69 In many of these conditions including the allergic states, such as urticaria, vaso- motor rhinitis, asthma, angioneurotic edema and the like, he found the same typical picture in the peripheral vascu- lar bed. He termed the arteriolar con- striction with capillary dilatation "the spastic atonic state," and noted, as oth- er observers have done, that not all tis- sue areas were involved but that areas of arteriolar and capillary dysfunction would alternate with normal areas. Ile pointed out that the anoxia in the in- volved tissue would lead to increased capillary permeability. Brown1s observed destruction of the leukocytes in the involved capillary loops. Codc27 has shown that most of the histamine in the body of a human being is contained in the leukocytes. Destruction of the leukocytes in the capillary loop together with more or less injury to other involved cells would result in the release of histamine, which Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. ALLERGY AS AUTONOMIC DYSFUNCTION 131 1950 also would increase capillary permeabil- in many arteries. In those instances in ity. Depending on the type of cell in- which vascular spasm did not occur for jured, other toxic substances, such as a minute or two, the slowing of the cir- heparin, or leukotaxine, the leukocyte culation was the most prominent fea- promoting factor, necrosin and pyrexin, ture. Cells moving in clumps separated as observed by Menkin,66 might be lib- by plasma, as though they had become erated. These substances could produce sticky and adherent, could be seen. This the salve fundamental type of vascular latter phenomenon, which they identi- change seen in all reactions of the or- fied as sledging of the blood, was ob- ganism to stress in the internal or ex- served by Timonen and Zilliacus103 in ternal environment, including those allergic reactions in the human being. found in the allergies. It has been point- It was their opinion that this did not ed out repeatedly that allergy is primari- result from an antigen-antibody re- ly a vascular phenomenon. Rich and action but depended on a more primitive Follis,12 for instance, found that the resistance mechanism involving the re- Arthus phenomenon could not be pro- action of the peripheral vascular bed. duced in an area devoid of blood vessels. The evidence appears convincing Klinge56 found evidence to indicate that that a typical fixed, unchanging type of in the pathogenesis of allergic lesions vascular reaction is present and is fun- produced both clinically and in the lab- damental in that it is an indispensable oratory, fibrous necrosis of the collagen part of the autonomic reaction to en- fibrils is the earliest observable organic vironmental stress. It also would appear pathologic change. Similar changes in reasonable to assume that in phylogene- the ground substance also were observed tic development the first stress to which by R6ssle.86 the organism would need to adjust itself The presence of this stereotyped re- would be physical and chemical changes action of the peripheral vascular bed in the environment. It remains to be has been observed in immune reactions suggested, however, how, on the basis of this stereotyped reaction of the per- constriction experimental animals. Ba11y7,8,9 found i hero' vasctlla~ bed consisting of ar- constriction and spasm of the vessels of teriolar constriction with atonic dilata- the rabbit's ear in histamine, peptone tion of the capillary and venule, we and anaphylactic shock. Szepsenwol can differentiate the allergies from other and Witebsky102 showed that three day types of inflammatory reaction result- old chick embryos contained the Forss- ing from stresses occurring g in either the man antigen and. that the vessels con- g internal or external environment. This strict when Forssman's antiserum is differentiation appears to reside in the applied directly. In microscopic observa- hypothesis of autonomic dysfunction. tions on the behavior of the living blood vessels of the rabbit during anaphylaxis, Hypothesis of Autonomic Dysfunction Abell and Schenck' observed constric- L in er and IIess36 suggested and tion of the arterioles. Wittich119 ob- described the hypothesis of autonomic served the same reaction in the vessels imbalance or dysfunction. This has been of the chick embryo during active ana- restated by Wen ern3 to bring it into phylaxis. McMaster and Kruse,64 on in- line with more recent findings. vestigating the peripheral vascular re- A. The differential chemical reactivity, and actions in anaphylaxis, found chiefly the physiological antagonism of the adrenergic vasos asm and arrest of the circulation P and cholinergic branches of the autonomic in sensitized mice. They found that nervous system permit of a situation in which sharply localized contractions appeared the action of one branch may predominate Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 TRANS. AMER. ACAD. OF O. & O. over that of the other. This predominance, or autonomic imbalance, may be phasic or chronic, and may obtain for either the adrener- gic or the cholinergic system. B. Autonomic imbalance, when measured in an unselected population, will be distributed continuously about a central tendency which shall be de- fined as autonomic balance. The Role of Autonomic Dysfunction in Allergy Kuntz58 pointed out that some of the most characteristic manifestations of al- lergic disease are causally related to heightened parasympathetic or choliner- gic activity. He was of the opinion that the so-called allergic state could not ex- ist in the presence of a normal function- al status of the autonomic nerves. It seemed to him that abnormal functional states of the autonomic nerves might be induced by the tissue reactions to the sensitizing agents in question, but on the other hand not infrequently the modified functional status of the auto- nomic system is a factor in the etiology of allergic disease: He stated that al- though many allergic manifestations un- doubtedly result from the antigen-anti- body reaction of the tissue elements, the manifestations of physical allergy can- not be explained on this basis. In either case, however, Kuntz noted that the functional disturbances bear essentially the same relationship to the autonomic nerves. These functional disturbances involve primarily tonic changes in the musculature of the visceral organs and especially in the vascular system. The cholincrgic influence in allergic reactions of all types is indicated by the fact that regardless of which tissue is affected, adrenin affords relief. The general ad- renergic reaction tends to counteract the effect of the local cholinergic stim- ulation wherever the disturbance may be. Kennedy53 also pointed out the im- portance of the autonomic system in allergic reactions. He observed that a sensitized person may exhibit allergic phenomena on emotion only when the autonomic system is "triggered" by such emotion and at the same time is in a reactive state. He felt that in time a system-habit reaction, referable to an unstable autonomic mechanism, might develop in such individuals. In mi- graine, he noticed the presence of ar- teriolar spasm with atony of the capil- lary and venule to be preponderantly on the same side of the body as the head- ache which he felt was on the basis of localized intracranial edema secondary to increased capillary permeability. BelAk13 presented evidence which sug- gested that the production of immune substances took place secondarily to an autonomic reaction. This would suggest that the reaction of the peripheral vascu- lar bed, which is an integral part of any autonomic reaction, probably preceded in phylogenetic development the appear- ance of an antigen-antibody reaction. In summarizing his own work and that of his associates, Belak classified immune substances in relation to the autonomic nerves as follows : 1. Sympathergic immune substances are the essential nonspecific antibodies, such as the alexins, opsonins and com- plement which are always present. He found their production to be increased by sympathetic stimulation and inhibited by parasympathetic stimulation. 2. Parasympathergic immune sub- stances are the essential specific anti- bodies, such as antitoxin, precipitin, ag- glutinin and lysine. He found that the production of these substances is aug- mented by parasympathetic stimulation. Kuntzss concluded that undoubtedly the specific immune substances are re- lated to cholinergic nerves both of sympathetic and parasympathetic origin and that they respond to cholinergic (parasympathetic) stimulation accord- ing to a common mode. Ilalphen and Maduro,39 in studying spasmodic coryza, stated that when an Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 :Nov.-DEC. ALLERGY AS AUTONOMIC DYSFUNCTION 133 1950 .attack of vasomotor rhinitis is produced Petersen" in his hypothesis of autonom- by contact with an allergen, the allergen is disintegration, and by Duke33 in his is unable to produce symptoms unless hypothesis of physical allergy. Selye the individual has a pre-existing func- noted. particularly that resistance could tional disorder of the autonomic sys- be developed to specific environmental tern. They considered that cold, humid- stimuli without the mediation of an an- ity, physical factors such as sunlight on tigen-antibody reaction. He also pointed .skin surfaces, and tobacco fumes cer- out the destruction of lymphoid tissue -tainly could produce vasomotor coryza that occurred during the alarm phase of :solely by an autonomic mechanism. They the general resistance mechanism. He were of the opinion that either local or called attention to the work of Sabin,91 ;general intolerance was fundamentally McMaster and Hudack,63 Dougherty, only the reflection of an acquired or Chase and White, Harris and asso- hereditary autonomic dysfunction.. That ciates,46 Ehrich and Harris34 which in- this is oversimplification of the problem dicated that the site of antibody forma- is suggested by the circumscribed area tion may be the lymphocyte, or at least ,of the lesions of allergy. White and the reticulo-endothelial system. Rosten- Smithwick,115 Kuntz and others have berg and Brunner88 also critically re- pointed out that the cholinergic fibers viewed the literature on antibody forma- are the ones giving a localized discharge tion. They favored the hypothesis of of stimuli. enzymatic adaptation suggested by Bur- In his hypothesis of the general adap- net,19 and stated that the somewhat di- tation syndrome Selye95 suggested that vergent experimental findings might be environmental stress of all types called welded together if it was' considered up a series of interrelated nonspecific that the primitive reticulum or undif- :systemic reactions of the body, the pur- ferentiated mesenchymal cell might be pose of which is restoration of physio- the site of the enzymatic adaptation. logic equilibrium. These reactions con- Valentine, Craddock and Lawrence107 sist of physicochemical changes in the have suggested that this work requires tissue fluids, reactions of the peripheral confirmation and that some of these vascular bed and, especially, hormonal conclusions may be erroneous. However, reactions. He pointed out that a review it can hardly be denied that this work ,of the literature indicated the control- does suggest that a stereotyped reaction ling position of hormones of the ante- of the autonomic system takes place rior pituitary and adrenal cortex in that before an antigen-antibody mechanism :such resistance reactions could not take develops. place in the absence of the adrenal cor- Selye divided the general adaptation tex or the anterior pituitary. mechanism into three stages : the alarm These reactions did not require an reaction, the stage of resistance, and antigen-antibody mechanism for their the stage of exhaustion. The stage of completion. Selye was struck by the the alarm reaction was subdivided into observation that these reactions were the stage of shock and the stage of coun- invariably the same no matter what tershock or reaction. The stage of shock stimulus called them forth. The "alarm- bears much resemblance to the stage of ing stimuli" which Selye found capable exhaustion. It seems reasonable to as- of initiating the general adaptation sume, therefore, that a defect in the mechanism are essentially the same as autonomic -mechanism which calls out those previously described by Cannon20 the stage of countershock, which even- in his hypothesis of homeostasis, by tually leads to the stage of resistance, Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 might well be considered a fundamental part of a dysfunction of the autonomic system. The similarity of the histologic picture of shock and. allergy has long been noted,97 For this reason the react- ing cells have been termed the "shock organ." The great difference in the two conditions is the localized or focal part of the peripheral vascular= bed involved in allergy as opposed to the generalized reaction in shock. That allergy might result from a disturbance of the ante- rior-pituitary, adrenal-cortical hormone also is suggested by the work of Ken- dali51'52 on the physiology of the adrenal cortex. In discussing the relation of the ad- renal glands to immunity, Whiterra stated that the factors which contribute to immunity are genetic, cellular, nutri- tional and hormonal. He stated that evidence is available that the adrenals play a significant role in the defense against physical, emotional and noxious stimuli. In his opinion elucidation of the role of the adrenal cortex has been obscured by studies with the hormone of the adrenal medulla since epinephrine has been established as a powerful stim- ulator of the rate of production of hor- mones of the adrenal cortex. While in this paper he emphasized the role of the adrenal cortex, White pointed out that the level of functioning of the adrenal cortex is markedly influenced by nutri- tion and by stimuli present in the en- vironment. He favored broad use of the term "immunity" with a connotation of increased resistance to both nonantigenic and antigenic stimuli. Tuftr05 recently stated that although the clinical findings of Duke have been verified repeatedly, no evidence has been presented as yet to indicate that the reactions depend on an antigen-anti- body mechanism. Attempts at antibody demonstration have been generally un- successful. For these reasons it seemed likely to Tuft that the reactions of TRANS. AMER. ACAD. OF O. & O. physical allergy are based on a physico- chemical rather than an antigen-anti- body mechanism. He also stated that there is no definite symptomatology or clinical picture characteristic of physi- cal allergy by which it could be readily differentiated from antigen-antibody al- lergy. It seems, therefore, that not only is "allergy" possible without the mediation of an antigen-antibody mechanism but that restriction of the term "immunity" by such an assumption of an antigen antibody reaction may be incorrect. COMMENT The evidence presented seems to in- dicate definitely that the hypothesis of von Pirquet is no longer adequate as a working hypothesis because too many conditions recognized clinically as al- lergy fail to meet the criteria established by it. It is felt that a more adequate working hypothesis has been established by search of the available evidence. This, evidence indicates that the peripheral vascular components of an autonomic reaction are the fundamental factors in the reactions by which the body attempts to restore physiologic equilibrium when subjected to environmental stress of any type. Allergy occurs when localized hy- peractivity of this primitive immune re- action, with a cholinergic preponder- ance, develops. Consideration of allergy as a result of a dysfunctional prepon- derance of the cholinergic portion of the autonomic system seems to fit the avail- able evidence better. Since the hormonal system is an integral part of the auto- nomic system as defined by Petersen,75 along with the physicochemical reac- tions at the semipermeable membranes and in the tissue fluids, and the auto- nomic nervous system, the hormones of the anterior pituitary and of the adrenal cortex would be included. There seems to be no particular rea- son for abandoning von Pirquet's term, "allergic," however. Its retention to Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 .Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. 1950 ALLERGY AS AUTONOMIC DYSFUNCTION 135 cover the conditions empirically di- agnosed as allergies would serve to re- tain in our memory his great contribu- tion to the study of immunologic mech- anisms. An attempt to replace it with another word might add to the confu- sion produced by the tendency to give different names to identical physiologic processes, on which Harley44 comment- ed adversely. Kahn50 has defined an allergic indi- vidual (1) as one who may react max- imally to stimuli that would produce only a mild autonomic response in a normal person, (2) as one who has a tendency to react to stimuli which would not develop a tendency to re- action in a normal person, and (3) as one who reacts to lesser stimuli than would provoke a similar reaction in a normal person. Stiles and Johnston,98 Baajol and as- sociates,6 Brown'8 and Miiller69 have presented evidence that this tendency to develop abnormal reaction to environ- mental stimuli is inherited. Duke33 has pointed out that a reflex type of allergic reaction may involve an area, a tissue or an organ. Petersen has spoken of "focal" autonomic dysfunc- tions. A NEW WORKING HYPOTHESIS Allergy may be defined, therefore, as an inherited predisposition to a localized type of. autonomic dysfunction mediated by cholinergic fibers of the auLo'nomic system. In these localized areas a stereo- typed reaction of the peripheral vascu- lar bed occurs consisting of arteriolar spasm with atonic dilatation of the cap- illaries and- venules. This picture pro- duced only by a maximal stimulus in a normal individual may occur in certain tissues and organs of an allergic indi- vidual in response to a normally minor stimulus. This reaction also may take place as a result of environmental ex- posure to stimuli to which a normal individual would not develop a reaction. The same degree of reaction may oc- cur in an allergic individual in response to a much Jess severe stimulus than would be required to produce it in a normal individual. These reactions re- sult in a greater or lesser degree of cellular damage and the release of hista- mine and other toxic substances de- pending-on the type of cell injured. The clinical picture of allergy may be produced by reaction of the peripheral vascular bed resulting in the produc- tion of anoxic capillary loops which may lead to typical allergic edema or necrosis and be classified. empirically and clinically as allergy. An antigen-antibody reaction may be associated with the vascular reaction and may aid in damaging the cell, but it is a secondary phenomenon, phylo- genetically more recent than the vascu- lar component of the autonomic reac- tion. This definition of allergy includes all types of allergy and yet serves to differentiate clearly allergic and non- allergic! processes. I have considered this focal type of autonomic dysfunction in a previous paper.117 The fundamental assumption was that allergy is a clinical phenome- non. The diagnosis of allergy is pri- marily made empirically by observation of a gross lesion and of changes occur- ring in the function of organs and tis- sue in the light of past clinical expe- rience. Observation may be extended secondarily by microscopic and immun- ologic methods. This is the manner in which the diagnosis of allergy has al- ways been made, but it is inconsistent with a strict adherence to the hypothesis of von Pirquet. Since von Pirquet and later Kahn (hyperimmunity) insisted that allergy is "altered reactivity," it should be pos- sible to discover the normal prototype from which in each instance allergy has diverged. It would seem reasonable, therefore, to speak of three related but Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANS. AMER. ACAD. OF 0. & 0, not identical types of allergy : (1) phy- sical allergy, (2) bacterial or tissue al- lergy, and (3) humoral allergy. In physical allergy no antigen-anti- body mechanism is present, cellular in- jury and the typical. clinical picture be- ing produced by anoxia. Its normal physiologic prototype can be considered the alarm reaction of Selye. In bacterial or tissue allergy the fun- damental autonomic (vascular) defense mechanism is retained, but it is sug- gested that in the process of phylogene- tic development this defense mechanism has been supplemented by the develop- ment of protective antibodies. These protective antibodies are primarily at- tached to certain tissue cells but cir- culating antibodies may occur as a sort of by-product of cellular immunity, as suggested by Cannon. The normal prototype of tissue allergy could be considered to be granulomatous inflam- mation. In humoral allergy, although anti- bodies are attached to cells, humoral or circulating antibodies are the outstand- ing feature. These may be the "block- ing" univalent antibodies described by Cooke and associates28 and Loveless.62 It would appear that circulating anti- bodies take up some of the impact of the invading antigen so that less severe tissue injury is produced in the "host." The normal prototype of humoral al- lergy could be considered to be sup- purative inflammation. There is nothing in this concept of allergy to suggest that these three types of allergy are mutually exclusive. For instance, perennial vasomotor corvza which appears to be on the basis of a physical allergy may be frequently ob- served, especially in the cold months, and yet have seasonal exacerbations that appear to be on the basis of a spe- cific sensitivity to pollen. The working hypothesis of allergy as a type of autonomic dysfunction sug- gests the gradual growth in the animal organism of an increasingly more elaborate defense mechanism and that the new developments are added to the primitive stereotyped autonomic de- fense mechanism rather than replace it. The concept of allergy as primarily a hyperfunction or dysfunction of this stereotyped mechanism does not appear to be in conflict with any of the observed facts. It explains the gradual, rather than the abrupt, transition from one type to the other and why there may he a mingling of types. It also explains why, since the circulating antibody would appear to be a later phylogenetic de- velopment, it is not possible to discover evidence of . circulating or sensitizing antibodies in so many patients with clin- ical allergies, nor to give them symp- tomatic relief by hyposensitization through the medium of the injection of specific antigens. Duke pointed out that in the majority of allergic individuals the reaction is not to a type of chemical stimulus (protein) that could reason- ably be expected to result in antibody formation. At present there are several disorders such as Me'niere's disease and myalgia in which the decision has not been made as to whether they are really allergic or not. With the present hy- pothesis of autonomic imbalance as a basis of allergy these disorders are read- ily classified as allergic, and successful treatment on a logical basis can be planned. This hypothesis throws the emphasis on the medical and psycho- somatic aspect of the treatment of al- lergy which is receiving increasing con- sideration, as opposed to the strictly immunologic aspect. THE MEDICAL TREATMENT OF ALLERGY The advantage to be gained by con- sideration of allergy in the light. of au- tonomic dysfunction is that all the al- lergies, whether an antigen-antibody re- action is present or not, can be treated from the viewpoint of clinical medicine. Approved For Release 2002/07/24: CIA-RDP8O-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. ALLERGY AS AUTONOMIC DYSFUNCTION 137 1950 Moreover, one type of treatment need ough review of the literature and added not exclude others. many suggestions in relation to the The effect of nonspecific stress such treatment of disease affecting the eye as inadequate nutrition, inadequate and its adnexa by vasodilatation.. rest, inadequate amusement and relaxa- Papaverine was one of. the earliest tion in lowering the threshold of allergic vasodilators suggested for use in Men- reaction has long been known, but it has iere's disease by Muller.69 Dieh130 sug- not been featured in allergic treatment gested its use in the common cold. Rus- because of a seeming reluctance to em- sek and Zohman90 have found papav- ploy any.but immunologic methods. The Brine useful in the relief of cerebral an- effects of physical agents in producing giospasm. Eppinger and Hess36 in 1914 allergic reaction have been decried and were among the first to suggest use of there has been a tendency to deny them the vasodilator histamine for vasomotor a place in allergy because immunologic neuroses such as angioneurotic edema. treatment accomplished little. Muller recommended it for similar con- Vasodilators. The vasodilators, how- ditions in 1922, and Kling55 in 1934 ad- vised its use for rheumatic affections ever, have been known for a long time because of its effect as a vasodilator. to produce favorable effects in physical Horton and his collaborators48,49,96 have allergy. The traditional form of attack found histamine effective in the treat- vasodilatation. many of the allergies has been by ment of urticaria and Meniere's disease. vasodilatation. Many of these conditions Weiss, Robb and Ellisli2 showed that were treated by the application of heat histamine produced marked vasodilata- before any concept of allergy had been p formulated. The treatment of vaso- tion of the intracranial vessels of most motor rhinitis and the vasomotor stage individuals. These findings were con- of the common cold by the hot mustard firmed by Wakim and his associates.11? bath and by the opiates preceded the The therapeutic effect of histamine use of the antihistaminics by a consider- on the allergies is the relief of vaso- able period. spasm ; its action is not essentially dif- Since the principal functional lesion ferent from that of any other similarly in allergy appears to be vasospasm af- acting vasodilator. fecting the arteriole, an attempt to cor- Harris and Moore45 were the first to rect this dysfunction would appear to suggest the use of nicotinic acid for be the most logical approach. Meniere's disease. Bean and Spies10 The use of vasodilators for treatment found that nicotinic acid and all of its of the allergies is based on the supposi- pyridine compounds which contained tion that a vasodilator will release the the free nicotinic acid radical were spasm of the arteriole, resulting in re- vasodilators. Popkin78 and Abramson, newed blood flow through the capillary Katzenstein and Senior,2 Crino and loop which sweeps the contained cellu- Lenzi29 and Malaguzzi Valeri and Pa- lar ' detritus and released toxic sub- terno65 observed the effects of nicotinic stances into the general circulation acid to be similar to those of histamine. where they are immediately metabo- Roniacol (3-pyradine methanol), which lized. is stated to be converted in the organism Duggan32 has indicated that many of to nicotinic acid, is a long-acting vaso- the vasomotor disorders affecting the dilator that can be given by mouth and eye, both those thought to be allergic has been found effective in the treat- and those not, are on the basis of ante- ment of the allergies. Wakim and asso- riolar spasm. He has furnished a thor- ciates709 found priscol (2-benzyl-4,5- Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 138 HENRY L. WILLIAMS TRANS. AMER. ACAD. OF O. & O. imidazoline hydrochloride) to be an ef- have been found. useful in treatment of fective vasodilator, and it has been used the allergies both by Stoesser and in the allergies with success. Cook99,100 and Kern.54 Sympathomimeti.c Drugs. The fact The Effect of Relative Acidity. that cholinergic nerves are concerned in K.untz58 stated that changes in the auto- the production of the allergies suggests nomic functional balance associated that a beneficial effect should be ob- with changes in the acid-base balance tainable by drugs which stimulate the have been amply demonstrated. Conse- adrenergic or paralyze the cholinergic quently restoration of the autonomic system. balance by appropriate therapeutic mea- White and Smithwick classified the sures designed to restore the acid-base neurohormones and the most potent balance should not be regarded as be- drugs which act on the sympathetic yond the range of possibility in allergic nerves as follows: disease. Of the drugs acting on the sympathetic Alden,3 Beckman,11 Roberts85 and nerves, those which produce a stimulating others have reported success in the effect are epinephrine or adrenalin, sympathin, treatment of allergic disease by the use ephedrine and amphetamine sulfate; those of acidifying agents to reduce the po- which produce a depressing effect are ergo- tential alkalosis. toxine and nicotine. O f the drugs acting on 95 the parasympathetic nerves, those which have Selye also advocated the use of a stimulating effect are acetylcholine and Pilo- acidifying salts in disorders apparently carpine ? those which are depressing are atro- provoked by an excess of the "salt ac- pine and nicotine. tive corticoids" as opposed to the "sug- The advisability of prohibiting the ar active corticoids" such as the com- use of tobacco in the, allergies has long pound E (cortisone) of Kendall. In been debated. The studies of Roth89 in- Meniere's disease ammonium chloride dicate that smoking promotes vaso- in enteric-coated capsules containing spasm. Use of tobacco in allergy, there- 0.5 gm., 4 to 6 capsules being given dur- fore, appears contraindicated.. Ing meals three times a day, appears to Atropine and epinephrine have long be useful when combined with vasodila- been found useful in the allergies as tor therapy. have ephedrine and amphetamine. Ascorbic Acid. It is suggested that in Extracellular Fluid. Because the typi- some individuals allergic reactions are cal allergic wheal or edema is produced produced by a relative depletion of the primarily by increased capillary permea- adrenal cortical hormones. That this bility with the consequent formation of may be owing to the lack of ascorbic an area of extracellular fluid collection, acid, the precursor of corticoid hor- drugs acting to decrease capillary per more, is indicated by the fact that ascor- meability and to get rid of extracellular bic acid has been reported to be effec- fluid have been found useful in the med- tive in relieving the symptoms of allergy ical treatment of the allergies. Allergic in some individuals. Ascorbic acid also edema has been shown by R6ssle86 to has a direct effect on capillary permea- differ from cardiac edema only in its bility, its lack being associated with in- increased content of serum proteins. creased permeability and fragility of Schemm93 found that extracellular the capillary wall. edema in cardiac failure could be re- Vitamin P. These substances have lieved by the elimination of sodium. been found necessary to complement Therefore, a low salt diet and diuretics the local action of ascorbic acid. The Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 1OV.-DEC. ALLERGY AS AUTONOMIC DYSFUNCTION 139 1950 absence of both ascorbic acid and vita- clinically useful information in regard min P appears necessary to produce the to foods, contacts and the like than skin symptoms of scurvy. Beiler and Mar- tests. In pollenosis and inhalant allergies tin12 found that in the presence of ascor- in general, however, useful clinical in- bic acid, compounds having a vitamin P formation may often be gained by skin activity manifest a well-marked inhibi- testing. When clinically significant posi- tory action on hyaluronidase. These au- tive results to skin tests are obtained, thors were unable to demonstrate attempts at hyposensitization are fre- whether this action was a direct inhibi- quently beneficial. I have found, how- tion of hyaluronidase by ascorbic acid ever, that supplementary medical treat- or was due to a potentiation of vitamin ment will often hasten and increase the P by this substance. symptomatic improvement even of pa- I have found the combination of tients who appear to be receiving clin- ascorbic acid. and rutin effective in cer- ical benefit from so-called specific ther- tain manifestations of allergy, especially apy. The detail of successful specific as a maintenance therapy to be taken management of the allergies forms a after the acute symptoms of the dis- literature in itself and will not be con- order have been relieved by other medi- sidered here. Possibly the best out- cation. In my hands 250 mg. of both lines of treatment from the immuno- rutin and ascorbic acid taken three logic viewpoint for conditions in the times a day tends to prevent the return ear, nose and throat are those furnished of allergic symptoms. Saylor92 recently by Ashley,5 Hansel,40'42 Black'' and has reported the effective treatment of Rawlins.8? allergic vasomotor rhinitis with hesperi- SUMMARY din chalcone sodium. A theory of allergy based on the au- Vitamin Therapy. Self ridge94 has em- tonomic vascular reactions is felt to phasized particularly the effect of. the furnish a better working hypothesis vitamins of the vitamin B complex on from the standpoint of clinical diag- lipoid metabolism and vascular func- nosis and treatment than one based on tioh. I have given vitamin therapy a the antigen-antibody concept. At pres- trial but I have rarely found evidence ent the diagnosis of allergy is made of a marked change in a patient's symp- clinically and positive reactions to skin toms or signs following vitamin ther- tests merely give confirmatory evidence apy. of allergy. In many such individuals positive skin reactions cannot be ob- Fatty Acids. cids. Hansen43 has shown tained. In the entire group, however, it that lack of unsaturated fatty acids in is possible to obtain confirmatory evi the diet may lead to allergic conditions. Bence of allergy by studying the capil- Hansen found. that certain infants with lary bed by biomicroscopy, Treatment eczema were materially benefited when by specific methods leaves much to be fats such as lard, corn oil and raw lin desired. Supplementary treatment by seed oil were added to the diet, nonspecific methods will often produce I have observed marked relief to a favorable clinical result unobtainable symptoms of vasomotor coryza, in chi' by specific methods alone. There is evi- dren who refused to eat the fat of the dente that the typical histologic picture meats served, by the feeding of the fats of allergy may occur without the inter recommended by Hansen. vention of an anti gen-antibody mecha- Specific Allergic Therapy. A careful- nism. A concept of allergy as localized ly taken history will often reveal more or focal autonomic dysfunction is far Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANS. AMER. ACAD. OF O. & O. more consistent with clinical practice than the antigen-antibody concept; it opens tip new avenues of therapeutic approach to the allergies and offers greater hope of symptomatic improve- ment to a patient who has one of the al- lergies. REFERENCES 1. Abell, R. G. and Schenck, II. P.: M'cro- scopic observations on the behavior of living blood vessels of the rabbit the reaction of anaphylaxis, J. Immune' 34:195-213 (March) 1938. 2. Abramson, D. I., Katzenstein, K. H. and Senior, F. A.: Effect of nicotinic acid cu peripheral blood flow in man, Am. J. M. Sc., 200:96-102 (July) 1940. 3. Alden, A. M.: The treatment of allergy based on the conception that it is a poten- tial alkalosis, Laryngoscope, 43:400-406 (May) 1933. 4. Alexander, H. L.: Allergic syndromes in the absence of allergens : presidential dress, J. Allergy, 11 :163-169 (Jan.) 1940. 5. Ashley, R. E.: Allergy in otolaryngology : Part III. Allergic: management-treat- ment, Tr. Am. Laryng., Rhin. & Otol. Soc., 51 :416-427, 1948. 6. Baajol, K. H., Berger, W., Hanhart, E., Hansen, K., Klinge, F., Rien, W., Sch- midt, H. and Schreiner, K.: Allergie, ein Lehrbuch in Vorlesung, Leipzig, Georg Thieme, 1940. 7. Bally, L. H.: Anaphylaxis : IX. Studies on histamine reactions in rabbits, J, Im- munol., 17:191-206 (Sept.) 1929. 8. : Anaphylaxis : X. Physiological studies of peptone reactions in the rab- bit, J. Immunol., 17:207-221 (Sept.) 1929. 9. ----: Anaphylaxis : XI. Physiological studies of the hypersensitive rabbit, J. Im- munol., 17:223-244 (Sept.) 1929. 10. Bean, W. B. and Spies, T. D.: A study of the effects of nicotinic acid and related pyridine and pyrazine compounds on the temperature of the skin of human beings, Am. Heart J., 20:62-76 (July) 1940. 11. Beckman, Harry: Allergy considered as a special type of alkalosis, J. Allergy, 1:496-500 (Sept.) 1930. 12. Beiler, J. M. and Martin, G. J.: Inhibitory action of vitamin P compounds on hya- luronidase, J. Biol. Chem,, 171:507-511 (Dec.) 1947. 13. Blaak, S.: Schutzstoffbildung als vegeta- tive Funktion, Klin. Wchnschr., 18:472- 474 (April 1) 1939. 1-1. Bell, E. T.: Search for Truth, Baltimore, Williams & Wilkins Co., 1934. 15. Black, W. B.: II. The allergic investi- gation, history taking, skin testing and diagnosis of the otolaryngologic patient, Tr, Am. Laryng., Rhin. & Otol. Soc., 51: 404-415, 1940. 16. Bronfenbrenner, J. J.: Human allergy and its relation to experimental anaphylaxis and to immunity, Tr. Am. Acad. Ophth., 45:30-42, 1940. 17. -: Is the hypersensitiveness to chemical and physical agents allergic in nature? J. Allergy, 14:105-115 (Jan.) 1943. 18. Brown, G. E.: Skin capillaries in Ray- naud's disease, Arch. Int. Med., 35:56-73 (Jan.) 1925. 19. Burnet, F. M.: Biological Aspects of In- fectious Diseases, London, Cambridge University Press, 1940. 20. Cannon, W. B.: The Wisdom of the Body, New York, W. W. Norton & Co., 1932. 21. Cannon, P. R. and Pacheco, G. A.: Stu- dies in tissue-immunity : cellular reac- tions of the skin of the guinea pig as influenced by local active immunization, Ain. J. Path., 6:749-765 (Nov.) 1930. 22. Cannon, P. R. and Sullivan, F. L.: Local formation of antibody by the skin, Proc. Soc. Exper. Biol. & Med., 29:517-520 (Feb.) 1932. 23. Carrier, E. B.: Studies on the physiology of capillaries : V. The reaction of the human skin capillaries to drugs and other stimuli, Am. J. Physiol., 61:528-547 (Aug.) 1922. 24. Carrycr, 11. M.: Discussion, Proc. Staff Meet., Mayo Clin., 24:523-524 (Sept. 28) 1949. 25. Chase, Jeanne H., White, Abraham and Dougherty, T. F.: The enhancement of circulating antibody concentration by ad- renal cortical hormones, J. Immunol., 52: 101-11.2 (Feb.) 1946. 26. Coca, A. F.: A brief critical review of fundamental knowledge concerning the allergic diseases, Ann. Allergy, 1:120-130 (Sept.-Oct.) 1943. 27. Code, C. F.: The mechanism of anaphy- lactic and allergic reactions : an evaluation of the role of histamine in their produc- Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 ' Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. 1950 ALLERGY AS AUTONOMIC DYSFUNCTION 141 tion, Ann. Allergy, 2 :457-471 (Nov.-Dec.) 1944. 28. Cooke, R. A., Loveless, Mai,: and Stull, Arthur: Studies on imnmr; :y in a type of human allergy (hay r-ver) : serologic response of non-sensitive individuals to pollen injections, J. Exper. Med., 66:689- 696 (Dec. 1) 1937. 29. Crino, S. and Lenzi, S.: Azione dell'acido nicotinico (vitamin P-P) sul metabolismo degli idrati di carbonio e sulla crasi san- guina, Biochim. e terap. sper., 26:168-169 (April 30) 1939. 30. Diehl, H. S.: Medical treatment of the common cold, J.A.M.A., 101:2042-2049 (Dec. 23) 1933. 31. Dougherty, T. F., Chase, Jeanne H. and White, Abraham : Pituitary-adrenal cor- tical control of antibody release from lym- phocytes : an explanation of the anamnes- tic response, Proc. Soc. Exper. Biol. & Med., 58:135-140 (Feb.) 1945. 32. Duggan, W. F.: Vascular basis of allergy of the eye and its adnexa, Arch. Ophth., n.s. 36:551-611 (Nov.) 1946. 33. Duke, W. W.: Physical allergy : pre- liminary report, J.A.M.A., 84:736-740 (March 7) 1925. 34. Ehrich, W. E. and Harris, T. N.: For- mation of antibodies in popliteal lymph node in rabbits, J. Exper. Med., 76 :335-348 (Oct.) 1942. 35. Ellis, R. V.: Differential diagnosis of allergy and infection in relation to the paranasal sinus, (Abstr.) Ann. Allergy, 6:49 (Jan.-Feb.) 1948. 36. Eppinger Hans and Hess, Leo : Vago- tonia; a Clinical Study in Vegetative Neurology (Monograph 20), New York, The Nervous and Mental Disease Publish- ing Co., 1915. 37. Fox, N., Harned, J. W. and Peluse, S.: Borderline allergy: its relation to hyper- plastic disease of the respiratory tract, Arch. Otolaryng., 31 :502-516 (March) 1940. 38. Fremont-Smith, Frank, Morrison, L. R. and Makepeace, A. W.: Capillary blood flow in man during fever, (Abstr.),J. Clin. Investigation, 7:489-490 (Aug.) 1929. 39. Halphen, Emile and Maduro, M. R.: Coryza spasmodique, glandes endocrines et systeme neuro-vegetatif, Semaine d. hop., Paris, 23 :199-201 (Jan. 28) 1947. 40. Hansel, F. K.: Allergy of the Nose and Paranasal Sinuses; a Monograph on the Subject of Allergy as Related to Otolaryn- gology, St. Louis, C. V. Mosby Co., 1936. 41. -: Allergy of upper and lower res- piratory tracts in children, Ann. Otol., Rhin. & Laryng., 49:579-627 (Sept.) 1940. 42. -: Allergy in otolaryngology, Tr. Ain. Laryng., Rhin. & Otol. Soc., 51:383- 403, 1948. 43. Hansen, A. E.: Evaluation of nutritional status of children, with note on unsaturat- ed fatty acids in nutrition, J. Omaha Mid- West Clin. Soc., 4:48-54 (April) 1943. 44. Harley, David : Some observations on the fundamentals of allergy, with special ref- erence to its aural manifestations, J. Lar- yng. & Otol., 62:1-10 (Jan.) 1948. 45. Harris, H. E. and Moore, P. M., Jr.: The use of nicotinic acid and thiamin chloride in the treatment of Meniere's syndrome, M. Clin. North America, 24:533-542 (March) 1940. 46. Harris, T. N., Grimm, E., Mertens, E. and Ehrich, W. E.: The role of the lym- phocyte in antibody formation, J. Exper. Med., 81:73-83 (Jan. 1) 1945. 47. Hill, L. W.: Some problems of atopic dermatitis in infancy and childhood, J. Allergy, 18:181-185 (May) 1947. 48. Horton, B. T. and Brown, G. E.: Systemic histamine-like reactions in allergy due to cold: report of 6 cases, Am. J. M. Sc., 178:191-202 (Aug.) 1929. 49. Horton, B. T. and Roth, Grace M.: Col- lapse while swimming : the most dangerous consequence of hypersensitiveness to cold, Proc. Staff Meet., Mayo Clin., 12:7-10 (Jan. 6) 1937. 50. Kahn, R. L.: Tissue Immunity, Spring- field, Ill., Charles C Thomas, 1936. 51. Kendall, E. C.: The adrenal cortex, Arch. Path., 32:474-501 (Sept.) 1941. 52. : The influence of the adrenal cor- tex on the metabolism of water and elec- trolytes. In Harris, R. S. and Thimann, K. V.: Vitamins and Hormones : Ad- vances in Research and Applications, New York, Academic Press, Inc., 1948, vol. 6, pp. 277-327. 53. Kennedy, Foster : Allergy of the nervous system with especial reference to migraine. In Kallos, Paul : Progress in Allergy, New York, S. Karger, 1949, vol. 2, pp. 264-284. 54. Kern, R. A.: The role of water balance in the clinical manifestations of allergy, Am. J. M. Sc., 199:778-789 (June) 1940. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 142 HENRY L. WILLIAMS 55. Kling, D. H.: Histamine therapy of rheu- matic affections and disturbances of periph- eral circulation, Ann. Surg., 99:568-576 (April) 1934. 56. Klinge, Fritz: Der Rheumatismus. Patho- logisch-anatomische trod experimentell- pathologische Tatsachen and ihre Auswer- tung fiir das Arztliche Rheumaproblem, Ergebn. d. allg. Path. u. path. Anat., 27:1-336, 1933. 57. Krogh, August : The supply of oxygen to the tissues and the regulation of the capil- lary circulation, J. Physiol., 52:457-474 (May 20) 1919. 58. Kuntz, Albert: ' The autonomic nervous system in relation to allergy, Ann. Allergy, 3:91-100 (March-April) 1945. 59. Lewis, Thomas : Blood Vessels of the Human Skin and Their Responses, Chi- cago, Chicago Medical Book Co., 1927. 60. Lewis, Thomas and. Landis, E. M.: Ob- servations upon the vascular mechanism in acrocyanosis, Heart, 15:229-246 (Dec.) 1930. 61. Lombard, W. P.: The blood pressure in the arterioles, capillaries and small veins of the human skin, Am. J. Physiol., 29: 335-362 (Jan. 1) 1912. 62. Loveless, Mary H.: Immunological studies of pollinosis : IV. The relationship be- tween thermostable antibody in the circula- tion and clinical immunity, J. Immunol,, 47.:165-180 (Aug.) 1943. 63. McMaster, P. D. and Hudack, S. S.: The formation of agglutinins within lymph nodes, J. Exper. Med., 61:783-805 (June 1) 1935. 64. McMaster, P. D. and Kruse, Heinz: Peripheral vascular reactions in anaphy- laxis of the mouse, J. Exper. Med., 89: 583-596 (June 1) 1949. 65. Malaguzzi Valeri, C. and Paterno, P.: Influenza dell'acido nicotinico e della nico- tinamide sulla secrezione gastrica, Gazz. d. esp., 60:925-928 (Oct. 1) 1939. '66. Menkin, Valy : Modern concepts of inflam- mation, Science, n.s. 105:538-540 (May 23) 1947. '67. Metschnikoff, Elias : Ueber die Beziehun- gen der Phagocyten z:u Milzbrandbacillen, Virchows Arch. f. path. Anat., 97:502- 526 (Sept. 8) 1884. 68. Meyer, M. G.: Nonreaginic allergy, Ann. Allergy, 6:417-427 (,July-Aug.) 1948. 69. Muller, Otfried: Die feinsten Blutgefasse des Menschen in gesunden and kranken Tagen, vol. 2. Popkin, R. J.: Nicotinic acid : its action on the peripheral vascular system, Am. Heart J., 18:697-704 (Dec.) 1939. von Pirquet, Clemens : Allergie, Munchen med. Wchnschr., 53:1457-1458 (July 24) 1906. Allergie, Berlin, Julius Springer, 1910. Etiology, Am. J. Dis. Child., 31:763-814 (June) 1926. Petersen, W. F.: The Patient and the Weather : Autonomic Dysintegration, Ann Arbor, Mich., Edwards Brothers, Inc., 1934, vol. 2. -: Anomalies der periphersten Ge- fasssystems als Krankheitsursache speziell bei Meniere and Glaukom, Munchen. med. Wchnschr., 71(pt. 1) :224-225 (Feb. 22) 1924. Peshkin, M. M.: Asthma in children : I Its Historical, Philosophical, and Scien- tific Foundations; a Guide for Students and Practitioners of Medicine, Montreal, Renouf Publishing Co., 1927. Parrisius, Walter : Kappillarstudien bei Vasoneurosen, Deutsche Ztschr. f. Ner- venh., 72:310-358 (Oct.) 1921. TRANS. AMER. ACAD. OF O. & O. Stuttgart, Ferdinand Enke, 1939, 70. Mygind, S. H. and Dederding, Dida: Stu- dies on some cutaneous and subcutaneous phenomena and their relation to the la byrinthal alterations in Mb. (Morbus) Menieri, Acta oto-laryng., 13:474-488,. 1929. 71. Oertel, Horst : Outlines of Pathology ; in 79. Randolph, T. G.: Food allergy, M. Clin. . North America, 2:245-263 (Jan.) 1948. 80. Rawlins, A. G.: Chronic allergic sinusitis (perennial nasal allergy), Laryngoscope, 57:381-399 (June) 1947. 81. Redisch, Walter and Pelzer, R. H.: Capil- lary studies in migraine: effect of ergota- mine tartrate and water diuresis, Am. Heart J., 26:598-609 (Nov.) 1943. Rich, A. R. and Follis, R. H., Jr.: Studies on the site of sensitivity in the Arthus phenomenon, Bull. Johns Hopkins Hosp., 66:106-118 (Feb.) 1940. Ricker, G.: Die Methode der direkten Beobachtung der lokalen Kreislaufsstorun- gen and die Verwertung pathologisch- anatomischer Befunde in den Kreislaufs- organen fur die Pathologie derselben. In Abderhalden, Emil: Handbuch der bio- logischen Arbeitsmethoden. Abt. VIII, Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. 1950 ALLERGY AS AUTONOMIC DYSFUNCTION 143 96. Shelden, C. H. and Horton, B. T.: Treat- ment of Meniere's disease with histamine administered intravenously, Proc. Staff Meet., Mayo Clin., 15:17-21 (Jan. 10) 1940. 97. Stern, L. S.: Shock : treatment by direct action on vegetative nerve centres, Lancet, 2:572-573 (Nov. 14) 1942. 98. Stiles, K. A. and Johnston, Elizabeth J.: A study of the inheritance of respiratory allergies, J. Allergy, 17:11-20 (Jan.) 1946. 99. Stoesser, A. V. and Cook, M. M.: Pos- sible relation between electrolyte balance and bronchial asthma, Am. J. Dis. Child., 60:1252-1268 (Dec.) 1940. 100.--: Possible relation between electro- lyte balance and bronchial asthma, (Ab- str.) Am. J. Dis. Child.. 56:943-944 (Oct.) 1943. 101. Swineford, Oscar, Jr.: Physical allergy: its role as manifested in the routine study of 325 consecutive allergic cases, J. Al- lergy, 6:175-181 (Jan.) 1935. 102. Szepsenwol, J. and Witebsky, E.: Recher- che de l'antigene "Forssman" dans l'oeuf et dans certaines regions de 1'embryon de poulet, Compt. rend. Soc. de biol., 115: 1019-1020, 1934. 103. Timonen, S. and Zilliacus, H.: Sludged blood in allergy, Acta med. Scandinav., 135:292-297, 1949. 104. Tuft, Louis : Critical evaluation of skin tests in allergy diagnosis, J. Allergy, 14: 355-367 (July) 1943. 105. -: Clinical Allergy, ed. 2, Phila- delphia, Lea & Febiger, 1949. 106. Urbach, Erich and Gottlieb, P. M.: Al- lergy, ed. 2, New York, Grune & Stratton, 1946. 107. Valentine, W. N., Craddock, C. G., Jr., and Lawrence, J. S.: Relation of adrenal cortical hormone to lymphoid tissue and lymphocytes, Blood, 3 :729-754 (July) 1948. 108. Vaughan, W. T.: Minor allergy : its dis- tribution, clinical aspects and significance, J. Allergy, 5:184-196 (Jan.) 1934. 109. Wakim, K. G., Peters, G. A. and Hor- ton, B. T.: The effects of a new sympa- tholytic drug (priscol) on the peripheral circulation in man, J. Lab. & Clin. Med., 35:50-62 (Jan.) 1950. 110. Wakim, K. G., Peters, G. A., Terrier, Jean C. and Horton, B. T.: The effects of intravenously administered histamine on the peripheral circulation in man, J. Lab. & Clin. Med., 34:380-386 (March) 1949. Teil 7, (Erste Halite). Berlin, Urban & Schwarzenberg, 1924, pp. 509-560. 84. Ricker, G. and Regendanz, P.: Beitrage zur Kenutniss der ortlichen Kreislaufsst- orungen. Nach Untersuchungen am Pank- reas and seinem Bauchfell, an der Con- junctiva and dem Ohrloffel des Kanin- chens, Virchows Arch. I. path. Anat., 231:1-184, 1921. 85. Roberts, S. E.: A new sinus syndrome, Tr. Am. Acad. Ophth., 49:177-189 (Jan.- Feb.) 1945. 86. Rossle, R.: Die geweblichen Ausserungen der Allergic, Wien. klin. Wchnschr., 45: 609-613 (May 13) ; 648-651 (May 20) 1932. 87." Rostenberg, Adolph, Jr.: Cutaneous aller- gic disorders : a review of fundamental theory with a discussion of certain clinical entities, M. Clin. North America, 33:177- 204 (Jan.) '1949. 88. Rostenberg, Adolph, Jr., and Brunner, M. J.: Remarks on the theories of anti- body formation, Ann. Allergy, 8:108-116; 148 (Jan.-Feb.) 1950. 89. Roth, Grace M.: Tobacco and the Cardio- vascular System : the Effects of Smoking and of Nicotine on Normal Persons. American Lecture Series, Springfield, Ill., Charles C Thomas, in press. 90. Russek, H. I. and Zohmau, B. L.: Papaver- ine in cerebral angiospasm (vascular en- cephalopathy), J.A.M.A., 136:930-932 (April 3) 1948. 91. Sabin, Florence R.: Cellular reactions to a dye-protein with a concept of the mech- anism of antibody fort-nation, J. Exper. Med., 70:67-81 (July 1) 1939. 92. Saylor, B. W.: Treatment of allergic and vasomotor rhinitis with hesperidin chal- cone sodium, Arch. Otolaryng., 50:813- 820 (Dec.) 1949. 93. Schemm, F. R.: A high fluid intake in the management of edema, especially car- diac edema: I. The details and basis of the regime, Ann. Int. Med., 17:952-969 (Dec.) 1942. 94. Selfridge, Grant : Arterial spasm and fat metabolism : their relation to certain dis- eases and to certain members of the vita- min B complex, Ann. Otol., Rhin. & Laryng., 54 :384-389 (June) 1945. 95. Selye, Hans : The general adaptation syn- drome and the diseases of adaptation, J. Clin. Endocrinol., 6:117-230 (Feb.) 1946. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 144 HENRY L. WILLIAMS 111. Walsh, T. E., Sullivan, F. L. and Cannon, P. R.: Local formation of antibody by the nasal mucosa, Proc. Soc. Exper. Biol. & Med., 29:675-676 (March) 1932. 112. Weiss, Soma, Robb, G. P. and Ellis, L. B. : The systemic effects of histamine in man, with special reference to the responses of the cardiovascular system, Arch. Int. Med., 49:360-396 (March) 1932. 113. Wenger, M. A.: The measurement of in- dividual differences in autonomic balance, Psychosom. Med., 3:427-434 (Oct.) 1941. 114. White, Abraham: Relation of the adrenals to immunity, Bull. New York Acad. Med., c2, 24:26-31 (Jan.) 1948. 115. White, J. C. and Srnithwick, R. H.: The Autonomic Nervous System : Anatomy, Physiology, and Surgical Application, ed. 2, New York, Macmillan Co., 1941. 116. Wiener, A. S.: Rh factor in immunologi- cal reactions, Ann, Allergy, 6:293-304 (May-June) 1948. 117. Williams, H. L.: A phylogenetic concept of allergy, Proc. Staff Meet., Mayo Clin., 24 :516-523 (Sept. 28) 1949. 118. Witebsky, Ernest, Mohn, J. F., Howles, Doris J. and Ward, Helen M.: A simple method for the concentration of Rh agglu- tinins, Proc. Soc. Exper. Biol. & Med., 61, :1-5 (Jan.) 1946. 119. Wittich, F. W.: Active anaphylaxis in the chick embryo : preliminary report, J. Allergy, 12:523-527 (Sept.) 1941. 120. Zinsser, Hans, Enders, J. F. and Fother- gill, L. D.: Immunity: Principles and Ap- plication in Medicine and Public Health, ed. 5, New York, Macmillan Co., 1939. DISCUSSION REA AsIrr.EV, M.D., San Francisco, Calif.: Dr. Williams' excellent paper reviews and analyzes much of the important allergic litera- ture which has accumulated over the past fifty years. Upon the basis of his analysis and upon his personal experience lie presents some of the newer concepts of allergy. I am in entire accord with these newer ideas and believe, as he does, that all aller- gic reactions cannot be explained according to the antigen-antibody theory of immunity. In fact, I believe it most unfortunate that the terms "antigen," "antibody" and "im- munity" should ever have been applied to allergy, since it has never been shown that allergy and infection bear any relationship whatsoever. The reactions of the body to allergic stimuli are entirely different from those produced by infection. Infections are the cause of cell injury. Allergic reactions are the result of cell injury. Today, instead of considering allergy an immunologic phenomenon caused only by con- tact with poisonous proteins, it is believed that the allergic response is simply the in- creasing of a normal physiologic process- namely, relaxation and dilatation of the small blood vessels-and that the so-called "im- munologic" mechanism is only one of the me- diators of allergy. Direct trauma and so- called psychogenic stimuli can also initiate allergic attacks. While Dr. Williams and I are in agree- ment as to the broad concepts of allergy, I should like briefly to emphasize some of the points he has made and to present certain other phases of the subject from a slightly different viewpoint. The normal basic physiologic mechanism of the body is the constant state of contraction and dilatation of the small blood vessels with its attendant effect on the blood vessel walls and the shift of fluid content from one area to another. Through this mechanism the cells receive nourishment and dispose of waste products. The small vessels arc regulated in their state of 'dilatation and constriction by three general sets of forces : (1) nervous impulses, (2) chemical stimuli (the usual products of cellular life, the products of glandular secre- tions and other environmental factors) and (3) physical agents-heat, cold, light and mechanical irritations. We do not know whether all of these forces act through the sane agency or independently, but we do know that the small vessel tone is maintained in a delicate balance by these forces and that the most minute changes in any one of them will affect this balance. In an allergic reaction the normal body sympathetic-parasympathetic balance is thrown out of balance, with the parasympa!hetics gaining dominance over the sympathetics. Ex- treme dilatation of the capillaries results, causing capillary walls to become overpermea- ble and thus allowing excessive amounts of serum and electrolytes to escape into the sur- rounding tissue, causing edema. Edema is the primary cause of symptoms in all allergic reactions, and the character of the symptoms is determined according to the organ or tissue in which the swelling takes place. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. ALLERGY AS AUTONOMIC DYSFUNCTION 145 1950 It is my belief that allergic manifestations Third, physical agents such as heat, cold, depend entirely upon disruption or imbalance sunlight and mechanical irritations which act of the autonomic nervous system caused by directly on the small vessels and indirectly a lowered autonomic threshold of tolerance through the same pathways as the emotional to alarm stimuli to which the autonomic sys- group. The allergen-reagen phenomenon is not tem is constantly being subjected. These stimuli present and hyposensitization is not usually may arise from within the individual or from possible. his environment. Any two or all three of these groups may, The tendency to imbalance or the lowering and often do, coexist and all must be taken of the autonomic threshold of tolerance may into consideration when outlining treatment. be influenced by heredity or may be acquired. In our experience, medical treatment through Frequently both factors operate. the use of drugs, vitamins, hormones and other The distinction between allergic persons and medical therapeutic agents is helpful espe- those who are. not allergic can be explained cially in controlling acute allergic symptoms, by the fact that no two individuals are identi- but to date none of these therapeutic measures cal in any respect and that the same varia- have been shown to alter permanently the tion which exists between individuals is also autonomic threshold of tolerance, i.e., to cause present in the individual cell's reactivity to the sympathetic-parasympathetic balance to be- stimuli and to injury. come more stable. IIyposensitization alone does In those individuals in whom cellular activity this, and while it is not always successful, it is great, hereditary allergy is apt to appear, is nevertheless the most effective treatment while in those in whom it is of lowest de- which we have today for a large proportion gree, symptoms of allergy may never occur. of allergic reactions. Between these two extremes of varying de- I wish to compliment Dr. Williams on the grees of cellular activity there exist all de- excellence and the timeliness of his most in- grees of allergic symptom probability. teresting and thought-provoking paper. As a The threshold of autonomic tolerance based basis for further investigative work, it is a on cellular activity is individual and is the real contribution and warrants careful read- primary factor which determines who shall ing and study. Regardless of what the initiating factor '""" or factors may be-house dust, chicken feath- Mich.: First I should like to congratulate Dr. Williams upon his most excellent pre- ers, tio shell stress nsect biter el over the same sentation. I do not believe that we can take muli pathways, ess san end travel over e same exception to his splendid concept, since we and as an en result produce the all appreciate the inadequacy of applying the same type of allergic reaction. antigen-antibody theory in the treatment of In general three main types of allergic all allergic patients. Perhaps in part such fail- stimuli are recognized. ure may be due to the result- of our lack of First, those proteins, protein-like and pro- sufficiently good tools or technics for demon- tein-attached substances which come in direct stration of antibodies. On the other hand, I contact with the shock organs. In this group am inclined to agree with Dr. Williams that are included the inhalants, the ingestants, the it is more likely that there are other mechanics injectants, the contactants, the infectants, and for the explanation of symptoms in certain the ingestants. This is the largest group and allergic people. the allergen-reagen reaction is present. Hy- The experiments of Selye and a number posensitization is frequently possible in this of other workers studying the pituitary-adrenal group. physiology may throw some light on the mech- Second, the emotional stress - group, which anisms of reaction on all states of hyper- includes fear, anger and anxiety. It is thought sensitiveness. Fundamentally parenteral ad- emotional stress initiates allergic manifesta- ministration of adrenocorticotropic hormone or tions by direct action on the sympathetic- certain adrenal steroids will effectively con- parasympathetic balance, upon the thyroid-pi- trol the symptoms of any allergic patient re- tuitary-adrenal glands, and through direct ac- gardless of type and including the types that tion on the vasomotor center in the brain stem. we have just heard described. The mechan- The allergen-reagen phenomenon is not pres- ism of such symptom control may possibly ent and hyposensitization is not possible. be a blocking effect at the tissue cell level. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 146 HENRY L. WILLIAMS Possibly this may be related to enzyme ac- tivity or to some other chemical which pre- vents the chain of events normally produced by a number of stimuli in allergic persons. You are all familiar with the fact that a multiplicity of stimuli may affect at different points this adrenal-pituitary axis. Perhaps stimuli arising in the higher motor centers through the hypothalamus may stimulate the pituitary gland, which in turn secrets ad- renocorticotropic hormone, which in turn has an effect on the adrenal steroids. The opposite effect may occur, inducing symptoms as well as initiating symptoms. On the other hand, certain stimuli may initiate the secretion of adrenalin, which in turn stimulates the pituitary, and the circle continues. The opposite effect may also occur. Further study along this line may further clarify the concepts presented today. At least such mechanisms explain why psychic trauma, physical agents, antigens and a multiplicity of stimuli will initiate allergic symptoms, and conversely can explain relief of symptoms from a multiplicity of approachs such as we have heard today. Unfortunately, administra- tion of substitutes such as adrenocorticotropic hormone or adrenal steroids is not the answer to clinical management and, therefore, it ap- pears to me that Dr. Williams' concept is of great clinical value. I am glad that Dr. Williams has emphasized that there are those individuals who have allergy related to antigen-antibody mechanism. TRANS. AMER. ACAD. OF O. & O. AS we emphasized a year ago at this meeting, it is imperative to demonstrate the antigen in this group of people if we are to obtain bene- fit by treatment with an antigen. In those patients in whom allergen cannot be demon- strated, treatment along epidemiologic lines will be of no avail. I believe that Dr. Williams has given us a greatly improved outline for the care of al- lergic people, and I have greatly appreciated the opportunity of reading and listening to his paper. DR. WILLIAMS : I am afraid I must apolo- gize to Dr. Ashley for a certain lack of clarity in my presentation. The principal thing which I tried to suggest was that the body uses the same stereotyped resistance mechanism in resistance to stress of all types, which consists fundamentally of arteriolar constriction with a secondary dilatation of the capillaries and venules. Even antigen-antibody reaction appears to be secondary to this fun- damental reaction. I am sorry that Dr. Ashley did not note that this was my fundamental concept. I want to thank Dr. Sheldon for his very kind treatment of this paper, and I hope that some of you in reading it will get some bene- fit as far as treatment of your clinical pa- tients is concerned, because even if an antigen- antibody reaction is present, this should not prevent physiologic therapy. I think there is very little more to say. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 DIFFUSE EXTERNAL OTITIS: ITS PATHOLOGY AND TREATMENT BEN H. SENTURIA, M.D. ST. LOUIS, MO. DIFFUSE external. otitis, which mas- ing organism is usually a Streptococcus -querades under many other 'names, or may be the Pseudomonas, Plaut-Vin- has been selected from the conglomer- cent or diphtheria organisms. Lederer20 ation of diseases of the external ear wrote of a low virulence Staphylococcus for discussion because it has been one pyogenes which infects the hair follicles .of the least understood symptom coin- and sebaceous glands. Boies7 spoke of a plexes of the ear canal. Due to its un- diffuse inflammatory process in which certain pathogenesis, treatment has the causative organism is usually a been diverse, unreliable and often in- Streptococcus or a Pseudomonas aeru- effective. ginosa. In order to understand this disease A brief review of the literature re- -entity, let us review this problem as pre- veals that W. D. Gill,14 Whalen,42 Dart,10 sented in both textbooks and literature. Trexler,41 and McBurney and Searcy2l Bezold and Siebenmann4 wrote that emphasized the importance of fungi in chemical and mechanical influences the car canal. Greaves,16 Syverton,4? must be named among the causes and Quayle,79 Bettington,3 Senturia,30 Con- emphasized the importance of the en- ley,8 and E. K. Gill13 emphasized the trance of water into the canal. They high incidence of gram-negative bacilli added that "the real causa efficiens in in cultures obtained from the external all different forms of this disease are mi- car. Swimming and bathing have been croorganisms, especially saprophytes." described as contributory causes of this Politzer27 stated that "the cast off epi- disorder,1,8'19 while many authors9,22 dermic scales must be microscopically point out that a high percentage of suf- examined for micrococci or for the as- ferers are nonswimmers, Morley,22 Pal- pergillus fungus." Kerrison1S and Mor- mer,25 Daggett,9 and Senturia30 made rison23 described only cases secondary to reference to hot weather as a possible trauma and purulent drainage from the contributing factor. middle ear. W. Gill in "Diseases of the Some attention has been directed to Nose, Throat and Ear" by Jackson and the character of the secretion. W. Gill15 Jackson17 stated that the most frequent and Conley,8 among others, noted the causative organisms are fungi, but noted absence of cerumen. Daggett9 was im- that "a resistant form of infection is pressed with the "desquamated debris" said to be produced by the Pseudomonas which he described as consisting of pyocyaneus." Brown in Fowler's "Med- epithelial scales, pus cells and organ- icine of the Ear"12 stated that the invad- isms. Senturia, Matthews and Adler35 From the department of otolaryngology. Washington noted the myriads of epithelial cells and University Medical School, St. Louis, Mo. bacteria and the remarkable absence of This research was aided by grants from the Research neutrophils in this form of external Study Club of Los Angeles, Calif., and the St. otitis. Louis Otological Foundation of St. Louis, Mo. Presented at the Fifty-Fifth Annual Session of the One comes away from such a review American 'Academy of Ophthalmology and Otolaryn- in much confusion and with many un- .gology, Oct. 8-13, 1950, Chicago, Ill. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 answered questions. What is the patho- genesis of diffuse external otitis? What is the role of fungi? Why are gram-negative bacilli found in such a high percentage of cases? Why do smears of the secretion reveal no neu- trophils ? In order to avoid any uncertainty as to the disease entity which is being discussed, let us describe the clinical picture which has been designated as diffuse external otitis. This is a specific symptom complex occurring mainly during hot, humid weather. It may occur as a mild, moderate or severe dis- ease and may be acute or chronic accord- ing to the symptoms and findings. The mild acute case has only slight pain on mastication or on manipulation of the auricle. A thin watery secretion may be 'found in the lumen. The skin of the ear canal reveals some edema, slight redness, and a coating of odorless, adherent secretion or exfoliated debris. Some loss of luster of the drum is seen. In the more severe cases patients complain of intense throbbing pain on mastication and on manipulation of the external ear. Although the auricle ap- pears uninvolved, there is marked peri- auricular edema and partial or com- plete obliteration of the canal lumen by the edematous walls. Gray or green serous or "seropurralent" secretions and sheets of exfoliated debris are seen in the remaining lumen. The skin of the canal is thickened, purplish red in color, and may have a papular or "goose- flesh" appearance, particularly on the superior and inferior walls. There is, characteristically, a smooth, convex sagging of the superior canal wall ex- tending to the tympanic membrane. Under otoscopic magnification, discrete, raised, milky white papules and flat grayish vesicles are seen with inter- vening zones of erythema. Because of the obliterated lumen the tympanic membrane cannot be well visualized. TRANS. AMER.. ACAD. OF O. & O. The chronic case reveals a variable thickening of the skin of the auricle and ear canal and a consequent reduction of the lumen of the entire canal. Dry, adherent, exfoliated debris often lines the canal, or there may be gray-brown or greenish secretion, with a fetid odor, coating the skin and filling the tympanic recess. Papules and vesicles may or may not be seen. The drum is lusterless, thickened and shows loss of some detail. Cultures of the ear canals almost in- variably show an overgrowth of gram- negative bacilli, while occasional fungi are seen. A stained smear reveals my- riads of bacilli and epithelial cells. Now that the entity with which we are dealing has been described, let us briefly designate its place in relation to the many other forms of disease involv- ing the external auditory canal. If we divide the cases on an etiologic basis, we may classify them as follows :34 Diseases of the External Ear 1. Malfunction of skin (etiology unknown) a. Diffuse external otitis b. Seborrheic dermatitis II. Infections a. Bacterial b. Fungus III. Neurogenic IV. Allergic V. Primary irritants VI. Senile changes VII. Endocrine dyscrasias VIII. Vitamin dyscrasias IX. Miscellaneous glands In order to understand the pathogene- sis of diffuse external otitis we must first examine the skin of the normal ex- ternal auditory canal (fig. 1).33 In the normal skin there is a constant exfoliation of the upper layers of the stratum corneum. The sebaceous and apocrine sweat glands discharge their secretions over the surface of the skin to form a thin, fatty, protective coating Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 } Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-)LC. 1950 with a slightly acid pH.5,11 These ele- ments, which in the ear canal combine to form the cerumen, have been shown to have a bacteriostatic and fungistatic action in other parts of the body.2,6,26 A culture of these secretions coating the normal skin of the ear canal shows some ;gram-positive bacteria, rarely a fun- .gus.32 A smear reveals occasional epi- thelial cells and bacteria.35 If, now, the normal skin is trauma- tized or irritated by the prolonged appli- cation of macerating or noxious sub- stances, there is produced an increased hyperkeratosis and plugging of the pilosebaceous follicles and. ducts of the sweat glands.24,28,39 These pathologic changes have been produced in experi- mental work on prickly heat by the pro- longed application to the skin of water, adhesive tape,36,37,38 chemicals,24,37 etc. It is seen in biopsy specimens of the skin obtained from the ear canal in cases of chronic otorrhea.33 It is conceivable that as a result of FIG. t-Photomicrograph of skin of normal external auditory canal showing stratum corneum, sebaceous glands, hair follicles and apocrine glands. prolonged exposure to intense heat and humidity and poor evaporation within the ear canal, the skin of the ear canal is bathed in apocrine sweat which is rel- atively low, in lipoids. The unprotected upper layers of the stratum corneum imbibe the water, become swollen and macerated, and proper cornification does not occur.28,39 As a consequence, marked hyperkeratosis develops (fig. 2). If, at this time, the patient avoids further exposure to high temperatures and humidity, the hyperkeratosis, as demonstrated in other skin areas,38 will disappear in approximately two to three weeks as a result of normal desquama- tion. On the other hand, if before this hy- perkeratosis subsides there is another prolonged exposure to high tempera- tures and humidity or the patient trau- matizes the skin surface, the following events may occur : A. As a result of the obstruction of the ducts of the sweat glands and pilo- Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 150 BEN H. SENTURIA FIG. 2-Photomicrograph of skin of external auditory canal showing hyperkeratosis and plugging. sebaceous follicles, the antibacterial and the antifungus elements are not secreted onto the skin surface of the canal and therefore bacterial or mycotic growth, or both, may occur. This growth would be determined by the transient flora present in the environment or intro- duced by the patient. In tropical areas there would be a relatively high inci- dence of fungi; in temperate zones few- er fungi would occur. In all parts of the world the widely disseminated gram- negative bacilli would be cultured. B. There may be thickening of the prickle cell layer (acanthosis), reten- tion of nuclei in the stratum corneum (parakeratosis), intracellular and inter- cellular edema. A dense cellular infil- trate may occur in the subepidermal areas and occasionally around the tu- bules of the sweat glands. Marked di- latation of lymphatics and blood vessels, Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 R Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. DIFFUSE EXTERNAL OTITIS 151 1950 FIG. 3--Photomicrograph of skin of external auditory canal showing hyperkeratosis, acanthosis, lengthening of rete pegs, dilatation of blood vessels and lymphatics, and dense cellular infiltrate in dermis. and collection of fluid in the interstitial spaces of the dermis may be observed (fig. 3). C. There may be dilatation of the apocrine sweat ducts as a result of plug- ging of the ducts and possibly a diffu- sion of the retained sweat into the epi- dermis (fig. 4),24 D. There may also occur changes in the tubules such as dilatation, and vac- uolization of the epithelial lining cells (fig. 5). E. Finally, as a result of the inflam- matory process plus the failure to elim- inate the obstruction of the ducts there may occur a disorganization of the epi- thelium of the tubules (fig. 6) and a de- struction of many of the sweat glands (fig. 7). Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANS. AM EA. ACAD. OF O. & O. Glands FIG. 4-Photomicrograph of skin of external auditory canal showing obstructing keratin plug and dilated duct. To recapitulate, although all the path- ologic evidence has not yet been ob- tained, it is my belief that the preceding findings justify the following concept of the pathogenesis of diffuse external otitis. As a result of excess sweating during hot, humid weather there is pro- duced in certain susceptible individuals a marked hyperkeratosis of the skin of the ear canal with plugging of the ducts of the sweat and sebaceous glands. If recovery is not allowed to occur before another period of exposure to a hot, humid environment, these glands are unable to pour their secretions onto the skin. As a consequence of the skin changes produced, a surface infection may readily develop. If the plugging re- mains and sweat gland activity persists, there occur inflammatory and mechani- cal changes within the epidermis and dermis. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. 1950 DIFFUSE EXTERNAL OTITIS 153 Thus diffuse external otitis is not caused by swimming or bathing, al- though these may be factors in produc- ing the increased hyperkeratosis and plugging of the glands which initiate the pathologic cycle of events. It is not caused by fungi or bacteria but rather these are secondary invaders resulting from the loss of skin resistance. Neu- trophils are not found on smears of the flow of secretions from the apocrine sweat glands and sebaceous glands Treatment, then, should be soothing and palliative during the acute stage while active, and curative in the subsid- ing stage. Thus therapy might be di- rected as follows : A. Palliative 1. Remove the patient from the hot, humid environment. This will re- afflaomm FIG. 5-Photomicrograph of skin of external auditory canal showing dilatation of tubules and vacuolization of lining cells. secretion since we are not dealing pri- marily with a pyogenic infection break- ing through the skin barrier except in the complicated cases. If we accept this concept of the path- ogenesis of diffuse external otitis, ther- apy, in order to be successful, must ac- complish three things : 1. Counteract the secondary infec- tion 2. Restore the depleted lipoid sub- stances of the skin 3. Modify the stratum corneum which is acting to obstruct the normal duce the activity of the apocrine sweat glands and thereby alleviate much of the discomfort. 2. Irrigate the ear canal with hyper- tonic saline" in order to obtain drainage and to clean away the keratin plugs, inspissated wax and debris which have collected in the ear canal and tympanic sulcus. 3. Apply into the lumen of the canal a mild, nonirritating antiseptic in a fatty vehicle (e.g., 5 to 10 per cent boric acid in anhydrous lan- Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 154 BEN H. SENTURIA TRANS. AMER. ACAD. OF O. & O. FIG. 6-Photomicrograph of skin of external auditory canal showing disorganization of the epithelium of the sweat gland tubules. olin) and allow to remain in place for 12 hours. This will restore the depleted lipoids and will also tend to push the pH towards the acid side, thus aiding- in the inhibition of bacterial growth. 4. Prescribe antibiotics where spe- cifically indicated. 5. Give vitamin A to assist in the restoration of normal keratiniza- tion. B. Curative As soon as the severe acute stage has subsided, active attempts should be di- rected towards eradicating residual in- fection and restoring the normal stratum corneum. This may be accomplished with the aid of the following medica- ments according to the severity of the residual inflammatory reaction and the sensitivity of the skin. Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 :NOV.-DEC. 1950 1. Burow's solution, 0.5 per cent, or similar stable proprietaries 2. Metacresylacetate in olive oil (one-half strength) 3. AgNO3i 5 to 10 per cent, followed by 5 to 10 per cent boric acid in .anhydrous lanolin 4. Streptomycin (5mg/gm) in a carbowax vehicle32 5. Vitamin A - 10,000 to 20,000 units per day FIG. 7--Photomicrograph of skin of external auditory canal showing destruction of sweat gland tubules and peritubular cellular infiltration. Astringents should be continued for 24 to 72 hours if the agent is tolerated. The natural healing processes of the skin should then be allowed to take over. Further therapy should consist of ade- quate cleansing of the skin surface with hypertonic saline and the application of soothing antiseptic ointments, keratoly- tics, fungicides or antibiotics as indicat- ed by individual requirements. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANS. AMER. AC AD. OF O. & O. I wish to express appreciation to Dr. Zola Cooper for advice and assistance in the pathologic studies, to Mr. Vernon Fischer and Mr. Wallace Johnson for technical assistance, to Mr. K. Cramer Lewis for photomicrographs, and to Mr. F. Kelly for diagrams. REFERENCES 1. Anderson, A., Jr., and Steele, C. H.: Use of nitrofuran therapy in external otitis, Laryngoscope, 58:1279-1286 (Dec.) 1948. 2. Arnold, Lloyd : Relationship between cer- tain physido-chemical changes in the corni- fied layer and the endogenous bacterial flora of the skin, J. Invest. Dermat., 5: 207-223 (Oct.) 1942. 3. Bettington, R. H.,: Bilateral acute external otitis due to Bacillus pyocyaneus, M. J. Australia, 1:17 (Jan. 6) 1934. 4. Bezold, Friedrich and Siebenmann, F.: Textbook of Otology, Chicago, E. H. Colegrove Co., 1908, p. 113. 5. Blank, Irvin H.: Measurement of pH of the skin surface: I. Technique, J. Invest. Dermat., 2:67-74 (April) 1939. 6. Burtenshaw, J. M. L.: The mechanism of self-disinfection of the human skin and its appendages, J. Hyg., 42:184-210 (April) 1942. 7. Boies, Lawrence R.: Fundamentals of Otolaryngology, Philadelphia, W. B. Saunders Co., 1949, p. 100. 8. Conley, J. J.: Evaluation of fungous dis- ease of the external auditory canal, Arch. Otolaryng., 47 :721-745 (June) 1948. 9. Daggett, W. I.: Desquamative otitis ex- terna in Malta, J. Laryng. & Otol., 57: 427-446 (Oct.) 1942. 10. Dart, Merrill 0.: Otomycosis : treatment with silver picrate, Arch. Otolaryng., 31: 885-910 (June) 1940. 11. Fabricant, N. D. and Perlstein, M. A.: pH of the cutaneous surface of the ex- ternal auditory canal, Arch. Otolaryng., 49:201, 1949. 12. Fowler, E. P., Jr.: Medicine of the Ear, New York, T. Nelson & Sons, 1947, p. 129. 13. Gill, E. K.: Evaluation of newer drugs in the treatment of otitis externa, Arch. Otolaryng., 52:25-30 (July) 1950. 14. Gill, W. D.: Otitis ex:terna mycotica : com- ments concerning the prevalence, diagno- sis and treatment of otomycosis, Arch. Otolaryng., 16 :76-82 (July) 1932. 15. Otitis externa, Ann. Otol., Rhin. & Laryng., 51:370-377 (June) 1942. 16. Greaves, F. C.: Phenyl mercuric nitrate in the treatment of otitis externa and of the dermatophytoses, U. S. Nav. M. Bull., 34::527-532 (Oct.) 1936. 17. Jackson, Chevalier and Jackson, Cheva- lier L., eds.: Diseases of the Nose, Throat and Ear, Including Bronchoscopy and Esophagoscopy, Philadelphia, W. B. Saunders Co., 1945, p. 232. 18. Kerrison, Philip D.: Diseases of the Ear, ed. 4, Philadelphia and London, J. B. Lippincott, 1930, p. 117. 19. Kos, C. M.: Evaluation of the diagnosis and treatment of external otitis, J. Iowa M. Soc., 39:560-567 (Dec.) 1949. 20. Lederer, F. L.: Diseases of the Ear, Nose and Throat, Philadelphia, F. A. Davis Co., 1939, p. 109. 21. McBurney, Ralph and Searcy, Harvey B.: Otomycosis : an investigation of effective fungicidal agents in treatment, Ann. Otol., Rhin. & Laryng., 45:988-1008 (Dec.) 1936. 22. Morley, George : Otitis externa-"hot weather ear" : an investigation of 100 cases and a method of treatment, Brit. M. J., 1:373-377 (Feb. 19) 1938. 23. Morrison, W. W.: Diseases of the Ear, Nose and Throat, New York, Appleton- Century-Crofts, Inc., 1948, p. 100. 24. O'Brien, J. P.: A study of miliaria rubra, tropical anhidrosis and anhidrotic asthenia, Brit. J. Dermat., 59:125-158 (April-May) 1947. 25. Palmer, F. J.: Hot weather ear : a clinical entity, Indian M. Gaz., 69:430-432 (Aug.) 1934. 26. Peck, S. M., Rosenfeld, IT, Leifer, W. and Bierman, W.: Role of sweat as a fungicide, with special reference to the use of the constituents of sweat in the therapy of fungous infections, Arch. Dermat. & Syph., 39: 126-148 (Jan.) 1939. 27. Politzer, Adam : A Textbook of the Dis- eases of the Ear, translated and edited by M. J. Ballin and C. L. Heller, ed. 4, Lon- don, Bailliere, Tudall and Cox, 1902, p. 173. 28. Pollitzer, S.: Prickly heat, J. Cut. & Genito-Urin. Dis., 11:50-56, 1893. 29. Quayle, A. F.: Otitis externa in New Guinea, M. J. Australia, 2 :228-231 (Sept. 2) 1944. 30. Senturia, Ben H.: Etiology of external otitis, Laryngoscope, 55:277-293 (June) 1945. 31. - : Discussion of Fowler, Edmund P., Jr.: Topical applications to the skin of the ear canal, Tr. Am. Acad. Ophth., 53:641-642 (July-Aug.) 1949. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 ,Approved For Release 2002/q7/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC- DIFFUSE EXTERNAL OTITIS 157 1950 32. Senturia, Ben H. and Broh-Kahn, R. H.: The use of streptomycin in the treatment of diffuse external otitis, Ann. Otol., Rhin. & Laryng., 56:81-89 (March) 1947. 33. Senturia, Ben 11. and Cooper, Z. K.: Un- published data. 34. Senturia, Pen H. and Marcus, M. D.: Classification of external otitis, to be pub- lished. 35. Senturia, Ben H., Matthews, John I. and Adler, Benard C.: External otitis : IV. Cytologic study of secretions, Laryngo- scope, 60:543-550 (June) 1950. 36. Shelley, W. B. and Horvath, P. N.: Ex- perimental miliaria in man: H. Production of sweat retention anidrosis and miliaria crystallina by various kinds of injury, J. Invest. Dermat., 14:9-20 (Jan.) 1950. 37. --: Experimental miliaria in man: III. Production of miliaria rubra (prickly heat), J. Invest. Dermat., 14:193 (March) 1950. 38. Shelley, Walter B., Horvath, Peter N., Weidman, Fred R. and Pillsbury, Donald M.: Experimental miliaria in man : I. Production of sweat retention anidrosis and vesicles by means of iontophoresis, J. Invest. Dermat., 11:275-291 (Oct.) 1948. 39. Sulzberger, Marion B. and Zimmerman, H. M.: Studies on prickly heat : II. Ex- perimental and histologic findings, J. In- vest. Dermat., 7:61-68 (Feb.) 1946. 40. Syverton, Jerome T., Hess, William R. and Krafchuk, John: Otitis externa : clini- cal observations and microbiologic {iota, Arch. Otolaryng., 43:213-225 (March) 1946. 41. Trexler, Clarence W.: Otomycosis in Ha- waii, Laryngoscope, 45:106-109 (Feb.) 1935. 42. Whalen, E. J.: Fungous infections of the external car, J.A.M..A., 111:502-504 (Aug. 6) 1938. DISCUSSION FRANCIS E. SCNEAR, M.D., Chicago, 111. (by invitation) : This has been a very interesting paper to me because this problem comes to us very frequently. The etiology of otitis ex- terna has, of course, been the source of con- troversy for many years. It has been our impression that until the past few years the majority of the otologists have emphasized chiefly the possibility of mycotic infection as the most common cause, since patients whom we have seen after they have previously con- sulted otolaryngologists have usually stated that they have been told their trouble was due to fungus infection, usually without any microscopic examination having been made. Dermatologists have in the main been un- willing to accept this concept due to the fact that the fungi demonstrable in the ear were usually of nonpathogenic varieties and rarely of types giving rise to the usual dermatologic disorders of mycotic origin. We, on the other hand, have been accustomed, I think, to in- criminate seborrheic dermatitis and streptococ- cic infections as being responsible for most of these cases, such diagnosis usually being made, likewise, on purely clinical grounds. In re- cent years, however, the literature of your specialty has minimized the importance of fun- gus infection, relegating it to an infrequent role and perhaps then considering it as only a secondary factor. Probably most often it is regarded as being only a saprophyte. Con- sequently a number of studies have pointed out that a variety of bacteria are of etiologic importance. These opinions with regard to the organisms responsible for diffuse otitis externa have not, however, given us any idea as to'thc basic pathogenesis of the process. A month or two ago, in looking through my files on eczema, I ran across an abstract I had made of an article by Dr. Senturia published in 1946, in which he discussed eti- ology from the fungus and bacterial stand- points, with nothing at all pertaining to what he has given us today. He is to he congratu- lated on having introduced a new idea in the study of this condition. We in dermatology during the second world war became aware of the importance of hyper- keratosis as it developed at the follicular ori- fices in the tropics during periods of exces- sive sweating, leading to suppression of per- spiration through retention rather than the failure of the glands to produce sweat, namely, sweat retention anhidrosis. Likewise in re- cent years we have recognized that in acne vulgaris, the disturbance in keratinization re- sulting from the disturbance of the piloseba- ceous apparatus in adolescence is of primary importance in preparing the way for patho- genic organisms to produce the pustular le- sions of disease. Dr. Senturia has presented a careful, well documented study of 'this problem, and while, as he states, all the pathologic evidence has not yet been obtained, his application of this principle that hyperkeratinization furnishes a soil of lowered resistance upon which organ- isms may flourish and produce the pathologic changes, opens a new avenue. I know that he is continuing his studies in this field, and I am sure that his work will be received grate- Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 158 BEN H. SENTURIA fully by those in dermatology. The illustra- tions which he showed you on the screen today and which I had the privilege of exam- ining in the photomicrographs lend excellent support to his thesis that we are going to have a very good basis upon which to pro- ceed in the future. I have enjoyed this paper very much and want to thank Dr. Senturia. W V. D. GILL, M.D., San Antonio, Texas : I am very much impressed with this paper. I think it is one of the hest presentations on the subject that I have ever heard. I think also that I am safe in saying that this is the first time in the history of otomycosis or dif- fuse external otitis that we have seen any histopathologic sections demonstrated. That is a great step forward. There is a great deal to be learned from the study of the fixed tis- sue cell in this condition, and Dr. Senturia has pointed the way for us. There has been a great tendency in the past few years to minimize the importance of fungi in external otitis. I am not quite ready to agree with that thesis-with that hypo- thesis. I believe there has been a marked decline in the number of fungus infections in the external auditory canal. Just why that has come about has not become immediately apparent, but we know that there has been in our section, at least, a very marked decline in the percentage of fungus infections in the ear, with a corresponding increase in the Ac- tinomyces and Staphylococcus. (Slide) My brother, Dr. King Gill, and I recently had occasion to study the bacterio- logic flora in the ears of 168 patients with the following results : We isolated bacteria in 117; bacteria mixed with fungi in 36; bac- teria and yeast in 12; and bacteria, yeast, and fungi in 3. To get the total number of ears in which fungi were present, it is necessary to add those last three figures together. (Slide) In a further breakdown, we found a very high percentage of gram-negative bacilli -104 cases. Those are the Pseudomonas, and at the present time these cases are in the as- cendency. Then we had 6 cases clue to staphy- lococci. I think that the incidence of Staphy- lococcus is certainly high enough to make it a very important factor in the etiology of diffuse external otitis. In cleaning the ear I have always just used a sterile swab rather than irrigation. Oc- casionally when an ear is irrigated there will be a marked flare-up with suppuration fol- lowing, and where it has been necessary to irrigate an ear to remove plugs of various TRANS. AMER. ACAD. OF 0. & 0. kinds of debris, we have immediately dried the canal and inserted a wick moistened with 1:100 neutral aqueous solution. That seems to prevent the onset of suppuration. Now a word about metacresylacetate. The pseudomonas respond to drugs containing ace- tic acid or the acetate radical; therefore, Bur- ow's solution is effective. Two per cent aque- ous solution of acetic acid is also effective, as well as cider vinegar and metacresylacetate. Metacresylacetate is bactericidal. It is fungi- cidal. It is analgesic after the first few min- utes. It is also anesthetic and possesses vary- ing degrees of keratolytic power, so that the top layer of the epithelial cells is removed merely by inserting a wick moistened with metacresylacetate and allowing it to remain 24 hours. The patient is asked to return at the end of that period, the wick is removed, and another one is inserted after cleaning the ear. The ear may be so acutely inflamed that it tolerates practically no manipulation on the patient's first trip to the office. When that takes place, it has been our practice gently to induce a very small wisp of cotton into the canal and to saturate that with metacresyl- acetate. All of the severe cases immediately receive roentgen therapy. They are referred to the radiologist immediately, and the amount of x-ray that is given is one-third of an erythema dose. If both ears are involved, the dosage is divided equally between the two ears. When a patient has come in to see you because he is in pain, lie wants quick relief. The metacresylacetate wick plus roent- gen therapy is about the quickest way to get it. I would implore you to use some type of sedative in all these cases that are at all severe. In this respect I should like to say that I consider codeine about the worst drug that can be used for sedation. In combination with some other drug it works fine, but alone it is practically worthless. One gram of co- deine combined with 5 grains of amidopyrine, or 3% grains of antipyrinc, or 5 to 10 grains of aspirin are all good combinations and they work. But just remember that the patient has cone in to see you because he wants re- lief and if you don't give it to him, Dr. John Jones across the hall will. At least I have found it that way. Cultures have been made in studying the effect of a lot of the present-day fungicides that are on the market. There is a plethora of fungicides that are advertised today for the treatment of so-called fungus ears. We have studied a group of some ten or twelve, with the result that we have found most of Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NOV.-DEC. DIFFUSE EXTERNAL OTITIS 159 1950 them to he practically useless. Sulfamylon This does not mean that the secondary in- was very effective, however. Except for the fection is a simple problem which one may burning which it causes, it works very nicely. neglect. One may have to use every thera- Streptomycin, we hesitated to use, internally peutic aid available, on occasion, to eliminate at least, on account of the possibility of corn- that superimposed infection. We heartily plications in the hearing apparatus. agree with the use of metacresylacetate for I have enjoyed this paper very uuuch. This otomycosis. We found, in our in vitro experi- is a subject that has been very close to my ments, that it was a potent agent for eradica- heart for about twelve years. I think we have tion of saprophytic fungi. I would hesitate, made great strides forward, and now we are however, to use it in the acute inflammatory glad to have some studies on the fixed tis- state. Thus, I. would imagine that Dr. Senear sue cells. would shudder at the thought of applying Personally, I should like to ask Dr. Sen- as strong an agent as full strength metacre- turia where he gets his specimens for biopsy. sylacetate to the acutely inflamed ear canal I cannot obtain specimens from my patients. of a patient with severe, diffuse external oti- They object. How does he persuade them? tis. On the other hand, I am fully aware that one must offer the patient relief, and DR. SENTURIA : I should like to thank the that sometimes one must throw caution to discussers. the wind and utilize an agent which may be To answer Dr. Gill's question about biop- irritating and caustic if it is to provide re- sies, we have been very fortunate in having lief from pain. the cooperation of physicians on various city We have investigated sonic of the acetates, hospital services. We have had very wonder- with the thought in mind that we desired an ful patients who have been willing to provide agent with an acid reaction and that these us with material for biopsies. We have utilized appear to be active against gram-negative material from autopsies and from mastoidec- bacilli. Acetic acid is well known as one of tomies. Dr. Theodore Walsh and his staff the best agents against the Pseudomonas or- have provided us with tissue from mastoidec- ganism, but we advise its use thoughtfully and tomies performed at McMillan Hospital, St. carefully in conjunction with other thera- Louis, during the past several years. peutic aids. I should like to say one word about the I should like to take just one more moment incidence of otomycosis. At Randolph Field, to tell you about the use of irrigations for Texas, we found approximately 10 per cent cleansing the car canal. We have trade serial of infected cases showed fungi in the ear cytologic studies of the secretions of the ear canal on cultural study of cases of external canals and have noted an absence of neu- otitis. Despite this low incidence we have trophils in uncomplicated acute, severe, diffuse continued to feel that otomycosis is an im- external otitis. We have observed the sud- portant problem. If one neglects this con- den appearance of netttrophils following the sideration of fungus infestation of the ear energetic cleansing of debris from the ear canal, these patients will not get well. I canal. Active, thorough cleansing is desira- should like to emphasize our belief that gram- ble, but not if you are going to traumatize negative bacilli are not the cause of diffuse the epidermis and push the infection into the external otitis. In a previous paper we noted sub. pidermal areas. Therefore, it is urged a 100 per cent incidence of gram-negative that saline irrigations be used to cleanse the bacilli in severe, acute, diffuse external otitis, ear canal, Exacerbations occur if one irrigates but we were not able to say that gram-ncga- with water or even with isotonic saline. To tive bacilli or Pscudomonas organisms were avoid flare-ups, a hypertonic saline solution the cause of diffuse external otitis. We feel is suggested. For the, past threeyears we that the findings in this report tend to cor- have used, routinely, a 3 per cent saline douche roborate,that impression. The gram-negative of the car canal in those cases where there bacilli occur as a secondary infection. We be- is sufficient lumen so that the water can be lieve that fungi are implanted secondarily. removed and the ear canal dried. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 160 TRANSACTIONS - NOVEM13E.R - DECEMBER, 1970 In Memoriam Ephraim Kirkpatrick Findlay............ Chicago, Illinois September 27, 1950 James Sonnett Greene ............. New York, New York September 17, 1950 Marcus Ravdin ...................... Evansville, Indiana September 12, 1950 Burt R. Shurly .......................Detroit, Michigan October 20, 1950 Edward McColgan Walzl ............ Baltimore, Maryland August 10, 1950 TRANS. AMER. ACAD. OF O. & O. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 TRANSACTIONS American Academy of Ophthalmology and Otolaryngology Official Publication of the American Academy of Ophthalmology and Otolaryngology Published under the direction of the Editorial Board WILLIAM L. BENEDICT, Rochester, Minnesota, Editor W. HowARD Monism, Omaha, Nebraska, Associate Editor HENRY L. WILLIAMS, Rochester, Minnesota, Associate Editor Printed by Douglas Printing Company, 109 North 18th Street, Omaha 2, Nebraska All communications regarding the TRANSACTIONS should be addressed to William L. Benedict, M.D., Executive Secretary - Treasurer, the American Academy of Ophthalmology and Otolaryngology, 100 First Avenue Building, Rochester, Minnesota COUNCIL MINUTES FIFTY-FIFTH ANNUAL SESSION October 7 and 11, 1950 Palmer House, Chicago Present: J. Mackenzie Brown, Derrick Vail, Edwin B. Dunphy, Kenneth L. Craft, James Mason Baird, Alan C. Woods, Carl H. McCaskey, Conrad Berens, William L. Benedict, Alger- non B. Reese, James H. Maxwell, A. D. Rue- demann, Dean M. Lierle, Lawrence R. Boies, Erling W. Hansen, Thomas D. Allen, Fletcher D. Woodward, Archie D. McCannel, C. Stew- art Nash. The meeting was called to order at 9:30 a. in. by Dr. J. Mackenzie Brown, President. I The Executive Secretary, Dr. William L. Benedict, reported on the membership as fol- lows : 1. Fellowship as of October 1, 1950: Juniors ----------------------------------------3,907 Seniors --------------------------------------- 150 4,510 2. Candidates : Complete ----------------------------------- 280 Incomplete ---------------------------------- 7 Some items are omitted from this report. Complete minutes are on file in the office of the Executive Secretary-Treasurer. 3. Elevations to Senior Fellowship on January 1, 1951: Beal, Homer A. ....................Kansas City, Mo. Birsner, Louis ............................St. Louis, Mo. Bonner, William F- -------- ........ Childress, Texas Brown, Albert L . ...................Cincinnati, Ohio Chapman, S. Jefferson, Colorado Springs, Colo. Cleff, Oscar ........................................Chicago, Ill. Daily, Louis ................................Houston, Texas Daily, Ray K .............................Houston, Texas Fox, Noah ........................................Chicago, Ill. Gipner, John F. - .................. ... Rochester, N. Y. Goar, Everett L .........................Houston, Texas Gordon, Charles II . ...............Portland, Maine Hamlin, Fred E .............................Roanoke, Va. ITands, Sidney G .....................Davenport, Iowa Hansel, French K. ........................St. Louis, Mo. Hargitt, Charles A .................Brooklyn, N. Y. Harrell, Voss_ .....................................Reno, Nev. Ilartshorne, Isaac ....................New York, N. Y. Hicks, Vonnie M ................._....--Raleigh, N. C. Jones, Edmund L. ................Wheeling, W. Va. Joy, Harold II ...........................Syracuse, N. Y. Kettelcamp, Fred 0., Colorado Springs, Colo. Key, Samuel N .............................Austin, Texas McLaurin, John G. __ .................... Dallas, Texas McMahon, Bernard J....... ...----- .-St. Louis, Mo. Minsky, Henry ....................New York, N. Y. Morrison, W. Wallace ........New York, N. Y. Myers, E. Lee ..............................St. Louis, Mo. Packard, Louis A .........................Phoenix, Ariz. Palmer, Arthur ........................New York, N. Y. Pember, Aubrey H . .................Janesville, Wis. Pendexter, R. Stevens ........Washington, D. C. Reincke, George F... .............. New Ulm, Minn. Seal, J. Coleman ....................New York, N. Y. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 162 TRANSACTIONS - NOVEMBER - DECEMBER, 1950 Seligstein, Milton B................. Memphis, Tenn. Sharp, Benjamin S .............. _.Providence, R. I. Sheahan, William L .............New Haven, Conn. Stokes, William H_________________ Lake City, Mich. Wagener, Henry P .................Rochester, Minn. Wright, Walter W. _.__._...___Toronto, Ont., Can. Young, Charles A . ........................Roanoke, Va. 4. Elevations to Life Fellowship on January 1, 1951: Alden, Arthur M. _ ...................... St. Louis, Mo. Bahn, Charles A. ................New Orleans, La. Brickley, Daniel W . ....................Marion, Ohio Brown, Mortimer G .................Syracuse, N. Y. Buvinger, Charles W......... East Orange, N. J. Cohen, Samuel .........................Philadelphia, Pa. Darmer, George A .............................Aurora, Ill. Dintenfass, Henry ....................Philadelphia, Pa. Hughes, T. E ....................--.........Richmond, Va. Husik, David N .....................Philadelphia, Pa. Jordan, George T .....................Vermillion, S. D. King, Edward Daniel .............Hollywood, Calif. Lewis, Fielding O .............................Media, Pa. Reese, Warren S .....................Philadelphia, Pa. Schlanser, Adam E......._____Washington, D. C. Williams, Walton H .............Middletown, Ohio Zentmayer, William ................Philadelphia, Pa. S. Deaths Reported since Last Council Meet- ing: Arnold, Francis J. ....................Burlington, Vt. Berry, David Franklin ........Indianapolis, Ind. Black, William Byron ............Kansas City, Mo. Brandenburg, Nora B. _............ .....Winnetka, Ill. Briglia, Frank Joseph ---.....--..Philadelphia, Pa. Burke, Thomas Aloysius ........Cleveland, Ohio Butterfield, Elwyn Temple, Las Vegas, N. M. Carter, Albert Arthur ..................Boston, Mass. Charles, Joseph W .------------ .--------- St. Louis, Mo. Donoher, William David ....Los Angeles, Calif. Durr, Samuel Abraham ..._.__.San Diego, Calif. Fowlkes, John Winston ........New York, N. Y. Friedenwald, Harry ....................Baltimore, Md. Fuller, T. E......... ..... .............Texarkana, Texas Gale, M. Jean ................. .......------- .Denver, Colo. Cradle, Harry S...__._...... Sherman Oaks, Calif. Hewitt, Wright Platt ----.--.Cambridge, Mass. Higgins, R. P.---------- ...................Cortland, N. Y. Hill, Emerson Stanley ...... ...Torrington, Conn. Howard, Joseph William .--...Kansas City, Mo. Howard, William H .....................Oelwein, Iowa Hunt, Westley Marshall --- New York, N. Y. Kayser, Reuben ........................Brooklyn, N. Y. Kutscher, Charles F. ..--------- ....Pittsburgh, Pa. Leavy, Charles A . ........................Clayton, Mo. Lingeman, Edward L. .___.._._.Indianapolis, Ind. Lore, John M .........................New York, N. Y. Matthews, Justus ................Minneapolis, Minn. McAuley, Albert G. __..Montreal, Que., Canada McDannald, Clyde Elliott, New York, N. Y. McDowell, Nathan D............Rochester, N. Y. McLaughlin, Roy Carlyle, Los Angeles, Calif. Mengel, Sterling F. ____________________Pottsville, Pa. Nance, Willis O . .............................Chicago, Ill. Neff, Eugene E .............................Madison, Wis. O'Connor, Thomas P. __ ........... .... Chicago, Ill. O'Hora, James T. _ .... __ .............. Detroit, Mich. Parsons, Joseph G .................Crookston, Minn. Randel, Harvey 0.........Oklahoma City, Okla. Ratner, Simon Harry --------- ._Miami Beach, Fla. Repass, Robert Eldon ....................Miami, Fla. Rindlaub, John H .........................Fargo, N. D. Ringle, Charles A .....................La Junta, Colo. Rubendall, Clarence ....................Omaha, Neb. Ryan, Maxwell D_---------------- New York, N. Y. Schoofs, Orlando P. ............Milwaukee, Wis. Spengler, John Arthur ................Geneva, N. Y. Stueber, F. G. _____._____.----------------- _____Lima, Ohio Van Poole, Gideon M.........Honolulu, Hawaii Walker, Orville J . ............Youngstown, Ohio Wells, David W. _ ..................... Newton, Mass. Williams, Horace J .................Philadelphia, Pa. Woodry, Norman Lee ................Detroit, Mich. 6. Resignations Received : Constans, George M ................. Bismarck, N. D. Crowe, Samuel J. __ .................... Baltimore, Md. Finney, Nancy E . ....................Cincinnati, Ohio Gubner, Julius ........................Brooklyn, N. Y. Nebinger, Reid .................... St. Petersburg, Fla. Neumann, Wm. Henry _..._.._....Sheboygan, Wis. Odeneal, Thomas H.........Winter Haven, Fla. Page, John Randolph _.---------- New York, N. Y. Risdon, Fulton ................Toronto, Ont., Canada Togus, L. Theodore .......... ..Manchester, N. H. 7. Eight Fellows requested that they be al- lowed to continue under the status of dues remitted. Five new requests were received. 9. The motion picture, Embryology of the Eye, produced by Sturgis-Grant Productions, Inc., aided by Dr. George W. Corner and Dr. George K. Smelser, and sponsored by the Academy, will be exhibited for the first time on Tuesday, October 10. This is the first professionally produced motion picture spon- sored by the Academy and sets a standard for teaching films in the basic medical sciences related to ophthalmology and otolaryngol- ogy. A suitable plaque has been prepared for each of the principals in the technical produc- tion of the film expressing the gratitude of the Academy for their splendid services. 10. At the request of the secretary of the American Ophthalmological Society, Dr. May- nard C. Wheeler, a committee of three was Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 COUNCIL MINUTES 163 appointed by President Brown to join similar committees of the American Ophthalmological Society and the Section on Ophthalmology of the American Medical Association in soliciting the next meeting of the International Congress of Ophthalmology for the United States. Ap- pointed on July 5 were Dr. Philip M. Lewis, Memphis, Tenn.; Dr. Erling Hansen, Minne- apolis, Minn., and Dr. Bernard Samuels, New York. A report has not been received from this committee. 11. At the request of the secretary of the International Organization Against Trachoma, a representative from the Academy was ap- pointed by President Brown on July 5. Dr. R. Townley Paton of New York was ap- pointed and has submitted his report to the Council through the Activities Committee. It was moved and seconded that the report of the Executive Secretary be accepted as read. The motion carried. II The Treasurer, Dr. Benedict, submitted the audit for 1949, made by Byers, Wobschall & Miller, Certified Public Accountants, and the financial status of the Academy as of Sept. 30, 1950. It was moved and seconded that the report be accepted. The motion carried. (The audit for 1949 appeared in the May-June 1950 issue of the TRANSACTIONS. The financial sta- tus of the Academy as of Sept. 30, 1950, is published herewith.) EXHIBIT "A" AMERICAN ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY Balance Sheet as of September 30, 1950 AssETS Current Assets: Cash, First National Bank, Rochester -.-...$ 42,354.05, Cash, Bank of Montreal .................... 5,726.71 Cash, First National Bank, Minneapolis.... 22,850.67 Checks for Col- lection ------------------------ 23.50 Petty Cash Fund 25.00 Membership Dues Receivable .................. 470.00 Motion Picture- Embryology Project 26,200.00 Inventory-Ab- stracts & Manuals .... 11,937.86 Total Current Assets $109,587.79 Investments : Research Fund -------- 231,738.48 Wherry Memorial Fund .......................... 4,600.00 236,338.48 Less: Reserve Mkt. Fluctuations .............. 2,390.53 Fixed Assets: Furniture & Fixtures 6,623.35 Less : Reserve for Depreciation .............. 3,344.74 Total Fixed Assets 3,278.61 Prepaid Insurance -....- 273.87 Prepaid Postage -....-... 21.88 Total Assets $347,110.10 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 164 TRANSACTIONS - NOVEMBER - DECEMBER, 1950 LIABILITIES Current Liabilities: Accrued Withholding Taxes .-------------------- Deferred Income : Membership Ducs ---- Net Worth : Balance, January 1, 1950 -'---------------------- $278,916.22 Revenues : 205.80 215.00 EXHIBIT "B" AMERICAN ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY Statement of Income and Expenses for Month Ending September 30, 1950, and Year to Date Excess Income over Expenses, Year to Date ----------------- --------- Interest ........._......... 262.50 6,000.00 Dividends ---------------- 90.00 937.74 Wherry Memorial Fund : Interest -------------------- 7.50 115.00 Sub-Committee on Noise in Industry ..... ._.. ----- 4,200.69 Other Income .----....-- Income from Securities : Research Fund: September 1/1/50 to 1950 9/30/50 Membership Dues .--.$ 99.00 $ 26,980.00 Membership Applica- cations -------------------------- 225.00 3,936.00 Abstracts & Manuals 976.00 3,173.55 346,689.30 Transactions -------------- 2,461.31 34,549.72 Home Study Courses 530.00 3,390.00 $347,110.10 Convention .................. 11,576.75 47,189.75 Committee on Stand- ardization of Tonome- ters -------- '-------------' ------- 10.00 650.00 Total Revenues ......$16,238.06 $131,277.29 Operating Expenses: General Adminis- trative ..........................$ 1,954.26 $ 24,617.51 Transactions .............. 2,275.16 24,582.22 Home Study Courses 1,094.41 5,382.46 Research -_------------------- 1,012.50 Convention and Meet- ings ---------------'-------------- 984.24 7,909.52 Total Operating Expenses ----------------$ 6,308.07 $ 63,504.21 Excess Income over Expenses ....................$ 9,929.99 $ 67,773.08 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 COUNCIL MINUTES American Academy of Ophthalmology and Otolaryngology Securities Owned as of September 30, 1950 RESEARCH FUND: BONDS RATE MATURITY PAR VALUE COST Canada, Dominion of-Series PS ............ 3 10/ 1/63 $ 2,500.00 $ 2,500.00 Citizens Bldg. Co. of Cleveland, 1st Mortgage .......................................... 6 1/ 1/46 5,000.00 5,000.00 .. Savings Bonds-Series F .............. S U 1 2/ 12/ 1/55 13,500.00 9,990.00 . . Savings Bonds-Series G .............. S U 2% 8/ 1/53 10,000.00 10,000.00 . . Savings Bonds--Series G .............. S U 2% 6/ 1/55 4,000.00 4,000.00 . . Savings Bonds-Series G .............. U S 232 3/ 1/56 6,000.00 6,000.00 . . Savings Bonds-Series G .............. S U 21/ 5/ 1/56 8,000.00 8,000.00 . . Savings Bonds-Series G .............. U S 2/ 7/ 1/56 2,000.00 2,000.00 . . Savings Bonds-Series G .............. S U 2/ 11/ 1/56 25,000.00 25,000.00 . . Savings Bonds-Series G .............. S U 2/ 1/ 1/57 2,000.00 2,000.00 . . Savings Bonds-Series G .............. S U 2% 7/ 1/58 30,000.0 l 30,000.00 . . Savings Bonds-Series G .............. U S 2/ 12/ 1/58 25,000.00 25,000.00 . . U.S. Savings Bonds-Series G .............. 2/ 3/ 1/59 15,000.00 15,000.00 (6) U.S. Savings Bonds-Series G 000 $5 00 .................................................... 2/ 7/ 1/60 30,000.00 30,000.00 . , .......................... Treasury Bond ....... U S 2% 12/15/72 10,000.00 10,000.00 . . . U.S. Treasury Bond .................................. 2/ 12/15/72 15,000.00 15,431.25 Van Sweringen Co., Cert. of Indebtedness .............................................. 6 12/31/48 3,445.70 3,477.03 $203,398.28 STOCKS KIND Citizens Bldg. Co. of Cleveland ................ SHARES 50 None 619 00 Commonwealth Edison Company ............Common 100 . 2, 31 2 47 DuPont de Nemours & Co ...................... Common 15 ,3 . 00 5 Louisville Gas & Electric Co ....................5% Preferred 200 5,4 0. 9 Massachusetts Investors Trust ................ 617 17,923.8 Ophthalmic Publishing Co .........................Capital 5 None Total Stocks ....................................... $ 28,340.20 Total ------------------------------------------------------ (A) $231,738.48 WHERRY MEMORIAL FUND: U.S. Savings Bonds-Series G ............... (B) $ 4,600.00 $236,338.48 (A) Held for safekeeping by Trust Dept., First National Bank, Minneapolis, Minn. (B) Held by Dr. W. L. Benedict, Executive Secretary-Treasurer, Rochester, Minn. The report of the Editor of the TRANSAC- TIONS was read by Dr. Benedict, Editor-in- Chief, as follows : For the period September 1, 1949, through August 31, 1950, in addition to the six bi- monthly issues of the TRANSACTIONS, a sup- plement containing papers read at the Oto- sclerosis Study Group meeting in October 1948 was printed and sent out with a regular mailing. A similar supplement containing pa- pers from the Study Group's 1949 meeting will appear soon. The Academy has also published four man- uals and one monograph during the past year. The Syllabus of Audiometric Procedures in the Administration of a Program for the Con- servation of Hearing of School Children has been reprinted. One hundred and forty-one abstracts have been prepared for the 1950 Instruction Section. A manual by Richard Scobce and a monograph by Clarence A. Vea- sey, Jr., are now being processed. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 166 TRANSACTIONS -- NOVEMBER - DECEMBER, 1950 MANUALS October 1949-Woods, Endogenous Uveitis March 1950-Leinfelder, Neuro-ophthal- mology June 1950-Berens and Loutfallah, Ocular Surgery June 1950-Sugar, Extrinsic Eye Muscles (revised edition) MONOGRAPH January 1950-Juers, Hearing Tests In the coming year we will continue to issue a supplement of the papers read at the Spe- cial Scientific Program of the Otosclerosis Study Group and will also publish a supple- ment containing papers read. at the Special Scientific Program of the American Society of Ophthalmologic and Otolaryngologic Al- lergy. Papers read at the meeting of the Committee on Conservation of Hearing (Sunday night meeting) will appear in one of the regular issues of the TRANSACTIONS. Most of the papers read before the Industrial Oph- thalmology-group will also appear throughout the year in the Industrial Ophthalmology Sec- tion of the TRANSACTIONS. An average of 6092 copies of the TRANSAC- TIONS was printed bimonthly. Of these, 675 were set aside for bound volumes and an average of 5373 was mailed, an increase in circulation of 348 over last year. The fol- lowing categories are represented : Members .------------------------------------------ 4554 Candidates ........... ----------- ------------------ 146 Subscribers .... ----- ---------- 411 Libraries -------------------------------------------- 103 Exchange & Miscellaneous -------- 78 Advertisers --------------------------------------- 52 Complimentary -------------------------------- 29 Four hundred and ninety-five orders for the 1949-1950 bound volume have been received to date. The average number of pages of paid ad- vertising was 18.7, representing 29 advertisers. The revenue from the TRANSACTIONS was as follows : Amount set aside from Fellows' dues ----------------------$19,844.00 Amount set aside from Candidates' fees -------- ------- 1,202.00 Subscribers (nonmembers) 3,272.00 Bound Volumes ----------------------- 3,018.00 Single issues sold _..--_..---- ---_.. 55.00 Reprints ................................. - 495.00 Advertisers ---------------------------- 9,637.66 Cuts (loaned) ---------------------- 87.55 Total ------------- ----------- ------------ $37,611.96 iixpenditures were as follows : Printing bimonthly issues ---- $17,704.74 Binding Bound Volumes ___... 1,097.25 Cuts and engravings _.....------ 1,664.70 Editor's honorarium ------------ 2,000.00 Postage ----------------------------------- 423.34 Reprints ....-------------------------- ---- 1,518.92 Directory -------------------------------- 3,019.92 Salaries ------------------------------------ 4,796.00 Supplies (stock, enve- - lopcs, etc.) ------------------------ . 5,327.73 Total -----------------------------------$37,552.60 Balance ------------------------------- $ 59.36 A motion to accept the report as read was seconded and carried. IV Communications 1. The secretary read a communication from Dr. James H. Allen of New Orleans regarding the exemption of medical students, interns and. residents in their final years of training. Dr. Derrick Vail moved that the Academy appoint a committee of ex-medical officers who had. served in World War II to be known as the Committee on Armed Forces. The mo- tion was seconded by Dr. Erling Hansen and carried. The following committee was ap- pointed : Dr. James N. Greear, Jr., Washing- ton, I). C., chairman; Dr. Brittain F. Payne, New York ; Dr. Gordon D. Hoople, Syracuse, N. Y.; Dr. Gordon M. Bruce, New York ; and Dr. Harry P. Schenck, Philadelphia. The committee is to formulate opinions of policy regarding exemptions and will represent the Academy as a liaison committee with the Armed Forces. 2. Dr. A. F. MacCallan of London wrote to Dr. R. Townley Paton in regard to the Lon- don activities of. the International Organiza- tion Against Trachoma and asked for a dona- tion from the Academy to assist this organiza- tion in its work. Dr. Paton, who represented the Academy at the meeting of the organiza- tion in June of this year, referred the letter to the Executive Secretary. The Council voted to send $25.00 to the organization. 3. The National Society for Crippled Children and Adults, Inc., requested "the offi- cial action of the American Academy of Oph- thalmology and Otolaryngology to create a formal liaison relationship with the National Society for Crippled Children and Adults. The Council approved the request, and Dr. Dean M. Lierle was appointed to the position of liaison officer. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 COUNCIL MINUTES 167 4. The Secretary presented a letter written by Captaih W. L. Berkley, MC, USN, con- cerning the Sixth Brazilian Jornadas of Oph- thalmology, which took place in Sao Paulo, Brazil, September 3-7, 1950. Dr. Berkley par- ticipated in the program. He praised the ex- cellence of the scientific program and the mani- festations of the very warm friendship which the people of Brazil have toward the United States. He commented on the importance of a Good Neighbor policy and urged more par- ticipation in the ophthalmologic meetings of Central and South American countries. 5. A communication addressed to the Presi- dent and signed by Dr. C. E. Kinney, con- cerning the advertising of cigarette manufac- turers, was read to the Council. There was no specific recommendation and, after some discussion, the matter was laid on the table for further consideration. 6. A communication was submitted by Dr. Iledrvig Kuhn as secretary of the Joint Com- mittee on Industrial Ophthalmology urging the approval or disapproval of the recommen- dations of the 1949 meeting of the Joint Com- mittee relative to monocular aphakia and com- pensation. Inasmuch as matters of compen- sation are handled by the American Medical Association, the Council recommended that the matter be referred to the Association. V Report of the Executive, Research and Fi- nance Committee-Dr. J. Mackenzie Brown, chairman. 1. The Committee recommends that the ap- plication fee shall be $25.00, and that the an- nual dues for Junior Fellows shall continue to be $12.00, and for Senior Fellows, $6.00. The allotment from clues for subscriptions to the TRANSACTIONS shall remain at $5.00. It was moved and seconded that this recommendation be approved. The motion carried. 2. The Committee recommends that the 10 resignations of Fellows from the Academy re- ported by the Executive Secretary be accepted. A motion to this effect was seconded and carried. 4. The Committee recommends that Dr. George W. Corner, Baltimore, Md., and Dr. George K. Smelser, New York City, be made Honorary Fellows of the Academy. This recommendation was approved. 5. The Committee recommends the follow- ing appointments to Standing and Joint Com- mittees : ,To the Advisory Committee to the Regis- tries of Pathology, Dr. Brittain F. Payne, chairman. To the Committee on Conservation of Hear- ing, Dr. Dean M. Lierle, chairman. To the Committee on Pan-American Rela- tions in Otolaryngology, Dr. C. L. Jackson, chairman; Dr. Norton Canfield; Dr. A. C. Furstenberg; Dr. Gordon B. New; Dr. Theodore E. Walsh ; and Dr. Paul H. Hol- in.ger. At the request of Dr. Jackson, Dr. Vic- tor Alfaro of Washington, D. C., was added to the Committee. To the Committee on Prevention of Blind- ness, Dr. Ralph I. Lloyd, chairman ; Dr. Law- rence T. Post; and Dr. Alan C. Woods. To the Committee on Scientific Exhibit, Dr. Kenneth L. Roper, chairman. To the Committee on Standardization of Tonomcters, Dr. Jonas S. Friedenwald, chair- man. To the Committee on the Study of Audio- Visual Instruction, Dr. Dean M. Lierle, chair- man; Dr. W. L. Benedict; Dr. Howard P. House, Dr. Algernon B. Reese; and Dr. A. D. Ruedemann. To the Advisory Committee to the Eye Health Committee of the American Student Health Association, Dr. Lawrence T. Post. To the American Association for the Ad- vancement of Science, Dr. M. Elliott Randolph. To the American Board of Ophthalmology, Dr. F. -Bruce Fralick. To the American Board of Otolaryngology, Dr. C. H. McCaskey and Dr. W. E. Grove. To the American College of Surgeons Board of Governors, Dr. James H. Maxwell. To the American Committee on Optics and Visual Physiology, Dr. Alfred Cowan. To the American Orthoptic Council, Dr. Kenneth C. Swan. To the American Society of Clinical Path- ologists Consultative Panel on Tumor Termin- ology, Dr. John S. McGavic. To the Joint Committee on Industrial Oph- thalmology, Dr. Edmund B. Spaeth, Dr. John B Hitz, and Col. Victor A. Byrnes (MC). It was moved and seconded that these ap- pointments be approved. The motion carried. 6. The Committee recommends that the Helmholtz Centenary Committee ,be discharged with thanks for the services rendered. The recommendation was approved. 7. The Committee nominates Dr. William L. Benedict as Editor-in-Chief of the TRANSAC- TIONS. It was moved and seconded that the nomination be approved. The motion carried. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 168 TRANSACTIONS - NOVEMBER - DECEMBER, 1930 8. The Committee recommends that the next annual meeting of the Academy be held Octo- ber 14-19, 1951, at the Palmer House, Chicago. The recommendation was approved. The Coun- cil directed the Executive Secretary-Treasurer to arrange for future meetings of the Acad- emy. 9. The Committee recommnds the following appropriations for the calendar year 1951: To the Advisory Committee to the Regis- tries of Pathology, a sum not to exceed $8,500 toward the completion of the atlases. This is to include the services of a fellow in ophthal- mology and one in otolaryngology. To the Committee on Conservation of Hear- ing, a sum not to exceed $9,000. To the Committee on Standardization of Tonometers, a sum not to exceed $1,000. To the American Committee on Optics and Visual Physiology, $100. To the American Orthoptic Council, $200 if requested. To the Joint Committee on Industrial Oph- thalmology, a sum not to exceed $1,000, if matched by an equal sum from the American Medical Association and if the Academy is accorded proper credit for its participation in this Committee. To the National Research Council, $2,500. To the National Society for Medical Re- search, $1,000. On the motion of Dr. Algernon Reese, seconded by Dr. Erling Hansen, the report of the Committee was accepted and the recom- mendations adopted. VI Report of the Activities Committee-Dr. Thomas D. Allen, chairman. Reports of the following committees were reviewed and approved by the Activities Com- mittee : 1. Advisory Committee to the Registries of Pathology 2. Committee on Conservation of Hearing 3. Committee on Scientific Exhibit 4. Committee on Standardization of To- nometers 5. Committee on the Prevention of Blind- ness 6. Committee on the Study of Audio-Vis- ual Instruction 7. Advisory Committee to the Eye Health Committee of the American Student Health Association 8. American Association for the Advance- ment of Science 9. American Board of Ophthalmology 10. American Board of Otolaryngology 11. American Committee on Optics and Vis- ual Physiology 12. American Orthoptic Council 13. Helmholtz Centenary Committee 14. Joint Committee on Industrial Ophthal- mology 15. American Society of Clinical Patholo- gists Consultative Panel on Tumor Terminology 16. Representative to the International Or- ganization Against Trachoma (Full reports of standing and joint commit- tees follow the report of the Business Meet- ing.) The report of the Committee on Pan-Ameri- can Relations in Otolaryngology was given verbally by the chairman, Dr. C. L. Jackson, who was instructed to submit a written report to the Chairman of the Activities Committee before the meeting of the Council on Wed- nesday. No reports were received from: 1. American College of Surgeons Board of Governors 2. Committee on Meeting of the Interna- tional Congress of Ophthalmology A motion was made and seconded that the report of the Activities Committee be accepted as a whole. The motion carried. VII Report of the Board of Councillors-Dr. Thomas D. Allen, chairman. 1. Nomination of officers : President-Dr. Derrick Vail, Chicago, Ill. President-Elect-Dr. James Milton Robb, De- troit, Mich. First Vice-President-Dr. Francis E. LeJeune, New Orleans, La. Second Vice-President-Dr. Peter Kronfeld, Chicago, Ill. Third Vice-President-Dr. Frederick A. Figi, Rochester, Minn. Councillor-Dr. John H. Dunnington, New York, N. Y. Executive Secretary-Treasurer-Dr. William L. Benedict, Rochester, Minn. Secretary for Ophthalmology-Dr. Algernon B. Reese, New York, N. Y. Secretary for Otolaryngology-Dr. Howard House, Los Angeles, Calif. Secretary for Instruction in Ophthalmology- Dr. A. D. Ruedemann, Detroit, Mich. Secretary for Instruction in Otolaryngology and Maxillofacial Surgery-:Dr. Dean M. Lierle, Iowa City, Iowa. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Secretary for Home Study Courses-Dr. Law- rence R. Boles, Minneapolis, Minn. Secretary for Public Relations-Dr. Erling W. Hansen, Minneapolis, Minn. It was moved and seconded that the recom- mendations of the Board of Councillors for the officers of the Academy for 1951 be ac- cepted. The motion carried.. 3. The Board of Councillors recommends that 285 candidates be accepted for Fellowship in the Academy : (The names of candidates for fellowship approved by the Council are published in the account of the Business Meeting.) A motion to accept these recommendations was seconded and carried. VIII Report of the Judicial Committee-Dr. J. Mackenzie Brown, chairman. There was no business for the Judicial Com- mittee and a meeting of the Committee was not required. IX New Business 1. It was moved by Dr. Alan Woods and seconded by Dr. W. L. Benedict that the fol- lowing addition be made to Article V, Section 6, of the By-Laws : (Following identification of Junior Fellows) Inactive Fellows : Senior or Junior Fellows who by reason of physical infirmity or re- tirement from practice may by action of the Council be classified as "Inactive." Inactive Fellows shall pay no clues, have no voting privileges, and shall not receive the TRANSAC- TIONS. The motion carried. 2. Dr. Alan Woods moved that the re- search fund be renamed Educational Fund. The motion was seconded by Dr. W. L. Bene- dict and carried. 3. At the January meeting of the Board of Secretaries, the organization of a Teachers' Section was recommended. It was moved by Dr. A. D. Ruedemann and seconded by Dr. Erling Hansen that the Council create a Teachers' Section as an Academy function. The motion carried and Dr. Lawrence R. Boies was named chairman and given the pri- vilege of adding to his Committee by ap- pointment. 4. The management of a special fund to be known as "The Isabella Wilson Research and Educational Fund for Frontal Sinus Path- ology," initiated by Dr. Robert H. Fraser of Battle Creek, Mich., was accepted by the Council. The purpose of this fund was set forth in a letter addressed to the Secretary under date of October 9, 1950. This is tenta- tively a fund of $500, $250 contributed from the estate of Miss Isabella Wilson, and con- tributions of not over $10.00 to be accepted from interested physicians and others. A check for $150 signed by Dr. Robert IL Fraser accompanied the letter. 5. The secretary of the American Orthoptic Council, Dr. Frank J. Costenbader, in a com- munication to the Secretary requested that the Academy publish certain papers from the Special Scientific Program of the American Association of Orthoptic Technicians and the American Orthoptic Council. It is the hope of the American Association of Orthoptic Technicians and the American Orthoptic Coun- cil that additional material may be combined with the scientific papers to make up a publica- tion to be known as the American Orthoptic Journal. A motion was made by Dr. Alan Woods and seconded by Dr. Conrad Berens that the proposal be accepted, the arrange- ments to be completed by Dr. Derrick Vail and Dr. W. L. Benedict. The motion carried. 6. Dr. Thomas D. Allen moved that the Academy have an exhibit at the Meeting of the Pan-American Congress of Ophthalmol- ogy in Mexico City in 1952. It was suggested that the Academy and the American Board of Ophthalmology might plan a joint exhibit. The motion was seconded by Dr. Alan Woods and carried. The Council authorized the expenses of Miss Maud Givens to accompany the ex- hibit. 8. The Joint Committee on Industrial Oph- thalmology presented for endorsement by the Council the following recommendations of basic principles, objectives and essentials to be met by manufacturer, distributor or any other representative, for introducing an effec- tive and ethical visual testing program to in- dustry : 1. The 'manufacturer, distributor or any other representative to recommend only accepta- ble and proper instrumentation for the testing of visual skills. 2. The presentation of currently acceptable visual testing procedures shall be made to the medical director and/or professional eye consultant of plant by the salesmen. 3. Insistence in sales approach that interpre- tation, evaluation of records and all refer- ral and correction programs are the re- Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 sponsibility of the medical director and/or professional eye consultant. 4. The presentation of the over-all subject of instrument testing of visual skills in indus- try shall be made to local professional groups and societies whenever at all possi- ble. 5. At no time shall a salesman of such in- strumentation indicate to lay personnel of industry that professional guidance is not necessary. 6. Any job standards and/or "profiles" pre- sented to the industry must be based on research available both to the industry pur- chasing the instrument and/or the profes- 7. When an instrument as such is sold out- right to the company without an additional continuous service, the price of the instru- ment should be for the instrument alone. It would be desirable that instrumentation be sold outright to plants that have profes- sional eye consultants. 8. The attitude and bearing of any salesman asking for an interview with a professional individual shall be in line with accepted ethical standards. A motion to endorse these recommendations was made by Dr. A. D. Ruedemann, seconded by Dr. Derrick Vail, and carried. The meeting adjourned. ANNUAL BUSINESS MEETING The business meeting of the Fifty-Fifth Annual Session of the American Academy of Ophthalmology and Otolaryngology convened at 5:30 p.m. in the Crystal Room of the Pal- mer House, Chicago, Oct. 12, 1950. President J. Mackenzie Brown presided. Report of the Executive Secretary-Treasurer, I)r. William L. Benedict The fellowship in this Academy as of Oct. 1, 1950: Junior Fellows, 3,907; Senior Fel- lows, 150; Life Fellows, 427; Honorary Fel- lows, 26; making a total of 4,510. Candidates to be considered at this meeting, 285. Elevation to senior fellowship on Jan. 1, 1951, 41. Elevation to life fellowship on Jan. 1, 1951, 17. Deaths reported since the last meeting, 53. Resignations received, 10. [.See Council Minutes.] Review of those whose dues have been re- mitted and who are carried on the member- ship roll at their request, 13. On motion of Dr. Alan C. Woods, seconded by Dr. John J. Shea, the report was accepted as read. Report of the Senior Member of the Council, Dr. Alan C. Woods Mr. President and Members : The Council has received and approved the reports of the Treasurer, the Editor of the TRANSACTIONS, the Council Committees, and joint and stand- ing committees. These reports will be pub- lished in the November-December issue of the TRANSACTIONS. [See Council Minutes and Com- mittee Reports.] Dn. WooDS : The Council recommends that the application fee for fellowship in the Academy shall remain at $25.00, and that annual dues for Junior Fellows shall be $12.00; for Senior Fellows, $6.00. A motion to accept the recommendation of the Council was made by Dr. Carl H. Mc- Caskey and seconded by Dr. James M. Robb. The motion carried. DR. Woods : A request for financial assist- ance to support the International Organiza- tion Against Trachoma was directed to the Academy by Dr. A. F. MacCallan, secretary. The Council recommends the appropriation of $25.00 to the organization. On motion of Dr. Thomas Allen, seconded by Dr. Shea, the recommendation of the Coun- cil was accepted. DR. WOOns : The -Council recommends the following appropriations for the year 1951: To the Advisory Committee to the Regis- tries of Pathology, a sum not to exceed $8,500 toward the completion of the atlases. This is to include the services of a fellow in oph- thalmology and one in otolaryngology at the Armed Forces Institute of Pathology in Wash- ington, D. C. To the Committee on Conservation of Hear- ing, a sum not to exceed $9,000. To the Committee on Standardization of Tonometers, a sum not to exceed $1,000. To the American Committee on Optics and Visual Physiology, $100. To the American Orthoptic Council, $200 if requested. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 ANNUAL BUSINESS MEETING 171 To the Joint Committee on Industrial Oph- thalmology, a sum not to exceed $1,000, if matched by an equal sum from the American Medical Association. To the National Research Council, $2,500. To the National Society for Medical Re- search, $1,000. On motion by Dr. McCaskey, seconded by Dr. Allen, the appropriations recommended by the Council were accepted. DR. Woons : The Council recommends the following appointments to standing and joint committees for the year 1951: To the Advisory Committee to the Regis- tries of Pathology, Dr. Brittain F. Payne, chairman. To the Committee on Conservation of Hear- ing, Dr. Dean M. Lierle, chairman. To the Committee on Pan-American Rela- tions in Otolaryngology, Dr. C. L. Jackson, chairman; Dr. Norton Canfield; Dr. A. C. Furstenberg; Dr. Gordon B. New; Dr. Theo- (lore E. Walsh; Dr. Paul H. Holinger; and Dr. Victor Alfaro. To the Committee on Prevention of'Blind- ness, Dr. Ralph I. Lloyd, chairman; Dr. Law- rence T. Post; and Dr. Alan C. Woods. To the Committee on Scientific Exliibit, Dr. Kenneth L. Roper, chairman. To the Committee on Standardization of Tonometers, Dr. Jonas S. Friedenwald, chair- man. To the Committee on the Study of Audio- Visual Instruction, Dr. Dean M. Lierle; chair- man; Dr. W. L. Benedict; Dr. Howard P. House; Dr. Algernon B. Reese ; and Dr. A. D. Ruedemann. To the Advisory Committee to the Eye Health Committee of the American Student Health Association, Dr. Lawrence T. Post. To the American Association for .the Ad- vancement of- Science, Dr. M. Elliott Ran- dolph. To the American Board of Ophthalmology, Dr. F. Bruce Fralick. To the American Board of Otolaryngology, Dr. C. H. McCaskey and Dr. W. E. Grove. To the American College of Surgeons Board of Governors, Dr. James H. Maxwell. To the American Committee on Optics and Visual Physiology, Dr. Alfred Cowan. To the American Orthoptic Council, Dr. Kenneth C. Swan. To the American Society of Clinical Path- ologists Consultative Panel on Tumor Termin- ology, Dr. John S. McGavic. To the Joint Committee on Industrial Oph- thalmology, Dr. Edmund B. Spaeth, Dr. John B. Hitz, and Col. Victor A. Byrnes (MC). On motion by Dr. McCaskey, seconded by Dr. Allen, the appointments recommended by the Council were accepted. DR. WooDS : The Council was requested to give suggestions and advice regarding the exemption of medical students and residents from military service. A committee to be known as "The Committee on Armed Forces" was appointed by the President.. The Com- mittee consists of Dr. James N. Greear, Jr., chairman; Dr. Brittain F. Payne; Dr. Gordon D. Hoople; Dr. Gordon M. Bruce; and Dr. Harry P. Schenck. On motion by Dr. Shea, seconded by Dr. Derrick Vail, the action of the Council was approved. DR. Woons : The National Society for Crip- pled Children and Adults, Inc., has requested official action of the Academy to create a for- mal liaison relationship with the Society. The Council recommends the appointment of Dr. Dean M. Lierle as liaison officer. On motion of Dr. A. D. Ruedemann, sec- onded by Dr. Shea, the recommendation of the Council was accepted. DR. Woons : The Council recommends the organization of a Teachers' Section. The pur- pose of this section would be to set up a forum for discussion of problems pertinent to teaching of the specialties in medicine. The Council has recommended that Dr. Lawrence R. Bores be named chairman and be given the privilege of adding to his committee by ap- pointment. Upon motion by Dr. Vail, seconded by Dr. Allen, the recommendations of the Council were accepted. DR. Woons : The Council nominates for honorary fellowship in the Academy, Dr. ? George W. Corner and Dr. George K.. Smel- ser. The Council also nominates for active fellowship the 285 candidates whose names appear on the sheets handed you when you came in the door. On motion by Dr. Carroll Mullen, seconded by Dr. Allen, the nominations made by the Council were accepted. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 172 TRANSACTIONS -NOVEMBER - DECEMBER, 1950 iVewlr elected Fellows of the Academy: Acquarelli, Mario John, Wadsworth Gen- eral Hospital, Los Angeles 25, Calif., ALR. Albers, George Donald, 81/2 Monroe St., Grand Rapids 2, :Mich., ALR. Anderson, Elam DeMar, Medical & Dental Bldg., Seattle 1, Wash., OP. Anderson, Elbert Carl, 201 N. Front St., Wilmington, N. C., OP. Anderson, H. Gordon, 403 Fulton St., Troy, N. Y., OP. Anslow, Robert Elmer, 10 Peterboro St., Detroit 1, Mich., OP. Baers, Harry Arnold, 4063 Radford Ave., Studio City, Calif., ALR. Baldridge, Max N., P.O. Box 778, Texar- kana, Ark.-Texas, OP. Barbee, John Young, 1109 State St., Bowling Green, Ky., ALR. Barrere, Luciano Enrique, Tulane Uni- versity, New Orleans 12, La., OP. Barton, William Lawrence, 403 Persons Bldg., Macon, Ga., ALR. Beasley, Clifton Harold. :1216 Pennsyl- vania Ave., Fort 'Worth, Texas, OP. Bergman, Macks Leonard, 8443 Crenshaw Blvd., Inglewood, Calif., ALR. Birmingham, Eugene E., 333 W. North Ave., Chicago 10, Ill., ALR. Blair, James Robert, 920 Metropolitan Bldg., Denver 2, Colo., ALR. Blanford, Sidney Edgar, Jr., 1624 Gilpin St., Denver, Colo., Pl S. Blodi, Frederick C., 635 W. 165th St., New York 32, N. Y., OP. Bloomberg, Louis, 506 Central Tower Bldg., Youngstown 3, Ohio, OP. Bobbett, Gordon Howard, 125 W. Cheves St., Florence, S. C., ALR. Boshnack, Malcolm, 70 Strawberry Hill Ave., Stamford, Conn., ALR. Bosworth, Wesley F., E. Main St., Clar- inda, Iowa, OP. Boucher, Irvan Andrew, 1221 12th Ave., Altoona, Pa., ALR. Braveman, Bernard Leon, 412 Fifth Ave., . McKeesport, Pa., CP. Breff eilh, Louis Andrew, 421 Medical Arts Bldg., Shreveport, La., OP. Brown, Kenneth Brien, 131 Fulton Ave., Hempstead, N. Y., ALR. Bryan, John Thomas, 2105 Hayes St., Nashville 5, Tenn., ALR. Burnham, Charles Joseph, 1529 N. 25th St., Birmingham, Ala., OP. Burr, Sherwood Petersen, 43 E. Jackson St., Tucson, Ariz., OP. Butler, Jay B. V., 919 Taylor Street Bldg., Portland 5, Ore., OP. Cairns, Adrian Bennett, 415 Pere Mar- quette Bldg., New Orleans 12, La., ALR. Callaghan, Winship C., Union Trust Bldg., Greensburg, Ind., ALR. Callahan, Neil, 315 Medical Arts Bldg., Norfolk 10, Va., ALR. Cammack, Bragg Charles, 6381 Holly- wood Blvd., Hollywood 28, Calif., ALR. Capriotti, Octavius A., 404 E. Broad St., Souderton, Pa., OP. Carris, James Vernon, 209 S. Nevada Ave., Colorado Springs, Colo., ALR. Casey, Edwin Joseph, 508 N. Grand Ave., St. Louis 3, Mo., OP. Christenberry, Kenneth William, 501 W. Church Ave., Knoxville, Tenn., OP. Clark, Archibald Fletcher, Jr., 225 Medi- cal Arts Bldg., San Antonio 5, Texas, ALR. Clay, Richard A., 416 N.W. 13th St., Okla- homa City, Okla., OP. Clayton, Sam, 119-05 80th Road, Kew Gardens 15, N. Y., ALR. Coleman, Howe Reese, 305 Young Bldg., Lynchburg, Va., ALR. Corgill, Donald Alton, Veterans Adminis- tration Hospital, McKinney, Texas, ALR. Crane, Edward Harrison, Jr., 127 S. Gre- villea Ave., Inglewood, Calif., ALR. Crawford, Walter James, 3333 Pachappa Drive, Riverside, Calif., OP. Cressman, Frederic E., 102 S. Second St., Artesia, N. M., OP. Crowder, Miles S., 603 W. Main St., Knox- ville, Tenn., OP. Daly, Joseph M., 1801 K St. N.W., Wash- ington 6, D. C., ALR. DeLuca, Charles Q., 255 S. 17th St., Philadelphia 3, Pa., ALR. Denicke, Ernest Webber, 1010 B St., San Rafael, Calif., OP.. Dennis, Richard Hollis, 33 College Ave., Waterville, Maine, OP. Dillahunt, Jack A., Copper Ave. at Mon- roe, Albuquerque, N. M., OP. Dorman, Purman, 1215 Fourth Ave., Se- attle 1, Wash., OALR. Dryden, James Spencer, 1835 Eye N.W., Washington 6, D. C., OP. Duncan, Herbert, 700 Church St., Nash- ville 3. Tenn., ALR. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 ANNUAL BUSINESS MEETING 173 duPrey, Robert E., 1150 Connecticut Ave., Washington 6, D. C., OP. Dwyer, Gregory Kennedy, Community Medical Group, Boonton, N. J., ALR. Edelstein, Isidore S., 259 New York Ave., Brooklyn 16, N. Y., OP. Edwards, Thomas Luther, 507 S. Wash- ington St., Van Wert, Ohio, OP. Egdorf, Otto Charles, 420 Hamilton Bldg., Wichita Falls, Texas, ALR. Esbin, Leo, 1333 President St., Brook,yn 13, N. Y., OP. Esposito, Albert Charles, First Hunting- ton National Bank Bldg., Huntington 1, W. Va., OP. Eubank, William Richards, 1102 Grand Ave., Kansas City 6, Mo., OP. Evans, John W., 325 Franklin St., Hunts- ville, Ala., ALR. Failla, Anthony, 3831 Frenchmen St., New Orleans, La., ALR. Fairbanks, Stephen, 1191/2 N. Superior St., Albion, Mich., OP. Feher, Alexander, 123 E. 83rd St., New York 28, N. Y., ALR. Feldman, John L., 416 S. 24th St., Quin- cy, Ill., ALR. Feldstein, Morris, 515 Park Ave., New York 22, N. Y., OP. Fields, James Allan, Naval Hospital, Beaufort, S. C., ALR. Florentz, Theodore Robert, 109 N. Eighth St., Boise, Idaho, OP. Follette, William James, 375 Engle St., Englewood, N. J., ALR. Freeman, David M., McMillan Hospital, St. Louis 12, Mo., OP. Friedman, Isadore Edward, 5248 Hob- man St., Hammond, Ind., ALR. Friedman, Paul Norman, 1111 St. Paul St., Baltimore 2, Md., OP. Fuchs, Jesse, 6363 Wilshire Blvd., Los Angeles 48, Calif., ALR. Gardner, James Frank, 11 N. Goodman St., Rochester, N. Y., ALR. Garner, Lawrence Lee, 238 W. Wisconsin Ave., Milwaukee 3, Wis., OP. Carron, Levon K., 426 17th St., Oak- land 12, Calif., OP. Gifford, Edward Stewart, Jr., 1913 Spruce St., Philadelphia 3, Pa., OP. Gillman, A. Marvin, 54 E. 72nd St., New York 21, N. Y., OP. Girard, Louis Joseph, Centre Island, Long Island, N. Y., OP. Glass, Walter Martin, 221 Middle Neck Rd., Great Neck, N. Y., ALR. Godwin, Robert William, 117 E. Eighth St., Long Beach 13, Calif., ALR. Golden, Samuel Charles, 150 Prichard St., Fitchburg, Mass., ALR. Goldsmith, Charles Porter, 1648 Hamilton St., Allentown, Pa., OP. Gooch, J. Oliver, 1203 Hermann Profes- sional Bldg., Houston 5, Texas, ALR. Gorin, George, 885 West End Ave., New York 25, N. Y., OP. Grayman, Harry Myer, 2900 Fresno Street Bldg., Fresno 1, Calif., OP. Greene, Richard W., 32 Johnson Ave., Newark 8, N. J., OP. Greenfield, S. Jerome, 31 Lincoln Park, Newark 2, N. J., OP. Greer, Rex E., 203 Fisk Bldg., Amarillo, Texas, ALR. Gros, Jose Conrad, Calle 25 no. 960, Vedado, La Habana, Cuba, ALR. Guida, Francis Paul, 67 Trumbull St., New Haven 10, Conn., OP. Haight, Whitney James, 9 Exchange Place, Salt Lake City 1, Utah, ALR. Harms, Edwin M., 104 W. Douglas St., Wichita 2, Kan., OP. Harper, Donald McCarthy, 1915 New Hampshire Ave., N.W., Washington 9, D. C., ALR. Hatfield, Haskell Doke, 1201 First Na- tional Bldg., El Paso, Texas, ALR. Hathcock, William Caldwell, 402 Grand Theatre Bldg., Atlanta 3, Ga., OP. Heck, Walter Emil, Stanford University Hospital, San Francisco, Calif., ALR. Heller, Morris Freund, 115 E. 61st St., New York 21, N. Y., ALR. Herman, Seymour J., 1601 E. 23rd St., Brooklyn 29, N. Y., ALR. Hirst, William Randolph, 2241 Central Ave., Alameda, Calif., OP. Hoch, Carl William, 2904 Wilbur St., Rockford, Ill., ALR. Hoffman, Franklin David, 626 Union Trust Bldg., Pittsburgh 19, Pa., OP. Hoffman, Parker M., 134 E. First St., Corning, N. Y., OP. Hogg, Stephen P., 556 Doctors' Bldg., Cincinnati 2, Ohio, ALR. Hosner, James Wesley, 255 S. 17th St., Philadelphia 3, Pa., OP. Hull, Forrest Edgar, Tokyo General Hos- pital, APO 1052, c/o PM, San- Fran- cisco, Calif., OP. Huston, James M., 1280 E. 14th St., San Leandro, Calif., ALR. Hynes, Edward Allen, U. S. Naval Acad- emy, Annapolis, Md., OP. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Hyslop, Volney Butman, 769 N. Milwau- kee St., Milwaukee 2, Wis., P1 S. Ittkin, Paul, 5921 Clark St., Montreal, Que., Canada, ALR. Jennings, Edward C., 2650 Wisconsin Ave., Washington 7, D. C., ALR. Kant, Alfred, 129 Clinton St., Watertown, N. Y., OP. Katz, Jacob, 1807 S. Sixth St., Philadel- phia 48, Pa., OP. Keck, William Struble, 122 Main St., Greensburg, Pa., ALR. Kelemen, George, 20 Gloucester St., Bos- ton 15, Mass., ALR. Kennon, William G., Jr., 706 Church St., Nashville 3, Tenn., ALR. Kimmelman, David Brown, 10 Downing St., New York 14, N. Y., OP. Kirsch, Ralph Emile, 903 Huntington Bldg., Miami 32, :Fla., OP. Kirshner, Harold, 20 Park Ave., New York 16, N. Y., OP. Knapp, Philip, University Hospitals, Iowa City, Iowa, OP. Kolodny, George Robert, 702 Hermann Professional Bldg., Houston 5, Texas, OP. Krishna, Ikbal, 1049 E. Washington St., Brownsville, Texas, ALR. Krug, Joseph Hoffmann, 988 Fifth Ave., New York 21, N. Y., OP. Kunkel, William Howard, U.S. Army Hos- pital, Camp Atterbury, Ind., ALR. Lane, Charles Spurgeon, Jr., 205 Mer- chants National Bank Bldg., Smith, Ark., ALR. Lateiner, Robert, 650 Main St., New Rochelle, N. Y., OP. Latella, Peter D., 524 North Ave., New Rochelle, N. Y., ALR. Lauren, George Peter, 205 Medico-Dental Bldg., San Diego 1, Calif., OP. Lavoie, Roland, 3 Claire-Fontaine, Que- bec City, Que., Canada, ALR. Lebo, Charles Phillip, 665 Sutter St., San Francisco 2, Calif., ALR. Lee, Jack Bennett, 607 New Moore Bldg., San Antonio 5, Texas, OP. Lewis, Paul M., 519 N. Highland Ave., Pittsburgh 6, Pa., ALR. Lhotka, Frank M., 6005 Cermak Road, Cicero 50, Ill., OP. Liebman, Sumner David, 115 Bay State Road, Boston 15, Mass., OP. Linden, Arthur Joseph, Shirlington Thea- tre Bldg., Arlington, Va., ALR. Locklin, Walter Kaye, 1410 American Na- tional Bank Bldg., Kalamazoo, Mich., ALR. Loring, Milton Jack, 304 North IN, St.,. Midland, Texas, OP. Love, William Robert, 321 Main St. E., Hamilton, Ont., Canada, ALR. Lovely, David K., 73 Deering St., Port- land 4, Maine, ALR. Lowrey, Austin, Walter Reed Hospital, Washington 12, D. C., O.P. Loy, David Taylor, 3207 W. 16th St., Great Bend, Kan., OP. Luedde, Fullerton Woods, 35 N. Central Ave., St. Louis (Clayton) 5, Mo., OP. Lymberis, Marvin Nicholas, 106 W. Seventh St., Charlotte 2, N. C., OP. MacMillan, Charles Wright, 4 Duryea Road, Upper Montclair, N. J., ALR. Magnet, Isaac Harry, 130 Rock St., Fall River, Mass., ALR. Maloney, Walter Hugh, Green and Coul- ter Sts., Philadelphia 44, Pa., ALR. Mandelbaum, Joseph, 101 Lafayette Ave., Brooklyn 17, N. Y., OP. Mannis, Aaron A., 109 N. Wabash Ave., Chicago 2, Ill., OP. Marshall, Alexander Washington, 145-A Rutledge Ave., Charleston 17, S. C., OP. Mathes, William Thomas, Jr., Jones EENT Hospital, Johnson City, Tenn., ALR. McFarland, James Jerry, 1150 Connecti- cut Ave., N.W., Washington 6, D. C., ALR. McGee, Hugh E., 117 Cedar Lane, Tea- neck, N. J., OP. McGowan, William Louis, Union Central Bldg., Cincinnati 2, Ohio, OP. McKeigue, John E., 94 Pleasant St., Ar- lington, Mass., ALR. Medof, Milton I., 130 S. Robertson Blvd., Beverly Hills, Calif., ALR. Merriam, George Rennell, Jr., 635 W. 165th St., New York 32, N. Y., OP. Merz, Arthur Edgar, 821 Franklin Ave., Garden City, N. Y., OP. Meyer, Eugene A., 427 Cooper St., Cam- den 2, N. J., ALR. Michelson, Robin P., 240 Stockton, San Francisco 8, Calif., ALR. Mietus, Conrad A., 930 Fillmore Ave., Buffalo 11, N. Y., OP. Milanese, Nicholas Peter, 123 E. 83rd St., New York 28, N. Y., ALR. Miller, Jack Barnett, 4212 N.E. Broadway, Portland 13, Ore., ALR. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 ANNUAL BUSINESS MEETING 175 Miller, William Jacob, 21 E. State St., Columbus, Ohio, ALR. Minnes, James Fortin, 1701 W. Broad- way, Vancouver, B. C., Canada, OP. Mishler, Jay Eli, 1616 Pacific Ave., At- lantic City, N. J., OP. Mitchell, Howard Lysle, 103 S. Main St., Lexington, Va., ALR. Montgomery, Earl Clifton, 1620 Medical Arts Bldg., Omaha 2, Neb., ALR. Moore, Ralph Lewis, 509 N. Broad St., Woodbury, N. J., ALR. Moorman, Victor Reuben, Wiley Bldg., Hutchinson, Kan., ALR. Moreland, Joseph Ivan, 2485 Center St., Salem, Ore., OP. Morgenstern, David Jacob, 433 Eastern Parkway, Brooklyn 16, N. Y., ALR. Morrison, Lewis E., 503 Hume Mansur Bldg., Indianapolis 4, Ind., ALR. Moulton, Everett Crockett, Jr., 205 Mer- chants National Bank, Fort Smith, Ark., OP. Mulberger, Robert D., 1930 Chestnut St., Philadelphia 3, Pa., OP. Myers, Roland Horace, 1720 Exchange Bldg., Memphis 3, Tenn., OP. Nakashima, Victor Katsuhiro, Veterans Administration, Des Moines 10, Iowa, ALR. Nickeson, Robert Warren, 179 Allyn St., Hartford 3, Conn., OP. Nisbet, Alfred Alan, 1110 South Texas Bldg., San Antonio, Texas., OP. Noble, Bertha Riveroll, 1430 Tulane Ave., New Orleans 12, La., OP. O'Connell, John D., 50 Farmington Ave., Hartford 5, Conn., OP. Olson, James Albert, Henry Ford Hos- pital, Detroit 2, Mich., OP. O'Neill, John Campbell, 205 W. Second St., Duluth, Minn., OP. Orzac, Edward Seymour, 460 Rockaway Ave., Valley Stream, N. Y., ALR. Parker, Francis William, 1102 Broad- way, Rockford, Ill., OP. Parks, Kirtland Garvin, 605 Professional Bldg., Long Beach 13, Calif., OP. Paul, Thomas Otis, 2205 Highland Ave., Birmingham 5, Ala., OP. Pedersen, Paul Milton, 2241 Central Ave., Alameda, Calif., ALR. Pendexter, Sidney Eugene, Jr., 11 S. Arlington Ave., East Orange, N. J., OP. Perzia, Anthony Peter, 910 Citizens Bldg., Tampa 2, Fla., OP. Peterson, John Hartley, 812 Medical Arts Bldg., Duluth, Minn., OP. Plotke, Harry L., 1058 Lowry Medical Arts Bldg., St. Paul 2, Minn., OP. Pole, Samuel Boyce, III, 401 E. Com- merce St., Bridgeton, N. J., OP. Polisar Ira Allan, 142 Joralemon St., Brooklyn 2, N. Y., ALR. Powell, James Robert, 501 Medico-Dental Bldg., Stockton, Calif., OP. Proctor, Malvin, 66 Main St., Tuckahoe 7, N. Y., OP. Rackwitz, George, 245 E. Broadway, New York 2, N. Y., OP. Rambo, John Henry T., 119 E. 74th St., New York 21, N. Y., ALR, Rea, Robert P., Gorgas Hospital, Ancon, Canal Zone, ALR. Reagan, Daniel Joseph, 507 Main St., Worcester 8, Mass., OP. Reddy, John Bernard, U. S. Naval Hos- pital, Annapolis, Md., ALR. Reitz, Russell E., 446 Linwood Ave., Buffalo 9, N. Y., OP. Reynolds, Garland Alexander, 826 The- mis St., Cape Girardeau, Mo., ALR. Richardson, George S., 201 S. Arno St., Albuquerque, N. M., ALR. Richardson, James Mark, 6306 Cottage Grove Ave., Chicago 37, Ill., OP. Richardson, Oscar B., 880 Bay St., To- ronto 5, Ont., Canada, OP. Rockwell, Albert George, Jr., 300 Homer Ave., Palo Alto, Calif., ALR. Romano, John Emil, 4010 W. Madison, Chicago 24, Ill., ALR. Rooker, Richard W., 423 Walnut Ave., Niagara Falls, N. Y., ALR. Ross, Maurice E., 535-E Grand, Beloit, Wis., ALR. Rothman, Harold, 41 Eastern Parkway, Brooklyn 17, N. Y., OP. Russell, William Marler, New Bank Ashe- ville Bldg., Asheville, N. C., ALR. Ryan, Robert Emmett, 3903 Olive St., St. Louis 8, Mo., ALR. Sacks-Wilner, Erwin Preston, 225 W. State St., Trenton 8, N. J., OP. Sanderson, Bruce A., 2575 E. Eighth St., National City, Calif., ALR. Santamarina, Fernando Garcia, Calle 13 No. 154, entre L y K, Vedado, Havana, Cuba, ALR. Saunders, Joseph Hamilton, 288 S. Lime- stone St., Lexington, Ky., OP. Scheer, Alan Austin, 522 West End Ave., New York 24, N. Y., ALR. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 176 TRANSACTIONS - NOVEMBER - DECEMBER, 1950 Schiff, Maurice, 5459 Diamond St., Phila- delphia 3, Pa., ALR. Schillinger, Robert John, 727 W. Seventh St., Los Angeles 14, Calif., OP. Schuknecht, Harold :F., 950 E. 59th St., Chicago 37, III., ALR. Schutz, William Jack, 672 Francis Bldg., Louisville 2, Ky., OP. Shafer, Donald McKay, 140 E. 64th St., New York 22, N. Y., OP. Shaffer, Robert Nesbit, 490 Post St., San Francisco 2, Calif., OP. Shepherd, Edwin McRae, 1106 Virginia St., Charleston 1, W. Va., OP. Sherman, Henry Knapp, 121 University Place, Pittsburgh 1.3, Pa., ALR. Shier, Julius Milton, 585 Main Ave., Pas- saic, N. J., O.P. Shefstall, William Howard, 300 W. 47th St., Kansas City, Mo., ALR. Simmons,'Frederick H., 520 Whites Ave., Marion, Ind., ALR.. Simses, John P., 144 Golden Hill St., Bridgeport 3, Conn., OP. Skolnik, Emanuel Mitchell, 55 E. Wash- ington St., Chicago 2, Ill., ALR. Smith, Graham Gable, 304 Doctors' Bldg., Minneapolis 2, Minn., ALR. Smith, Hal Waugh, Second & "G" Sts., San Rafael, Calif., ALR. Smith, Joseph George, 490 Post St., San Francisco 2, Calif., OP. Smith, Trent W., 345 E. State St., Co- lumbus, Ohio, ALR. Spencer, James Avery, 135 Monte Vista, Watsonville, Calif., OP. Spencer, James Thomas, Jr., 1112 Vir- ginia St., E., Charleston 1, W. Va., ALR. Spiro, Barbara, 7449 Cottage Grove Ave., Chicago 19, Ill., OP. Springer, Kurt C., 504 Arcade Bldg., Kankakee, Ill., ALR. Stack, David Rodney, Jr., 641 David Whitney Bldg., Detroit 26, Mich., ALR. Stanfiil, James Rose, Medical Dental Cen- ter Bldg., Bellingham, Wash., ALR. Stanfill Charles Mac, Medical Arts Bldg., El Paso, Texas, ALR. Steffensen, Ellis H., Henry Ford Hospital, Detroit 2,, Mich., OP. Steiner, Albert, 1308 Eutaw Place, Balti- more 17, Md., ALR. Stillerman, Manuel Leon, 109 N. Wabash Ave., Chicago 2, Ill., OP. Stone, Vean Melford, 3616 Main St., Riverside, Calif., OP. Stonehill, Alfred A., 6 N. Michigan Ave., Chicago 2, Ill., OP. Stuart, Edwin Alexander, 1390 Sher- brooke St. W., Montreal, Que., Canada, ALR. Sun, Kuei Shu, Box 451, Ames, Iowa, OP. Tabb, Harold Granberry, 1124 Maison Blanche Bldg., New Orleans 16, La., ALR. Taylor, George Dekle, 111 W. Adams St., Jacksonville, Fla., ALR. Teitgen, Ralph Emil, Mayo Clinic, Roches- ter, Minn., OP. Thompson, Floyd Forrest, 1301 N. Broad- way, Santa Ana, Calif., ALR. Thumim, Mark, 121 Main St., Middle- town, Conn., ALR. Tibbetts, Otis Benson, 33 Court St., Au- burn, Maine, OP. Titche, Leon L., Veterans Administration Hospital, Tucson, Ariz., ALR. Trent, Robert Irvine, 708 Medical Arts Bldg., Oklahoma City 2, Okla., OP. Trombetta, Alessandro, U. S. Naval Hos- pital, San Diego 34, Calif., ALR. Trotter, John H., 212 High St., Morgan- town, W. Va., OP. Turley, John C., 899 Madison, Memphis, Tenn., ALR. Ulvestad, Harold S., 202 Doctors' Bldg., Minneapolis 2, Minn., ALR. Underwood, Ernest Arthur, 601 Main St., Vancouver, Wash., OP. Virant, John A., 906 Olive St., St. Louis 1, Mo., ALR. Voorhees, Charles Hammell, 308 College Ave., Elmira, N. Y., OP. Wainstock, Michael Allen, 1508 David Broderick St., Detroit 26, Mich., OP. Walker, Donald H., Dollar Title Bldg., Sharon, Pa., ALR. Walker, James S., 602 W. University Ave., Urbana, Ill., ALR. Waters, Zack James, 220 Camden Ave., Salisbury, Md., ALR. Weih, Jack E., c/o Dr. J. G. Beall, 118,/2 E. Front St., Traverse City, Mich., OP. Weinstein, Francis Saul, 840 S. 11th St., Newark 8, N. J., ALR. Weisman, Edward, 2336 Coney Island Drive, Brooklyn 23, N. Y., OP. Wells, Aubrey Hanson, 400 Hart-Albin Bldg., Billings, Mont., ALR. West, George Brooks, Jr., 9 Race St., Cambridge, Md., ALR. West, Stephen Lewis, 109 W. Main St., Taylorville, Ill., ALR. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 ANNUAL BUSINESS MEETING 177 Westsmith, Richard Alan, 30 S. El Ca- DR. WOODS: The Council recommends the mino Real, San Mateo, Calif., OP. election of the following officers for the year Wexler, Manuel R., 1917 Wilshire Blvd., Los Angeles 5, Calif., ALR. Whitaker, Charles Frederic, 55 E. Wash- ington St., Chicago 2, Ill., ALR. White, Irving Leonard, 812 Pine Ave., Long Beach 13, Calif., ALR. Wiesenthal, Fred, 30-77 36th St., Astoria, N. Y., OP. Wiesinger, Warren Edward, 3022 E. 14th St., Oakland, Calif., ALR. Wolff, Joachim Berthold, 125 E. 84th St., New York 28, N. Y., OP. Wolkowicz, Michal I., 2959 Richmond St., Philadelphia 34, Pa., OP. Wright, Joseph William, Jr., 301 Hume- Mansur Bldg., Indianapolis 4, Ind., ALR. Zurik, Samuel, 3706 Prytania St., New Orleans 12, La., ALR. DR. Woons : The Council has received a request from Dr. Frank J. Costenbader, sec- retary of the American Orthoptic Council, that the Academy publish the papers from the special scientific program of the American Association of Orthoptic Technicians and the American Orthoptic Council, with certain ad- ditional material which is to be reprinted and assembled as the American Orthoptic Journal. The Council recommends the appointment of Dr. Derrick Vail and Dr. W. L. Benedict as a committee to explore the question, with power to act. On motion of Dr. Shea, seconded by Dr. Allen, the recommendation of the Council was approved. DR. Woons : The Council recommends that the so-called Research Fund be renamed "Edu- cational Fund." On motion of Dr. Shea, seconded by Dr. Allen, the recommendation of the Council was accepted. DR. WOODS : The Council was requested to accept the management of a fund to be known as "The Isabella Wilson Research and Edu- cational Fund for Frontal Sinus Pathology," initiated by Dr. Robert II. Fraser of Battle Creek, Michigan. The purpose of this fund is to pay the clerical help in review of case records from the office of Dr. Likely Simpson of Memphis. The Council recommends that this request be accepted. Upon motion by Dr. McCaskey, seconded by Dr. Vail, the recommendation of the Council was accepted. President : Dr. Derrick Vail President-Elect: Dr. James Milton Robb First Vice-President : Dr. Francis E. Le- Jeune Second Vice-President: Dr. Peter Kronfeld Third Vice-President : Dr. Frederick A. Figi Councillor : Dr. John H. Dunnington Executive Secretary-Treasurer : Dr. Wil- liam L. Benedict Secretary for Ophthalmology : Dr. Alger- non B. Reese Secretary for Otolaryngology : Dr. Howard P. House Secretary for Instruction in Ophthalmology: Dr. A. D. Ruedemann Secretary for Instruction in Otolaryngology and Maxillofacial Surgery: Dr. Dean M. Lierle Secretary for Home Study Courses : Dr. Lawrence R. Boies Secretary for Public Relations: Dr. Erling W. Hansen Upon motion by Dr. Mullen, seconded by Dr. Allen, the nominations were closed and the nominations recommended by the Council were accepted. DR. Woons : The Council recommends that the next scientific session of the Academy be held at the Palmer House, Chicago, October 14 to 19, 1951. Upon motion by Dr. McCaskey, seconded by Dr. Vail, the recommendation of the Council was accepted. DR. Woons : The Council recommends the following revision of Article V, Section 6 of the By-Laws : (Following identification of junior Fellows) Inactive Fellows : Senior or junior Fellows who by reason of physical infirmity or retire- ment from practice may, by action of the Council, be classified as "Inactive." Inactive Fellows shall pay no dues, have no voting privileges, and shall not receive the TRANSAC- TIONS. On motion of Dr. Vail, seconded by Dr. Allen, the recommendation of the Council was approved. DR. Woons : I have nothing further to re- port. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 178 TRANSACTIONS - NOVEMBER - DECEMBER, 1950 DR. BROWN: A motion to adopt the entire report is in order. On motion by Dr. Allen, seconded by Dr. Vail, the report of the senior member of the Council was accepted and the recommendations of the Council were approved. New Business DR. BROWN : Is there any new business? DR. BENEDICT : No new business has been presented to this table. DR. ALLEN : Dr. Silva and Dr. Sanchez Bulnes from Mexico City have been sent here as representatives of the Fourth Pan- American Congress of Ophthalmology which is to be held in Mexico City, January 7 to 12, 1952, and they wish to extend a cordial invitation to all members to be present. DR. BROWN : Thank you. Since no other new business was presented, Dr. Brown introduced to the Academy its new President, Dr. Derrick Vail. DR. VAIL : Although you may get sick and tired of hearing me say how much I love the Academy and how much. I have enjoyed work- ing all these years for the Academy and for my friends in the Academy, I feel that I cannot let this occasion go by without reiteraiuig what I have already said. I can promise you that I will do my best to serve you faithfully and that I will do my best to make the regime of my office a success and a pleasurable experience for all of you. Thank you again for the very great honor you have bestowed upon me. DR. BROWN : I should like to present the President-Elect, my old friend James Milton Robb. DR. ROBB : Mr. President and members of this great organization : You have bestowed upon me an abiding honor in naming me President-Elect. I do not know whether any- body who receives this honor ever really feels that he deserves it. It is a great honor, for teaching and education are essential factors in the whole problem of medicine. I accept it with all humility. DR. BROWN : I think we are all grateful to those who have helped make this meeting of the Academy a success, but I personally forgot the Council-men like Dr. Woods, Dr. McCaskey and the others who have done such wonderful work and have helped in every way possible. I want to thank them all for what they have done. The meeting is now adjourned. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 COMMITTEE REPORTS Upon recommendation by the Activities Committee, the Council voted acceptance of the following reports of standing and joint committees. REPORT OF THE ADVISORY COM- MITTEE TO THE REGISTRIES OF PATHOLOGY BRITTAIN F. PAYNE, M.D., Chairman Work on the revision of the Atlases of Oph- thalmology and Otolaryngology has feached a satisfactory stage and it is predicted that both will be published before the Academy meets in 1951. The advisory mission of this Committee will be completed with its meeting October 8, 1950. Final suggestions will be discussed with members of the Armed Forces Institute of Pathology to accelerate publication of the volumes. A report of this meeting will be filed with the secretary of the Academy. Since the Committee has completed its work the Council is respectfully requested to dis- charge it with a letter of appreciation from the secretary. It is suggested that the chair- man of the Committee, representing ophthal- mology, and Dr. Fowler, subchairman for otolaryngology, be retained for administrative purposes until the revision is completed. The advice of former members of the Committee will be asked as the need arises. A tentative agreement has been made with Saunders and Company, through the Secre- tary of the Academy, to publish the Ophthal- mic Atlas. With the exception of three chap- ters, the. text has been written but not com- pletely edited. The illustrations are being ar- ranged and prepared according to the pub- lisher's specifications. The illustrations for the Atlas of Otolaryn- gology are being revised by Dr. Muriel Raum under the direction of Colonel Ash and Dr. Stacy Guild. Her work is most satisfactory but she will need almost another year to com- plete the work, according to Dr. Fowler. Dr. Raum receives $291.67 each month from the Academy. Approximately $5,000.00 will be needed to complete the work on the two Atlases. A brief statement of expenditures for the period from August 31, 1949, to September 1, 1950, follows : Salaries : Dr. Muriel Raum .................... $2,508.32 Mrs. Helen Knight Steward 375.00 Marjorie Davig ........................ 372.48 Margaret M. MacFadyen..... .. 252.22 Incidentals ................................ 143.50 Reports from Colonel Ash and Dr. Hugh D. Grady, Scientific Director, Armed Forces Registries of Pathology, are submitted for the information of the Council. Report of Hugh A. Grady, M.D.: THE AMERICAN REGISTRY OF PATHOLOGY Number of cases December 31, 1949 Registry of Ophthalmic Pathology 28,855 Registry of Otolaryngic Pathology 3,375 During calendar year 1949, 292 cases were deleted from the Otolaryngic Registry and 265 cases were transferred to other Registries. Publications sold during calendar year 1949: Otolaryngic Pathology 181 Ophthalmic Pathology 297 Loan sets used during the calendar year 1949: Ophthalmic Pathology 128 Otolaryngic Pathology 199 REPORT OF THE COMMITTEE ON THE CONSERVATION OF HEARING DEAN M. LIERY.E, M.D., Chairman During the past year the Committee on the Conservation of Hearing of the American Academy of Ophthalmology and Otolaryn- gology held two meetings in Chicago-one during the Academy convention, October 1949, and the other in April 1950. ? The activities of the Committee are as fol- lows : 1. Considerable progress has been made in the research project on noise in industry. We are enclosing a copy of the reports of Dr. Grove, chairman of the subcommittee, and Dr. Wheeler, research investigator, concerning the work that has been accomplished. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 2. A new motion picture scenario on the problem of hearing has been written, but the production has been delayed because of the lack of equipment. 3. The question of unification of hearing organizations was discussed and Dr. Canfield was appointed to make a survey of the eco- nomic need for unification, for which the Audiology Foundation granted the sum of $500. In view of the fact that the Academy's interests are primarily in the field of educa- tion and :research, no definite action has been taken at this time. 4. The committee on the requirements for training of audiologists formulated by-laws for the establishment of an "American Regis- try of Audiometrists" and prepared the "Es- sentials of an Acceptable School for Audiome- trists" which were submitted to the Council on Medical Education and Hospitals of the American Medical Association at the meeting in San Francisco in June 1950. A second hearing before the Council will be held in Cleveland in January 1951. 5. A number of new projects have been outlined and work has been started on the following : a. Manual for the otolaryngologist which will have as its aim, "Raising the Standards of Audiometric Testing and Selection of the Proper Hearing Aid." b. Syllabus on the Testing of Hearing in Young Children. c. Manual for Organization of State and Local Conservation of Hearing pro- grams. d. Revision of the Newhart Syllabus of ministration of a Program for the Audiometric Procedures in the Ad- Conservation of Hearing of School Children. b. Dr. Henry L. Williams of the Mayo Clinic, Rochester, Minn., has been appointed as a new member of the Committee to suc- ceed Dr. Ernest Seydell, who resigned. 7. We feel that marked progress has been made, and the Committee on the Conservation of Hearing respectfully recommends that the American Academy of Ophthalmology and Otolaryngology continue its financial support to the extent of granting $0,000 for the next year in order that Dr. Wheeler may further pursue the research on noise in industry. In addition, $3,000 will be needed for expenses and other activities of the Committee. During the time since the October 1949 meeting of the Committee on the Conservation of Hearing, the work of the subcommittee has been somewhat handicapped by the indisposi- tion of the chairman. Nevertheless, Dr. Doug- las Wheeler has been actively working for the most part on the West Coast in conjunction with Dr. House, with Mr. Cantor of the Surgical Mechanical Supply Company, and with the Navy installations at Terminal Is- land and Mare Island. In conjunction with Mr, Cantor, and also with Dr. Reger, consid- erable work has been done by him on new types of ear defenders both of the ear plug type of obturator and of the ear muff or hel- met type. During the past few weeks Dr. Wheeler has been working in Milwaukee, first with the Chain Belt Company, where a pre- employment hearing testing program has ac- tually been set tip and is in operation, and also with the health and safety department of the Allis Chalmers Manufacturing Company, where such a program is still in contempla- tion. While this program at the Allis Chal- mers Manufacturing Company is not yet in active operation, it has been ordered by the higher-ups, and Dr. Wheeler has been re- quested to return there in June. Dr. Wheeler's salary is being paid by the Academy. His working expenses are being paid by a $5,000 grant from the engineering committee of the Mutual Casualty Association. We hope that these insurance carriers will continue this sup- port for the next few years. A growing interest in the subject of noise and hearing is being advanced by the public as evidenced by articles appearing in the lay press and by inquiries from manufacturers and their agents reaching the office of the chairman and also in the mail of Dr. Wheeler. Our mailing list has expanded from around 1,200 to about 1,700, and in the near future reprints of papers by Dr. Wheeler and Dr. Guild will be mailed out. In February of this year a round table dis- cussion of the subject of noise and hearing was set up by the Council on Industrial Health of the American Medical Association, and at this conference Drs. Wheeler, Hoople, and Guild took part. The American Hearing Society has set aside one afternoon at its next meeting in Chicago in June for a symposium on the subject of industrial deafness on which Dr. Wheeler, Dr. Nash and I will appear. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 COMMITTEE REPORTS 181 A meeting was held by the Subcommittee .on Noise in Industry at the Palmer House, Chicago, Ill., April 30, 1950 at 9:00 a.m. The following were present, Drs. Hoople, House, Guild, Wheeler and Grove. Dr. Guild presented a report of the joint conference held at the Roosevelt Hotel in New York be- tween the Council on Industrial Health of the A.M.A. and the Subcommittee on Noise in Industry at which he acted as a co-chairman together with Dr. James Sterner of Rochester, N. Y., representative of the Council on In- dustrial Health. This report had originally been written by Dr. Sterner and briefly re- vised by Dr. Guild. This report is to be published and the reprints sent out to industrial hygienists all over the country. It should be very good propaganda. Dr. House discussed the possibility of investigation of the produc- tion of sound pictures illustrating the hazards of excessive noise as far as the hearing is concerned, and it was felt that possibly the Union Pacific Railroad or some other large plant employing labor where noise was a hazard might be interested in financing such .a project. It was also suggested by the members of the subcommittee that 'a letter be drafted and sent to the otologists of the country outlining the facts concerning the problem of industrial loss of hearing that should appear in specific reports such as otologists address to insurance carriers. It was believed that at the present time otologists cannot give any positive au- thoritative answers to the question of whether noise has damaged an individual's hearing un- less 1. 2. 3. certain factors are known, such as: The pre-employment status of the hearing The noise level of the individual's job The length of daily exposure to that noise level The total length of exposure to that noise level The protection devices supplied and used The possibility of other factors in opera- tion to reduce the hearing II Dr. Douglas Wheeler has accomplished a great deal on the research work on the West Coast and he has presented the following re- port : At the present time, this Committee has access to organizations representing four di- visions of industry : (a) aircraft production, (b) shipyards, (c) railroads, and (d) fabri- cation of heavy metals. Aircraft Shipyards Lockheed, Douglas Terminal Island North American Mare Island American Helicopter Heavy Metals Railroads Allis Chalmers Union Pacific Chain Belt The Lockheed Company has a well organized hearing conservation program, in which all new employees are routinely checked by au- diometry as part of the initial medical ex- amination and all employees in excessive noise areas are checked every month or oftener, if indicated. These data are available to the Committee. North American is giving us ex- cellent cooperation. In addition to a hearing conservation program similar to that at Lock- heed, this company is welcoming research ; we have an experimental study in progress now, with several more to follow. Recently, arrangements have been concluded with Doug- las Aircraft to begin research and to assist in the development of its conservation pro- gram. American Helicopter, a smaller com- pany, has invited inspection for the purpose of determining the seriousness of its noise prob- lem. The Terminal Island facilities are now largely inactive, although a maintenance staff is still present. The authorities at Mare Is- land have welcomed the work of this Com- mittee and made all facilities available for study. The plan of research originally de- signed for Terminal Island has been trans- ferred to Mare Island and an initial survey of the apprentice group conducted. Dr. House has made arrangements with Union Pacific for a study of noise levels pre- vailing in diesel locomotives under heavy load. This railroad is also interested in noise and hearing problems around its freight yards. Recently two companies in Milwaukee have undertaken a hearing conservation program. Chain Belt has added audiometry to the medi- cal examination of new employees. The Allis Chalmers Company has submitted a proposed program, based on recommendations from this Committee. Their safety engineer hopes to visit Iowa for instruction under Dr. Reger ; he will select and have trained a suitable au- diometrist. Dr. Grove and I expect to visit Allis Chalmers again in June, at which time it is hoped that the program will be under way. This summarizes the locations from which data either are already available or are to be expected in the near future. The evidence from the mailing list indicates, potentially, a Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 182 TRANSACTIONS - NOVEMBER - DECEMBER, 1950 more diversified interest. This Committee has received correspondence from companies rep- resenting the following divisions of industry: steel, farm machinery, chemicals, elevators, automobiles, light metals, arsenals, glass, mining, food packaging, boiler plate and paper refining. In Los Angeles, two agencies have given evidence of interest in the work of this Com- mittee. Aircraft Industries Association, which is composed of management representatives, engineers, and medical directors from the vari- ous aircraft companies on the West Coast, maintains contact with similar companies all over the country. The general purpose of this organization is to share information on com- mon problems, including those involving aero- medical subjects. A division of this Association is the Sub-Committee on Noise and Vibration, a group with which Dr. House and I have met on several occasions. Through this latter agency, we have received important data on noise and vibration in air frames and from motors. Recently, the AIA held a joint con- ference with the Air Materiel Command, at- tended by engineers from every major air- craft company in the country. The conference dealt with noise as a nuisance and a public liability. This Committee was given a place on the program; acting for Dr. House, I de- scribed in general the work of the Committee on Conservation of Hearing through its sub- committee on noise in industry. Aircraft Manufacturers Safety Council is composed of industrial relations officers and safety engineers from the West Coast aircraft industry. In January, I presented the views of the Committee on Conservation of Hearing in a speech before this group; I have been asked to return when additional[ data are released by our Committee. This Committee now has contact with the Aero Medical Laboratory at Wright-Patterson Air Force Base, Dayton, Ohio. The Labora- tory is studying acoustic mufflers and will also take up the matter of ear defenders. Dr. H. 0. Parrask, Chief of the Bio-Acoustic Unit, is prepared to exchange information with this Committee. Correspondence with Mr. L. P. Walters, loss prevention research engineer for Hardware Mutual, indicates that certain companies in- sured by this carrier may be willing to enter- tain research on noise problems. Mr. Walters has mentioned several specific cases. Dr. Grove and I expect to confer with him in June. Through Dr. Grove, I met and talked with Dr. E. G. Meiter, industrial hygiene director for Employers Mutual. Dr. Meiter believes that heavy industry in the Milwaukee area will soon be more receptive to investigation of the noise problem. He would like us to meet with insurance company representatives there and suggests that such a meeting be arranged during June. Predictive Tests A. Administration One experimental form of this test has been administered to apprentices at Terminal Is- land and Mare Island. These groups were selected for four reasons: 1. A sufficient number of normally hearing: subjects could be obtained. 2. These men are studying their trades in a program which offers the possibility of some experimental control. 3. Noise exposure is relatively high. 4. There will be very little turnover among these subjects for at least three years. The results of the test given indicate that more information is needed about the applica- tion of the test principle. The data already collected will continue to be useful, but it ap- pears that their interpretation will depend upon additional data ; these data may best be col- lected under laboratory conditions. A list of the suggested experimental data required is given at the close of this report. B. Laboratory Studies There is a good possibility that the necessary studies can be conducted at the State Univer- sity of Iowa and at the University of Southern California. Dr. Reger and I have discussed the problem at some length; Dr. Charles Light- foot at the University of Southern California is also interested. In all probability, some as- pects of the test development will be improved by application of the subject-controlled au- diometer. Dr. Reger has designs for such an audiometer; a somewhat different form may be made available by the Allison Laboratories in Los Angeles. Ear Defenders The work on ear defenders may arbitrarily be divided into research and development. A. Research A good deal o f attention has been given to the study of basic materials and technics for occluding the ear. Some of this work has already been reported before this Committee. Because unusual difficulty has been encountered in creating effective occlusion, the possibility arose that some alternate pathway might be present, by-passing the obstruction in, around, Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 COMMITTEE REPORTS 183 or over the meatus. One such pathway might be the eustachian tube. I spent several days at the Walter Reed General Hospital in Wash- ington, and while there Dr. Aram Glorig and I attempted to measure the relative efficiency of the eustachian canal in air conduction. The results of our work indicate that the eustachian pathway is probably not important to the prob- lem of occlusion. The study of basic materials and technics has, as yet, disclosed no essentially new prin- ciples. In general, it may be said that the best occlusion measured to date was obtained by a technic difficult to apply practically. It also appears that the effect of mass as factor in occlusion must be re-evaluated. B. Development Board of Secretaries meeting on May 28, both of which I attended. Immediately after the meeting of the Pro- gram Committee in January, application forms were sent out to prospective exhibitors. Twenty-four exhibits were accepted for this year's Scientific Exhibit. A diagram showing the layout of the en- tire Scientific Exhibit was prepared, and printed copies of the layout were ordered through the Academy office. A copy of this diagram was sent to each exhibitor along with a letter of acceptance under date of June 1. Information regarding these exhibits was for- warded to the Academy office for publication purposes. Eight of the applications for exhibits re- ceived were not considered. Eight additional applications for exhibits, while regarded as worth while, were received too late for con- sideration and allotment of space and are to be carried over for consideration by the Committee on Scientific Exhibit for the 1951 meeting: The objectives in development of an im- proved car defender are still, as previously reported, comfort, effectiveness, and low cost. It has been possible to improve ear effective- ness of the standard SMR plug, as will be shown. A new design, however, produces bet- ter occlusion and is aimed at meeting some of the objections brought against plugs. Research Data Required for Predictive Test Physical-the exposure stimulus and conditions a. Simple b. Complex c. Length of exposure d. Level of exposure e. Continuous or repeated exposure Psychological-subject response measures a. The critical frequency or frequencies b. The rate of onset of threshold shift c. Maximum shift in decibels required d. Rate of recovery Problems-to be resolved by application of above data a. The optimum choice among the above variables b. Reliability of selected measures on nor- mal ears When these facts have been satisfactorily de- termined, the test may be standardized on a sample of unexposed (nonindustrial) normal ears. Validation still depends upon application in the industrial situation. REPORT OF THE COMMITTEE ON SCIENTIFIC EXHIBIT KENNETH L. ROPER, M.D., Chairman I was invited to attend the meeting of the Program Committee which met in Chicago on January 14 and 15, 1950, and also the REPORT OF COMMITTEE ON STANDARDIZATION OF TONOMETERS JONAS S. FRIEDENWALD, M.D., Chairman Testing Stations Three testing stations have continued in operation during the past year, directed re- spectively by Drs. Posner, Kronfeld, and Harrington. The statistical summary of their activities is given in Table I. Certification of Tononaeters Certification of tonometers by the Electrical Testing Laboratories, Inc., has been continued. Two hundred and sixty instruments were test- ed and certified during the year July 1, 1949 to June 30, 1950. During the past year arrangements for the certification of the new model Gradle tonome- ter have been worked out and a calibration scale for this instrument supplied to the manu- facturers. Special Investigations Work on the basic calibration of tonometers, on the effect of general anesthesia on tonome- try, and on the calibration of tonometers for buphthalmic and microphthalmic eyes is con- tinuing. Exhibits An exhibit on the methods used in stand- ardization of tonometers was prepared for the Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Pan-American Conference on Ophthalmology in Miami and a more extensive exhibit was presented to the International Congress of Ophthalmology in London in July. International Standardization of Tonometers' Your Committee has recommended to the Concilium Ophthalmologicum consideration of the formulation of internationally acceptable standards for tonometers and has offered its assistance in working out the technical details. TABLE I TONOMETERS SUBMITTED TO TESTING STATIONS July 1, 1949 - June 30, 1950 1 N W O TESTING W I a W ? I 4 W STATION Pt ' N a a A a V z z a m H a t F a Dr. Kronfeld Chicago 188 165 9 14 Dr. Harrington San Francisco 28 2 16 2 8 Dr. Posner New York 98 3 75 12 EXPENSES July 1, 1949 - June 30, 1950 Testing Stations : San Francisco ...................................... 184.00 New York ....... ............................. --...... 260.16 Part Time Secretary and Technician 460.00 Office Expenses .......... ..................--------- . 22.54 Miscellaneous .................. ...----...--------- ..-. 10.00 REPORT OF THE COMMITTEE ON THE PREVENTION OF BLINDNESS RALPH I. LLOYD, M.D., Chairman Our function is to cooperate with the Na- tional Society for Prevention of Blindness and do what we can to further efforts along the lines of prevention. The first question coming before us was whether penicillin should be recommended to take the place of silver ni- trate instillations at birth. Dr. Post and I felt that the time had not yet conic when a change- over from a reliable method should be made. Dr. Woods felt otherwise. Dr. Post and I felt that there should be a lot more evidence available before we could approve of laying aside a method which had reduced blindness due to ophthalmia neonatorum to a neglible quantity. The National Society for the Prevention of Blindness held a three-day conference in New York City which the committee had endorsed and to which a subscription of $150 was recommended to the Council. I attended the conference and spoke on behalf of the Academy. I represented the Academy at the meeting of the Lions Club of New York where scholar- ships for courses in ophthalmology were a- warded. This is an annual custom started by Mr. Fryxell of Halpert & Fryxell, opticians. The courses are given by the New York Uni- versity Post-Graduate Medical School under Dr. Braley. I also attended the meeting of the New York Society for Service to the Blind, where the Megil medal was awarded Miss Grace Harper of the New York State Department of the Blind. REPORT OF THE COMMITTEE FOR THE STUDY OF AUDIO-VISUAL INSTRUCTION DEAN M. LIERLE, M.D., Chairman This Committee has had no meeting since the 1949 Academy convention. There was no busi- ness pending; consequently, there is no report. REPORT OF THE ADVISORY COM- MITTEE TO THE EYE HEALTH COM- MITTEE OF THE AMERICAN STUDENT HEALTH ASSOCIATION LAWRENCE T. POST, M.D. Academy Representative There is no report from the Eye Health Committee of the American Student Health Association as there was no meeting of this committee. REPORT OF THE AMERICAN ASSO- CIATION FOR THE ADVANCEMENT OF SCIENCE M. ELLIOTT RANDOLPH, M.D. Academy Representative In my capacity as representative of the Academy to the American Association for the Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Y COMMITTEE REPORTS 185 Advancement of Science, this is to notify you that during the year 1949-1950, I have been in contact with the Administrative Secretary of the Association. The minutes of the meet- ing of the Council have been carefully re- viewed and your representative feels that there are no matters of sufficient significance to be brought before the Academy. REPORT OF THE AMERICAN BOARD OF OPHTHALMOLOGY ALCERNON B. REESE, M.D. Academy Representative Since the last meeting of the Academy, two examinations were held by the Board: St. Louis, October 18-22, 1949, and Boston, May 22-26, 1950. A third examination will be held before the next meeting of the Academy, and this will be in Chicago, October 2-6, 1950. At the St. Louis examination, there were 85 candidates and of these 51 passed, 27 condition- ed, and 7 failed. At the Boston examination, there were 149 candidates of which 98 passed, 49 were conditioned, and 2 failed. A written qualifying test was held on Janu- ary 13 and 14, 1950, at various places through- out the country. Three hundred thirty-nine candidates took the examination, and of these 151 passed, 141 were conditioned, and 44 failed. The Board is most grateful for the splendid help of many members of our specialty who have served as associate examiners. Their service is, of course, indispensable and the sacrifice they make is appreciated. Also, the cooperation of the staffs of the institutions at which the examinations are conducted is great- ly appreciated. The officers for 1950 are: chairman, Dr. Algernon B. Reese, New York; vice-chair- man, Dr. John H. Dunnington, New York; secretary-treasurer, Dr. Edwin B. Dunphy, Boston. The examinations scheduled for the future are San Francisco, March 12-16, 1951 ; New York, May 31, 1951, and Chicago, October 1951 at the time of the Academy meeting. A new directory listing all diplomates was issued January 1, 1950. To those who have purchased this directory, the annual supple- ments are sent gratis. At the Boston meeting, Dr. James H. Allen of New Orleans, La., was elected to the Board as representative from the Section on Oph- thalmology of the American Medical Asso- ciation to serve until December 31, 1954. During the fiscal year ending April 30, 1950, 273 applications have been received. The total number of certificates issued to date by the Board is 3,035. REPORT OF TIIE AMERICAN BOARD OF OTOLARYNGOLOGY CARL II. MCCASKEY, M.D. Academy Representative During the past year the Board has issued a booklet of information stating the required qualifications of candidates for examination. It was necessary to hold one extra examina- tion in 1950 to care for a part of the large backlog of applicants who have applied for examination. The following is a report on the examina- tions held during 1949 and 1950, with the re- sults of each : 1. 84 examined, 19 per cent failures and con- ditions, Chicago, Illinois, October 4-7, 1949. 2. 76 examined, 12 per cent failures and con- ditions, New Orleans, Louisiana, January 8-11, 1950. 3. 79 examined, 28 per cent failures and con- ditions, San Francisco, California, May 16- 19, 1950. The average percentage of failures and conditions was 193/3. The next examination will be held in Chi- cago, October 2-7, 1950. REPORT OF AMERICAN COMMITTEE ON OPTICS AND VISUAL PHYSIOLOGY ALFRED COWAN, M.D. Academy Representative During the past year, the various subcom- mittees have been active. The Committee on the Standardization of Instruments is attempt- ing to establish standards for the development of new ophthalmic equipment. It has been the experience of the .American Committee on Op- tics and Visual Physiology that when standards are established by manufacturers without gui- dance, they are often faulty and difficult to modify. Also, they are often accompanied by misleading advertising. The Committee is es- pecially concerned about the rather careless way in which ophthalmologists purchase and use instruments for the application of beta radiation, with no further idea of their po- Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 186 TRANSACTIONS -- NOVEMBER - DECEMBER, 1950 tency than the salesman's word or an unveri- fied statement of the manufacturer. This subcommittee is encouraging several other types of research on new instruments, e.g., the development or suitable polaroid vec- tographs for use with standard visual acuity projectors to aid in determination of the status of the fusion mechanism in routine examina- tions. A study is being made in the Clinic at the University of Oregon Medical School to de- termine the suitability of fluorescent .germici- dal units for darkroom lighting and the pre- vention of the spread of communicable dis- eases in ophthalmologists' offices. It has been called to the attention of the sub- committee that there is need for develop- ment of several types of apparatus, e.g., an improved haploscopic device which will permit the use of bigger and opaque targets with better control of interpupillary distances and a lessened sensation of nearness than is possi- ble with the presently available major amblyo- scopes. It is felt by this subcommittee that the American Committee on Optics and Visual Physiology can serve an important purpose by fostering this type of research and encouraging the development in ophthalmology of 'more laboratories suitably equipped with optical and electrical equipment to conduct research in visual physiology. At present this type of research is being conducted in only a few clinics and medical schools. Another subcommittee is still working on the contact lens problems. Not only the scien- tific, but the commercial and the medicolegal aspects are being discussed at length, so that a valuable contribution may be made. The recommendations made by this subcommittee, which have already been presented, seem ex- cellent suggestions for regulating the pre- scribing and fitting of contact lenses. I f their intent is carefully followed, even if controlling legislation is not forthcoming, there should be a minimum of danger to the patient and there is a good possibility of continuing improvement in these lenses through well directed research. The National Society for the Prevention of Blindness has sponsored a visual screening test of 1239 school children in the first and sixth grades of public schools in Saint Louis, which has been completed. This investiga- tion was made for the purpose of evaluating the various rival methods proposed for screen- ing school children. The data have been col- lected and are being subjected to statistical study, upon completion of which and approval by the Committee they will be published. The Committee on Research in Visual Acuity in Myopia has continued the myopia training project and in the last 27 subjects examined, the time element in assessing visual acuity has been introduced, which should help us in the final evaluation of that method of training. All orthoptic training and manipulation of the eyes has been purposely avoided in the hope of assessing the value of that training in which the speed of perception is stressed. In the last group trained, all subjects showed im- proved visual acuity at the end of the train- ing period, but it is our belief that a sufficient number of controls is not yet available so that final analysis of the data obtained should not yet be made. We have evidence that the myopia is not changed. In conclusion, the Committee believes that the problem presented commonly requires ex- tensive research and that this often has to be done by outside workers. The Committee recommends that sufficient funds be made available by the parent societies so that these needed studies may be made under the direct supervision of the Committee and more scien- tific answers may be obtained. REPORT OF THE AMERICAN ORTHOPTIC COUNCIL KENNETH C. SWAN, M.D. Academy Representative The fifteenth annual meeting of the Ameri- can Orthoptic Council was held in Chicago on October 8, 1949, with Drs. Swan, Campion and Costenbader representing the American Academy of Ophthalmology and Otolaryn- gology. The outstanding activity of importance for 1949 was the conducting of the second annual Council-sponsored didactic course for orth- optic technicians under the leadership of Dr. Walter B. Lancaster, with the assistance of some of the lecturers and instructors who helped with the 1948 course. This was held in Boston with an enrollment of 20 students. It is hoped that if. the demand for centralized, intensive didactic instruction in orthoptics con- tinues, such courses may become an annual event. The course for 1950 is coming along apace and will be held in Boston again for nine weeks during July and August. The American Orthoptic Council would commend the American Association of Orthop- tic Technicians for their increased activities during the past year : the technicians arranged a most attractive booth among the exhibits of Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 COMMITTEE REPORTS 187 the American Academy of Ophthalmology and Otolaryngology. The Association has estab- lished annual meetings of each of four re- gions, Western, Midwestern, Southern and Northeastern. The programs of these regional meetings were participated in by ophthalmolo- gists and technicians, the programs being of great interest and doing a great deal toward improving the information level of orthoptics. During the past year certain additional .activities interested the American Orthoptic Council : 1. The annual symposium for ophthalmolo- gists and technicians was held at the time of the Academy meetings. The speakers were Dr. Edwin F. Tait, Dr. Robert Hill, and Miss Marjorie Enos. Discussers were Dr. Michel Loutfallah, Miss Electra Healy and Mrs. Louisa Wells Kramer. 2. The following new members were elected to the Council: Dr. Frank D. Costenbader from the Ameri- can Academy of Ophthalmology and Otolaryngology Dr. Walter H. Fink from the American Ophthalmological Society Dr. Beulah Cushman from the American Ophthalmological Society (to fill the unexpired term of Dr. Derrick Vail, who resigned) Dr. LeGrand H. Hardy from the Section of Ophthalmology, American Medical Association Dr. Alston Callahan from the American College of Surgeons The associate member (technician) elected by the Council was Miss' Dorothy Bair. 3. Through the combined efforts of the American Association of Orthoptic Tech- nicians, the American Academy of Oph- thalmology and Otolaryngology, and the American Orthoptic Council, instruction courses were made available to the tech- nicians and were well -attended at the time of the Academy meetings. 4. The Council would again call to the at- tention of the American Academy of Oph- thalmology and Otolaryngology the gener- ous scholarship offered by the Delta Gam- ma sorority to help train orthoptic techni- cians and instructors for the blind. These scholarships have been quite helpful to in- dividual students. The following officers of the American Orthoptic Council were elected in October 1949: president, Dr. Walter B. Lancaster; vice-president, Dr. Richard G. Scobec; secre- tary-treasurer, Dr. Frank D. Costenbadcr. Your committee respectfully recommends : 1. That the American Academy of Ophthal- mology and Otolaryngology continue its sponsorship of the American Orthoptic Council, and that it appoint Dr. Kenneth C. Swan for a period of three years. 2. That the American Academy of Ophthal- mology and Otolaryngology continue its fi- nancial support of the American Orthoptic Council to the extent of $200 for 1950-51. The expenses of the Council have material- ly increased with the establishment of the annual training course. REPORT OF THE CONSULTATIVE PANEL ON TUMOR TERMINOLOGY OF THE AMERICAN SOCIETY OF CLINICAL PATHOLOGISTS JOHN S. McGAVIC, M.D. Academy Representative I regret to report that the Consultative Panel on Tumor Terminology of the American So- ciety of Clinical Pathologists has taken no action during the past year. REPORT OF THE HELMHOLTZ CENTENARY COMMITTEE F. BRUCE FRALICK, M.D., Chairman The Academy's Helmholtz Centenary Com- mittee has had no formal meeting during the past year. We have had no correspondence from Dr. Burton Chance referable to any further assistance which we might be to him. Since Dr. Chance and his committee from the American Ophthalmological Society initiated this program, it was felt that they should be the leaders and that we should be ready to serve in an advisory capacity or to help them in any way they might suggest. I have again contacted all of our Commit- tee members and they have no further sug- gestions to offer other than those which they have transmitted to Dr. Chance in the past year. REPORT ON THE INTERNATIONAL ORGANIZATION AGAINST TRACHOMA R. TOWNLEY PATON, M.D. Academy Representative The International Organization against Trachoma was founded officially by the Thir- Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 188 TRANSACTIONS -NOVEMBER - DECEMBER, 1950 teenth International Congress of Ophthalmol- ogy in 1929. It provides meetings at which all matters connected with trachoma may be dis- cussed. It was my privilege to attend the last meet- ing as official delegate from the United States of America. This meeting was held in Lon- don on Wednesday, July 19, as part of the program of the Sixteenth International Cong- ress of Ophthalmology. The opening paper on "The Initial Signs of Trachoma" was given by the President of the Society, Dr. A. F. Mac- Callan, and he was introduced by Dr. Sedan. A general discussion followed and then a tium- her of papers were given on the newer methods of treating trachoma. Perhaps the most in- teresting of these papers was given by Dr. Ta- hone of Malta, who reviewed Dr. Alson E. Braley's experiences in the use of aureomycin in treating trachoma and then gave his re- sults. His results confirmed those of other workers in this field, although he remarked that trachoma in the Mediterranean did not re- spond so dramatically as had been reported by many previous workers. He summed up his experiences by saying that aureomycin is per- haps the most effective drug in trachoma so far if given in adequate doses. He used aureo- mycin locally and systemically and feels that probably a combination of both methods shows the best response. Dr. Tabone was inclined to treat trachoma- tous patients for periods of five days, and cau- tioned that many patients might require three or four five-day courses of treatment before showing optimum results. He also mentioned that results should not be looked for in less than two weeks, although in many cases im- provement subjectively and objectively was dramatic early in the course of treatment. Locally he has employed aureomycin borate instillations as well as aureomycin ointment; more surprising still, he has used 0.5 per cent solution aureomycin hydrochloride without significant signs of irritation. In administer- ing aureomycin by mouth, he felt that a close of 500 mg. three times a day should he em- ployed. The papers and discussions confirmed Dr. Maxwell Lyons' observation. Dr. Lyons has used aureomycin locally and systemically as well as a combination of the two methods. He left little doubt in the minds of his list- eners that aureomycin is effective in the treat- ment of trachoma. While he is not ready to give a final opinion, he feels that aureomycin by mouth may be just as effective as the com- bined administration of the antibiotic. The dosage he employed locally was the instilla- tion of 0.5 per cent solution hourly during the morning hours and again before the patient went to sleep ; when administering aureomycin systemically, he prescribed 50 mg. per kilogram per clay, divided into two doses. Dr. Lyons continued treatment for a period of about ten clays. It was my good fortune after leaving Lon- don to go to Iran and set up an extensive trachoma control program for the country. One city we visited, Dizfoul, had apopulation of 60,000 persons. The local eye doctor said that 90 per cent of the population had had trachoma or were in the active stages of the disease. During a two-hour ramble about the city many persons, young and old, were stopped on the street, and everyone had evidence of trachoma as far as one could tell in a cursory examination. A method extensively used in Iran in the treatment of trachoma is electrocoagulation. The native doctors who use this method claim that not only are the follicles completely de- stroyed with a minimum of scar tissue for- mation, but that the current penetrates the lids and kills the virus. This method of treating trachoma did not meet with the general ap- proval of ophthalmologists at the London Con- ference. Electrocoagulation for the treatment of trachoma is an old method, but it is being kept alive in Iran, as the technic is taught to all medical students. After personal observa- tion on several hundred cases, I could only see that coagulation did destroy the follicles and was an easy method for mass treatment. Each and every case after coagulation also re- ceived a liberal swabbing of copper sulfate solution. Anyone interested in keeping abreast of the latest developments in the field of trachoma should subscribe to La Revue International dti Trachome. Articles by members may be sent to the editor, Dr. Sedan, 94 Rue Sylvabelle, Marseille. Membership in the Organization is by annual subscription of thirty shillings ster- ling. REPORT OF JOINT COMMITTEE ON INDUSTRIAL OPHTHALMOLOGY A. D. RuEDEMANN, Chairman The three main objectives of the work of the Joint Committee continue to follow along the lines of research, education and service to industry. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 COMMITTEE REPORTS 189 TRANSACTIONS of the American Academy of Ophthalmology and Otolaryngology Important papers on industrial eye prob- lems of interest to members of the profession continue to be a feature of the Section on In- dustrial Ophthalmology of each issue. Much interest has been stimulated through this me- dium and reprints of the articles published have been requested by medical directors, nurses, safety and personnel directors of industry. Bibliography The bibliography on industrial eye subjects to date contain approximately 3000 references and is enlarged continually in the office of the secretary. Reference material is available at all times upon request and is published cur- rently in the TRANSACTIONS. Kodachrome Slides (2 x 2) A library of lantern slides for lecture pur- poses is being accumulated. A limited number of duplicate slides is already available for loan- ing purposes. Consultation Services Considerable correspondence is carried on by the secretary in response to requests for information in the handling of various prob- lems which have to do with injuries, path- ology, medicolegal, testing programs, illumina- tion and safety eye wear. The requests come from home and abroad and any unusual prob- lems are referred to recognized authorities in their respective fields. Dr. Andrew C. Ivy, vice-president of the University of Illinois School of Medicine; Col. Victor A. Byrnes, and Dr. Hedwig S. Kuhn, secretary of the Committee, will speak at a special scientific program during the Academy meeting. The general subject to he discussed will be "Eyes and Disaster." Research 1. Development of a thesis on emergency, eye care in disaster. 2. A survey of second injury funds in the 48 states in which the National Society for the Prevention of Blindness and the Pan- American Association of Ophthalmology are especially interested. 3. An attempt is being made to evaluate the opportunities for industrial rehabilitation of the blind and to work out a practical plan whereby the ophthalmologist may be better equipped to assist in this important work. The secretary and another member of the Joint Committee are serving on the Armed Services N. R. C. Vision Committee, a con- tact which has enriched our awareness of in- dustrial problems considerably. A panel program was arranged by the secre- tary for the American Association of Indus- trial Physicians and Surgeons during their annual convention in April, 1950. During the past twelve months, the Joint Committee worked directly with the optical companies in an effort to ensure ethical and efficient methods of distributing their products. Much of the work of publicizing the Manual on Toxic Eye Hazards was handled by the Committee through the secretary's office and the response to the 2500 direct contacts made with ophthalmologists, medical directors and public health officials was very gratifying. The work of the Committee has been aug- mented by the generous increase in the grants from the Council of Industrial Health of the American Medical Association and the Ameri- can Academy of Ophthalmology and Otolaryn- gology. This will make possible a wider field of opportunity for the projects that are now under way and those being formulated. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 190 TRANSACTIONS - NOVEMBER - DECEMBER, 1950 Financial Statement : Joint Committee on Industrial Ophthalmology September 20, 1950 Balance, Aug. 16, 1949 -------------------------------------------------------------------------------------------------- $ 25.00 Receipts : Council on Industrial Health, American Medical Association .... ............... ..... 500.00 American Academy of Ophthalmology and Otolaryngology -------------------__-_ 500.00 Sale of Manuals on Toxic Eye Hazards .......... .:............... -_____. 7.00 $1,032.00? Disbursements : Secretarial, Convention, October 1949 ---------------------------------------------------------------- 45.36 Toxic Eye Hazards Manuals on hand ---- _--------------------------- _...... _------------------------ 21.00 Clerical help, mimeographing and postage, Blind Project _ ...................... 51.00 Postage -----------------------------------------------------------------------------------__---------------------------------- 203.64 Plastic mountings for magnifying lens ------------------------------------------------------------ 66.45 Reprints ------------------------------------------------------------------------------...--------------------- 47.25 Subscription to industrial publications for English contacts ........................ 50.00 Negatives made from charts for publication (Dr. Peterson's article) .__- 15.00 Lantern slides ------- ----------------------------- ------- ------------ ------- ------- -------- -............ ------ ------- 14.99 Bank service charges .......... .............................................. .--------- .......... ..------- -....... 1.76 Sallye Rosenberg (Gift for Dr. Ivy) ................................................................ 78.80 Expense of Dr. Rieke to American Association of Industrial Physicians and Surgeons, April 1950 .................................. .------------ .....-... 248.63 Balance, Sept. 20, 1950 $843.88 ----------------------------------------- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -------------------...--- 188.12 12 DIRECTORY OF EYE, EAR, NOSE AND THROAT SOCIETIES Secretaries of all eye and/or ear, nose, and throat societies - inter- national, national, regional, state, and local - are requested to aid the Academy in keeping up-to-date the Directory of Ophthalmologic and Otolaryngolic Societies, a regular feature of the TRANSACTIONS. Please supply us with the following information: Name of society (write out in full) . Names of current officers (president and secretary or corresponding offices) . When elections become effective. Place of meeting (exact if known, or supply to this office when available) . Date of meeting (exact if known, or monthly, bimonthly, October through May, etc.) . Send to: W. L. Benedict, M.D., 100 First Ave. Bldg., Rochester, Minn. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 It INDUSTRIAL OPHTHALMOLOGY MEDICAL CIVIL DEFENSE: THE BACKGROUND ANDREW C. IVY, M.D. CHICAGO, ILL. MAN of you know that the Ameri- can Medical Association and the state and city medical societies each have had a committee on civil defense for four or five years. The medical profession re- alized at the close of the war,'and it still realizes, that this country is vulnerable to atomic attack-to a bacterial warfare and chemical warfare-and it has only been in recent years that other people have developed the same opinion. After the close of the war, I belonged to a group in the city of Chicago which talked about the potential hazards of the atomic bomb used by direct attack or used through the medium of sabotage. We should not forget that it is easy to assemble parts of an atomic bomb, which may then be set to go off at a certain time without being detected. All the makings can be brought in a box and the only way one can find out the con- tents is to open the box. We not only have to think of that as a possibility but also have to realize that a plane-guided missile or sabotage can result in disaster. The United States Armed Forces warn us that we can expect an attack by any means at any time. A little over a year ago the mayor of Chicago became concerned over a pos- sible attack on Chicago, for he felt Chi- cago or any near city would be a stra- tegic target. He then sent a directive to several groups, and one to the Commis- sioner of Health, Dr, Bundesen, to or- Vice President, University of Illinois School of Medicine. Presented at the meeting of the Joint Committee on Industrial Ophthalmology, Oct. 10, 1950, Chicago, Ill. ganize against and prepare for any sort of disaster that might strike Chicago, particularly one that might result from warfare. Dr. Bundeson called together representatives of the medical profes- sion, scientific, chemical and other groups, who had had experience during World War II with atomic and chemi- cal warfare. This constituted the Gen- eral Committee, and I happened to be selected chairman. In my response to Dr. Bundesen I wrote that I was in favor of the Committee and that I felt it was worthy and in line with my basic general philosophy-to work and hope for the best but to be prepared for the worst. That is the spirit and motive of the people working in the Chicago Emergency Medical Service, one of five divisions. Of the entire civil defense organiza- tion with all its divisions, the Public Health Division has the greatest respon- sibility in that it has to deal with the human beings living in the attack area. This Committee took as its objective, after studying the problem thoroughly, a plan to decrease the deaths among the nonfatal casualties by 75 per cent. Some- thing can be done about an atomic attack in the densely populated city of Chi- cago. I can prove to you that, by work- ing together and educating and training the public to cooperate with the medical profession, we can achieve that goal. Those two basic conditions are absolute- ly necessary. We first set up a committee to de- velop technics to cover all the problems that might arise from an attack on the city of Chicago. In a catastrophe of this sort, one cannot, outside of hospital practice, permit any variation in the type of treatment given. In the first place, there are not enough physicians Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 192 TRANSACTIONS - NOVEMBER - DECEMBER, 1950 to go around-so we have to get optom- etrists, chiropodists, biochemical stu- dents, dental students, pharmacy stu- dents, and so on, who have some knowl- edge of human anatomy. We have to prepare specific instructions to be given in the training of this personnel. We also will have to train close to 5000 adult lay persons who will become roving first aid teams and who for the first time will be administering drugs such as mor- phine. Many people don't like to do it; we have to do a number of things we don't like to do. This instruction will be given under Red Cross to first aid classes by the doctors assigned by vari- ous branches of the Chicago Medical Society. Specific instructions will be outlined as to the sort: of treatment to be given by the roving first aid team, col- lecting stations, and hospitals. In the third place, we have to be very specific and definite about the treatment that will be required in order that the neces- sary supplies will be available. One can- not get together all varieties of supplies to take care of various ailments as is generally considered good medical prac- tice. Instead, one must get together basic materials to be put in medical warehouses. Many of these have to be found in the community in which you live. We have a committee surveying the city of Chicago to find out where the medical supplies are, as we may have an atomic attack before we can stockpile gauze, bandages, etc. The Council appointed committees consisting of leading medical persons in the city of Chicago ; these committees have drawn up rules for treatment and have outlined exactly what is to be done at each of the several locations. In the same way, we have asked a small group of ophthalmologists who have had in- dustrial experience to serve as our ad- visers, and we are relying on this group to classify eye injuries, to decide what is to be done by assistants, and to de- termine what cases should be sent to the operating sections. Again one has to be very specific in the instructions is- sued. When the report of the joint Committee on Industrial Ophthalmology comes in, our Emergency Committee will meet to consider it and to adopt it as policy. It will then be taken before the Chicago Medical Society to be adopted there. In this way we can avoid the confusion that would come as a re- sult of one doctor stating that burns should be treated in a certain way, while another may in a newspaper item rec- ommend another method. All this would be confusing to the public-something we have to avoid. Medical units consisting of a roving first aid team will be organized under the leadership of a physician and stir- geon. For those positions we shall select doctors who have had experience in front line combat and who will not be subject to the draft. Records of all cas- ualties will be kept ; in the city of Chicago the accountants are taking over the responsibility of keeping records in first aid and collecting stations. Finally, there must be managers. For those positions we are selecting presidents and executive vice-presidents living at the edge of town who, because of their in- itiative and resourcefulness, can best organize the first aid stations to be located at the street intersections at the two mile bomb perimeter-i.e., two miles away from the zone of explosion. We will have 340 first aid stations with 88 members on each team, including a carpenter. When we run out of splint material, a carpenter will take over to make splints and, as the need arises, forage lumber from sides of houses or garages. We will need 600 casualty stations with an average bed capacity of 300 each to take care of the approximately 180,000 casualties. For this we will use public schools, hotels, bowling alleys, Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 INDUSTRIAL OPHTHALMOLOGY 193 etc. The professional personnel of the Chicago Society of Anesthetists will have to train 6000 people to give and draw blood. The drug stores will be manned twenty-four hours a clay by one or two pharmacists at each store. The rest of the pharmacists will be part of the general pool. The hospitals are now setting up an emergency organization. They will be staffed. by a surgeon, assistant surgeon, anesthetist and an aide-all to be on an 18- to 24-hour schedule. Two sets of in- struments are to be provided so that one may be in use when the other is being sterilized. We have organized the hospi- tals on the basis of seniority-the doc- tors and nurses not needed on the basic teams will become a part of the general pool. There will be refugee camps where simple fracture cases can be sent, as well. as those suffering from simple burns and all those who have been ex- posed to radiation after they have been decontaminated. Blood counts will be taken in every case in which there has been exposure to radiation. The last units are the outlying hospi- tals-within a radius of forty miles of Chicago. These hospitals will also un- dergo emergency organization, making it their responsibilty to see that the houses in the hospital area are evacu- ated to provide more space. For casualties requiring skilled sur- gery, we will need 28,000 hospital beds in Chicago, and we have asked that double the capacity be provided, using beds in nurses homes and nearby houses. If there is an attack in the Loop, the first aid collecting station teams will move in, with or without instructions by radio. The chief at each first aid station will have the job of sorting-if the in- dividual is contaminated by radiation and injured he goes to one area, if con- taminated and uninjured to another, etc. In that way we will be able to han- dle within six hours the 180,000 people who will come out of the bombed area. This is the World War II principle of getting the wounded in early and sort- ing them. Forty per cent of our doctors will be drafted. The registered nurses in Chi- cago will have to train 32,000 nurses' aides in an eighty-hour course. In this program the ophthalmologist must take care of all surgical cases. The minor eye injuries will have to be cared. for by lay persons who have been instructed in regard to treatment and taught to recog- nize cases that should be referred for more professional care. DISASTER STRIKES - WHAT HAPPENS? COL. VICTOR A. IBYRNES (MC) RANDOLPII FIELD, TEXAS TILE importance of vision in our highly complex civilization can hardly be overemphasized. The loss of vision is a more serious handicap to the indi- vidual than is the loss of many other abilities. The eye is a very critical organ inso- far as prompt, proper care following in- jury is concerned. An injury, which if treated early will give complete restora- tion of sight, may easily result in loss of the eyeball if treatment is delayed. Improper early care of eye injuries by well meaning friends may also cause the loss of an eye for a patient in spite of the best later efforts of a skilled oph- thalmologist. While the eye makes up only a small portion of the body, its relative injury rate will be high in proportion to its to- Presented at the meeting of the Joint Committee on Industrial Ophthalmology, Oct. 10, 1950, Chicago, 111. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 194 TRANSACTIONS -- NOVEMBER - DECEMBER, 1950 tal exposed area. This is true, of course, because a wound or foreign body in the eye can be a serious injury, while the same wound or foreign body would be an insignificant injury almost anywhere else on the body. It is for these reasons that a program for care of injured eyes in the event of disaster should be formulated. No pro- gram can be initiated, however, until the situation expected to exist following a disaster is evaluated. One must know (1) what type of eye injuries will oc- cur, (2) how many eye injuries there will be, (3) who will be available to treat the eye injuries, and (4) what fa- cilities will be available for use (fig. 1). OIS i TE PLANNING"", L WHAT KIND Ol: INJURIES , 2 'HOW MANY INJURIES >.3..? 3 . ' CAN TREAT THEM 4. WITH WHAT ... FIG. 1-Necessary information for planning care of any type of casualties. The types of eye injuries will depend somewhat upon the type of disaster which occurs. Such disasters can be ex- plosions within factories, or they can be larger industrial explosions of the Tex- as City, Texas, or Amboy, New Jersey, type. Finally, they can be due to bom- bardment by an unfriendly nation using either high explosives or the atomic type of bombs. To be prepared adequately for an emergency one must be prepared for the most severe disaster which is at all likely to occur. One is then prepared for any eventuality and anything less than the most severe type can be prop- erly handled. Since the nuclear, fission type of bomb represents the most severe disaster that could occur, any program for eye care should be geared to a dis- aster of this magnitude. F. CASUALTY PRODUCING EFFECTS ,O EXPLOSION I. BLAST EFFECTS,: LONG: WAVE RADIATION 3. SHORT WAVE RADIATION FIG. 2-Casualties produced by any type of ex- plosion are due to one or more of the above factors. If one considers the factors in ex- plosions which produce injuries (fig. 2), they can be considered under the fol- lowing headings : 1. Effects of Blast (present in all types of explosions) a. Direct blast effects on the eye b. Secondary effects produced by falling buildings and scattered de- bris c. Displacement effects by which in- dividuals are thrown violently against other objects 2. Effects of Long Wave Radiation (heat, including visible and ultravio- let light-present in some degree in all types of explosions) a. Flash burns, the direct effect of the radiant energy produced by the explosion b. Secondary effects produced by fires started by the explosion 3. Effects of Short Wave Radiation (gamma rays, alpha rays, beta par- ticles and neutrons-present only in the atomic type of explosion) Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 INDUSTRIAL OPHTHALMOLOGY 195 .Injuries Due to Short Wave Radiation Let us consider the last named head- ing first-injuries due to short-wave ra- diation. This is the principal factor in an atomic explosion which differentiates it from other explosions. Cogan, Martin and Kimura2 stated that at Nagasaki and Hiroshima it produced the follow- ing effects in the eyes of some of the ex- posed population : 1. Keratoconjunctivitis with mucopur- ulent discharge one to three days af- ter exposure. (Probably due to ultraviolet radiation.) 2. Keratitis coming on three to four weeks after exposure. 3. Retinal complications of radiation sickness occurring 10 to 14 days af- ter exposure. 4. Radiation cataracts coming on in a matter of years after exposure. y , leaves, then, the same characteristics as their primary interest the effects of for all explosions except for a differ- short-wave radiation on the eyes. They ence in degree. Explosions produce were not designed to study the thermal acute eye injuries through two mocha and traumatic effects. Flick3 was prob- nisms-heat and blast. ably the first American to study these One other point with regard to radia casualties and he states : tion should be mentioned. It has to do with residual radiation in the bombed There were large numbers of patients ex- area and its effects on rescue personnel. hibiting facial burns of the ordinary type with dense cicatrix. These burns in ,some instances If an atomic bomb were exploded in the involved the conjunctiva and. cornea to such air (its position of maximum effective- an extent that the red, inflamed, lacrimating Hess), the residual radiation after the eyeball had only slight movement and seemed first minute or two would be well within set in a dense mass of contracting scar. tolerance limits. It would be perfectly He also stated concerning mechani- safe for rescue parties to enter these cal injuries: It is quite obvious that none of these lesions require any emergency eye care at the time of a disaster. For purposes of this discussion we can, therefore, ignore this group of symptoms. This bombed areas insofar as radiation is concerned. Heat and Blast Effects With radiation eliminated from con- sideration in the immediate postexplo- sion period, the discussion can be nar- rowed to the heat and blast effects. It would be very desirable to know the to- tal number of casualties which would be produced by an atomic explosion, the percentage of this total which would be eye casualties, and the percentage of these eye casualties which would require definitive care. We would further like to know how many would be burned as compared with how many would have traumatic injuries. Unfortunately, figures on these points are not readily available. In almost all disasters there is such disruption of ac- tivities that adequate medical records are not kept. This was true of most of the bombing raids on the continent of Europe in World War H. It is also re- grettable for this study that accurate figures on the Hiroshima and Nagasaki atomic bomb explosions are not avail- able. This is true because the chaos that existed following the bombing prevented any accurate study. Even the total num- bers of people injured or killed have only been estimated. These estimated totals may vary as much as 30,000. Then, studies which were made had earl too Among those noted were penetrating in- juries of the globe, leucoma of the cornea, traumatic cataract, various lid deformities, de- tachment of the retina, and various syndromes involving fractures of the skull and walls of the bony orbit. Many ambulatory casualties' were ~ecn in the streets wearing eye patches. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 196 TRANSACTIONS - NO VEMIBER - DECEMBER, 1950 Drs. David Cogan, S. Forrest Martin and Samuel J. Kilnura2 conducted an ophthalmologic survc~ of atomic bomb survivors in Japan in 1949. .They as- sumed their task was "(1) ... to de- termine qualitatively, by history and ex- amination, whether or not ocular le- sions, other than traumatic, resulted from the atomic bombing...." The Japanese investigators, Tamura, tkui, Nakano, I_tiwatashi and Oshio,d,7 Hirose,4 and Shoji,' reported similar findings. In no instance did they attempt to estimate the total number of eve cas- ualties or the percentage of serious eye injuries in relationship to total eye in- juries. They, too, were mostly interested in the radiation effects on the eye and the fundus changes which occurred as a result of radiation sickness in the indi- vidual. Tamura and his associates made the point that the injuries clue to blast effects are essentially the same as other bombardment injuries. The burns of the eyelids were in general not as severe as burns on the faces of the individuals. Perhaps the height of the explosion, plus the oriental type of eyelids, was re- sponsible for this fact. Burns of the cornea and conjunctiva were present but not as frequently as might be ex- pected. They tended to heal with only slight scars. These authors made one very significant notation. They stated that of foreign bodies in the eyes, the most frequent one was window glass. When one considers the relatively great- er amount of window glass present in homes in American cities, this particu- lar factor becomes very important. Because of the lack of available sta- tistical data and because the same fac- tors are operative (though in different intensities), an estimate of probable casualties was attempted by a study of 2. SECONDARY BURNS I. COWUStON OF TIC GLOBE 4. LAMRATION OP TPE GLOW { LOS 5. INIRAQOt1L.AR lE16N BOMES rrT E OF 1N kRIESI 1 FLASH 6URNS FIG. 3-The types of injuries of the eye which comprise practically all the eye casualties produced by explosions. In the event of disaster from any type of explosion the following types of in- j. uries require consideration (fig. 3) : Flash burns of the eyelids and eye- hall (high intensity infra-red, visible light, and ultraviolet radiation) Secondary burns due to fires started by the explosion Contusions of the globe Lacerations of the globe and lids Intraocular and intraorhital foreign bodies In order to get statistics on the inci- dence of injuries in smaller comparable catastrophes, the Texas City disaster of April 1947 was reviewed. Mocker and Blocked have made a tabulation of cas- ualties, which is shown in figure 4. disasters for which. more accurate fig- Texas City disaster. (From locker and 131.,ker.1) Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 TEXAS OtrY SEVERE INJURI HOSPCfALtZ 1 l i FIG. 5-The number of severe eye injuries in com- parison with total eye injuries in the Texas City disaster. In this series, 30.9 per cent of the eye injuries were severe (fig. 5).' If only the 38 severe eye lesions were included in the 800 hospitalized, they make up 4,75 per cent of all hospitalizations. It is probable that more than this were in- cluded, thus raising the percentage of hospital beds required for eye patients. It will be noted that eye injuries rank fourth in the number of severe lesions requiring hospitalization. The total of the slightly injured is as- sumed to be half way between the 3000 to 4000 figure quoted above, or a total of 3500. Add to this the 800 hospitalized patients, and. we have a total injured group of 4300 people. The total number ,of eye injuries was 123. Thus 2.8 per cent of all individuals injured had eye injuries (fig. 6). In considering only the severe eye injuries we find that 0.87 per FIG. 6-The total number of eye injuries in com- parison with total of all injuries. FIG. 7-The number of severe eye injuries in com- parison with the total number of severely injured persons. cent of all individuals injured were in this category, If the 800 hospitalized cases can be considered to be the serious nonfatal cases, then severe eye lesions make up 4.75 per cent of such seriously injured individuals (fig. 7). Dr. Gaynelle Robertson of Texas City was kind enough to review the records of all eye patients she could find who were injured in the Texas City disaster. Her review showed the totals for these eye injuries were: Mild or inadequately recorded ................78 Lacerations ---------------------------------------------------- 3 Burns ------------- ---------------------------------------------- 8 Loss of eye (1 bilateral) ----------------------------11 Concussion of eye (1 bilateral) ------------10 Severe lid or orbital injuries (2 bilateral) ---------------------------------------------16 Penetrating wounds of eyeball with glass or other foreign body (5 bilateral) . ......... ----- ------------------------26 Foreign body in orbit ------- ................. 4 Damage to optic nerve ..... -..---_------------------- 2 Loss of sight, one eye-no details ..-.....-... 2 Severe bilateral injuries ............................10 Mild bilateral injuries ...... ................ .--------- 5 Total with at least 1 severe eye injury----44 Her analysis showed that 44 out of 138 cases had at least one severe eye condition, a percentage of 31.8 per cent of all eye cases. The British made a very careful sur- vey of their casualties occurring in air raids. Their results showed that 7 per Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 ORDER - OF FREQUEN FIG. 8--The order of frequency of severe injuries incurred in the aerial bombardment of London. cent of the serious nonfatal casualties had severe eye injuries. Nearly one- third of these had other serious injuries. Eye injuries were the fourth most com- mon cause of serious injury (fig. 8). They found that 2.7 per cent of all air raid casualties had eye injuries. Types of eye injury found in this Brit- ish study were as follows: Per- cent- age Foreign bodies in the conjunctival sac-_-31 Lacerations of cornea, sclera and iris ----17 Abrasions of cornea ---_--_------ ---............ ---_-_-12 Subconjunctival hemorrhages --------- .----- ---12 Conjunctivitis -------------------------------------------- 6 Hemorrhage in vitreous chamber --- ------ 5 Blast effects (not serious) ------- ----------- ------ 3 FIG. 9-The direct causes of the eye injuries in- curred by the population of London under aerial bombardment. The causes of these eye injuries are shown in figure 9. [n the later bombardment experience with parachute mines and flying bombs, the incidence of eye injuries was higher, being 11.7 per cent of hospital casual- ties. They took for a planning figure a total of 10 per cent of hospitalized cas- tialties to be eye cases. It is interesting to note the similarity in the incidence of eye injuries in the Texas City disaster and in the British .reports (fig. 10). SERIOUSLY; WOUNDED `; WITH ,SEVERE INJURIES FIG. to-A comparison between the British boin- bardment figures and the Texas City disaster figures. It is also interesting to note the higher incidence of eye injuries reported in the later study on the more powerful bombs - the parachute mines and the flying bombs. This same trend would be ex- pected. with the even more powerful atomic bombs. These figures cannot be directly ap- plied to the prediction of the incidence of atomic bomb casualties, but there are two things about them which are impor- tant. They are essentially injuries due to blast effect since the thermal effect of high explosives is not great. Secondly,. they are the type of casualties produced in individuals living in essentially the same types of buildings as those in which we live. For estimation of casual- ties which might occur here, these fig- ures should be useful. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 ' INDUSTRIAL OPHTHALMOLOGY 199 Estimation of Eye Casualties In an Atomic Raid The British have informed their peo- ple in the newspapers that if an atom bomb struck one of their large cities they would expect not less than 50,000 casualties. While the Japanese experience is not entirely comparable, we can get a great deal of information from a study of the atomic bomb blast of- Hiroshima. Most of the Japanese buildings are flimsier than ours. On the other hand, their bet- ter earthquake-proof buildings are stronger than most of our buildings. Their cities have a great deal less glass than American cities. The numbers giv- en in figure 11 indicate the casualties they received from one of the early weaker atomic bombs.`' POPULATION DE PER SQUARE MILE , FIG. 11-Estimated casualties produced by the atom- ic bombing of Hiroshima. Characteristics of the Atomic Bomb Which Must Be Considered In Casualty Estimation HEAT PRODUCED: BY ATOMIC BOMB: FIG. 12-Heat produced by the explosion of an atomic bomb. It has been estimated that the bomb burst at Hiroshima released 21 billion calories. and that the temperature at the core of the explosion was 126,000,000 F. (fig. 12). Even as far away as three-fourths of a mile the temperature for a fraction of a second was 2,100 F., which is hot enough to blister tile on roofs. This heat is due to the production of infra-red radiation, which travels at the speed of light. At Hiroshima it produced severe generalized burns at a distance of 7,000 feet. This amount of heat existed for only a fraction of a second, and cloth- ing and the shelter of a building or wall were sufficient protection from it. These direct radiation burns, however, were very severe in unprotected. skin. Direct- ly under the blast, skin was charred brown and black by the heat. Serious third degree burns occurred out to 4,500 feet. The available literature does not show the percentage of eye and eyelid burns which one would expect, though Flick3 mentions severe burns as stated above. A factor of importance is the protection afforded by the orbital ridges diation effects of and the film of moisture on the cornea. The short wave ra an atomic blast have already been dis- It is known that about 40 per cent of cussed and will not be further consid- the casualties had flash burns produced ered here. The relative amount of heat by infra-red radiation, or had ordinary produced is greater than with other thermal burns produced by fires. The bombs. A higher percentage of casual- exact incidence of eye burns, however, ties will be due to the heat than is true cannot be estimated because there are with high explosive bombs. In the bomb no figures available for Hiroshima and burst at Hiroshima it is estimated that no comparable figures in other explo- 21 billion calories of heat were released sions. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 FIG. 13--The damage and destruction caused by the explosion of the bomb at Hiroshima, which oc- current at an attitude of 1,500 feet, Blast Effect The blast lasted about one second, It was not sharp, but was very strong. It didn't punch holes in buildings. It was much more apt to push them over. Of the 90,000 buildings in Hiroshima, 62,- 000 were destroyed (fig. 13). The blast produced flying glass up to 15,000 feet. Although it produced a relatively small group of casualties by direct effect, it produced many by displacement of peo- ple, flying missiles, falling debris, etc. About 40 per cent of the injuries were produced by these forces, although some authorities estimate as high as 70 per cent. The number of casualties which would be produced in. an American city would depend upon the time of day the attack occurred. This would in turn de- termine the population density in the area attacked and whether or not indi- viduals were in or outside of buildings. In some of our larger cities population density is as high as 145,000 per square mile in the daytime. This may drop to less than 50 per cent of this figure at night. By comparison the population density of Hiroshima was 35,000 per square mile. The Hiroshima bomb de- stroyed 4.7 square miles. Various newspaper estimates of cas- ualties in an American city in event of an atomic attack vary fr'om 50,000 killed TRANSACTIONS - NOVEMBER - DECEIMIBER, 1950 r,rt r - t r INJUP1IES 837 1,863 MILD EYE WARES FIG. 14-Planning figures for estimating the num- ber of eye injuries which might be produced in all atomic bomb explosion in an American city. and 50,000 injured to 150,000 killed and 150,000 injured. Suppose, for example, we take the middle figure of 100,000 dead and 100,000 injured (fig. 14). The injured is the group with which we would be concerned. Applying the Brit- ish and the Texas City figures, we know that of this number 2.7 per cent, at least, will have some eye injury due to blast. Of these 2,700 eye injuries, about 31 per cent will be seriously injured, giving a total of 837 severe and 1,863 mild eye blast injuries. The total flash and secondary burn cases would be ap- proximately 40,000, of which at least 10 per cent would probably have burns involving the eyelids or eyeballs re- quiring some type of treatment (fig. 15). The number of these who would be severely burned cannot at this time be FIG. 15-Planning figures which might be used in estimating eye injuries produced by beat. These are admittedly only guesses since no accurate figures are available. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 INDUSTRIAL OPHTHALMOLOGY 201 estimated. A total estimate is made, then, of 4,000 eyelid and eye burns requiring varying amounts of treatment. Factors in Planning Care of Eye Casualties Now suppose we are faced with this staggering total 'number of casualties. Who and what will be available to care for them? atoms ens FIG. 16--Casualties which occurred in professional personnel at Hiroshima. Personnel for care of casualties. The number of doctors and nurses would depend upon the time of day the explo- sion occurred. A higher percentage would probably be injured in a daytime attack on the heart of a city than at night. In Hiroshima, of about 250 doc- tors, 90 per cent were casualties and only 30 were able to work at the end of 30 (lays (fig. 16). There were 1,780 nurses in Hiro- shima before the bombardment. Of these, 1,654 were killed or injured (89 per cent casualties). This means, then, that personnel normally present to care for eye patients would not be available. Hospital facilities. Iiroshima had 45 hospitals. Only three were left usable. Those within 3,000 feet were totally de- stroyed, Two were 5,000 feet away. They were of reinforced concrete con- struction and had 90 per cent casual- ties because of falling plaster, flying glass and fire. They could not be used for a long time. Hospitals between 7,000 and 10,000 feet distant were badly dam- aged and had many casualties. Other facilities. In an atomic explo- sion, facilities other than hospitals would also be of immediate concern. Fires would break out immediately, over a large area. Streets would be damaged, destroyed, choked with refugees trying to get out of the area, or blocked by fire. Telephone and other communication services would be interrupted. Electric power would not be available. The water supply would be cut off. At Hiroshima there were 70,000 breaks in the water supply system. The sewage system would also probably be destroyed. SUMMARY To summarize, then, the problem of proper eye care in the event of atomic attack : 1. There may be 100,000 total casual- ties with about 837 severely injured eye cases, 1,863 mildly, injured eye cases, and 4,000 burned eye and eye- lid cases of undetermined severity requiring immediate eye attention. 2. About 90 per cent of the ophthal- 111ologists and eye 'nurses would themselves be casualties and, there- fore, unable to help. 3. Hospitals within 3 miles would be incapable of being utilized. Their medical supplies would be destroyed in most instances. 4. Fires and falling buildings would be present in the damaged area, with streets blocked and filled with burn- ing debris. 5. Electricity, water, food, communica- tion and sewer systems would be damaged or destroyed. 6. It would be safe so far as residual radiation is concerned for rescue crews to enter the area if it was an air burst. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Any plan for the care of eye injuries which does not take into consideration these factors would be inadequate. The ideal treatment for eye injuries probab- ly cannot be administered. The treat- ment which will accomplish the most for the largest number of cases in the hands of general practitioners and first aid personnel is probably the one that will do the greatest amount of good in the event of an atomic attack. If a good plan can be formulated for eye care it should result in better final vision for a larger number of people in the event of any future disaster. 1. Blocker, Virginia and Blocker, T. G., Jr.: The Texas City disaster : a survey of 3,000 casualties, Ani. J. Surg., 78:756-771 (Nov.) 1949. EMERGENCY EYE CARE IN DISASTER: THE LAYMAN WHO PRECEDES US HEDWIG S. KUHN, M.D. HAMMOND, IND. COLONEL Byrnes has shown us that our concern with injured eyes in case of disaster (atomic or explosive) is mainly to be focused on the care of (1) burns-flash (which here means infra-red, ultraviolet and high intensity visible light) as well as burns from fire itself, (2) contusions and lacerations, (3) removal of foreign bodies, and (4) intraocular foreign bodies. Radia- tion as we think of it in this connection does not immediately concern the eyes. Its effects appear days, weeks, or even years after the disaster as keratitis or radiation cataract. 2. Cogan, P. G., Martin, S. F. and Kimura, S. J.: Ophthalmologic survey of atomic bomb survivors in Japan (an ABCC sur- vey), November 1949. 3. Flick, John J.: Ocular lesions following the atomic bombing of Hiroshima and Naga- saki, Atn. J. Oplith., 31:137-154 (Feb.) 1948. 4. Hirose, K.: Ocular lesions in atomic bomb disease in Nagasaki, Kurme Igakkai Zos- shi, 42:26, 1946. 5. Shoji, Y.: Ocular injuries by air attacks, Gnaka, Y.: Ocular injuries by air attacks, 6. Tamura, S., Ikui, H., Nakano, K., Hiwa- tashi, R. and Oshio, S.: Injuries of the eyes by the atomic bomb : clinical observa- tion Gnaka, Rinsho Iho, 40:90-99, 1946. 7. Tamura, S., Ikui, H.,, Nakano, K. and Oshio, S.: Patho-histological examination of the injuries of the eyes in atomic bomb disaster (radiation sickness). To be pub- listed in Gnaka, Rinsho Ilto. In Texas City almost all eye injuries occurred to office workers or business people watching the fire from behind windows and not wearing eye protec- tive equipment; therefore, only 5 per cent of all injuries were eye injuries. In Britain (luring the blitz, as Colonel Byrnes' figures show, between 7 and 11 per cent of cases of serious injuries were eye injuries. If we use the low fig- ure of 100,000 serious casualties in any major city where an atomic explosion occurs and use 10 per cent as the num- ber having serious eye injuries, we have 10,000 serious eye injury cases on hand! This reiteration is necessary because we cannot realize the magnitude of these numbers. They remain fantastic and be- yond comprehension. Dr. Ivy has been hammering the "facts of life" into aca- demic heads for many weary months. Here, in brief, is the procedure: Presented at the meeting of the Joint Committee on Industrial Ophthalmology, Oct. 10, 1950, Chicago, Ill. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 INDUSTRIAL OPHTHALMOLOGY 203 Advance Roving First Aid Teams 1. Fill eye with t Y2 per cent pontocaine in 1 to 3000 zephiran (packaging not yet decided on) 2. Tear a piece of sterile cloth from roll carried on back of first aid man and cover eye 3. Pain of an eye injury (other than burns) is not great, therefore hypo- dermic injection of morphine is not necessary. First Aid Collecting Station 1. Cases of severe lacerations, perfora- tions and obviously badly tratima- tized eyes a. In laceration of lids, leave same bandage on and send to the rear. 1). Casualties with severe injuries of the globe should be sent to the rear as stretcher cases if at all possible. Bandage lightly if neces- sary. c. Tag everyone who has not al- ready received preventive tetanus antitoxin so as to be sure that it is given at the next station. d. If sliver of foreign matter (glass, metal or wood) extends from eye, do not touch. Close eye with band- age and send to rear. 2. Burns in any one of the three 'cate- gories (thermal, ultraviolet or chemical) a. Anesthetize again if necessary with pontocaine-zephiran solution. b. Insert hydrosulphosol (made up in new gelatin capsule form). c. Close securely with pressure ban- dage. d. Hypodermic injection of morphine if necessary. 3. Foreign bodies a. If on cornea, anesthetize (same solution of pontocaine and zephiran). b. To remove foreign body use ap- plicator wound with cotton or closest substitute available. c. If very deep, close eye with some sort of patch and send to rear. Casualty Station (may or may not have ophthalmologist) 1. Careful inspection of eye a. To further separate serious eye injuries overlooked in panic b. To pick up any unrecognized dam- age c. Lay personnel to use following findings as guides to serious dam- age: Severe pain in cases that are not burn cases Change in size or shape of pupil Blood in anterior chamber Protrusion of tissue of interior of eye 2. Treat and re-dress external eye burns, if necessary, with hydrosul- phosol as used in collecting stations. 3. Dress minor lid lacerations 4. It is important to accept the use of medication approved by local com- munity civil medical defense com- mittee without argument or regard for personal preference. Disaster forces a condition resembling war; therefore we take orders just like in the Army. Hospitals here is where the ophthalmologist takes over, but we must ever realize that we are still with limited means-a minimum selection of instruments, re- duced supply of dressings, and a sharp- ly reduced number of assistants. Our part, therefore, as ophthalmologists can be described as follows : 1. To assist directors of local (or re- gional) civil medical defense organ- izations ; to implement and formu- Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 204 TR.,ANSACTIONS--NOVDM131?R-DECEMBER, 1950 late the programs they set up with much more "give" than "take." a. Accept previously agreed upon medication b. Accept approved collecting station technics c_. Accept approved casualty station procedures d. Accommodate to hospital needs 2. Assist those agencies set up to teach and train not only first aid but also self help, which is the one construc- tive good thing about this whole catastrophe defense effort. a. Write simple instruction sheet to be inserted into loose leaf manual to be used by Red Cross and other citizens for teaching purposes. b. Accept teaching assignments when asked or, better, volunteer. c. Have ready now your own sepa- rate bag with all you need to work with for use at casualty station or at hospital so that you need not stand around and wait for some- one to 'bring you instruments or supplies. d. Offer your help and time now. This whole gigantic potenial task is real and staggering, but it has been proved that (1) we can erect safeguards and prevent human destruction and hu- man agony; (2) we can as physicians save lives and prevent permanent in- jury to legs, arms, and heads; (3) we can as ophthalmologists set up a proper- ly trained lay "chain of command" and gear ourselves to the task of saving eves also. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 News Notes SECTION MEETINGS OF THE AMERICAN LARYNGOLOGICAL, RHINOLOGICAL AND OTOLOGICAL SOCIETY, INC. The section meetings of the American Laryngological, Rhinological and Otologi- cal Society, Inc., will be held in January 1951. The Eastern Section will hold its meet- ing on Friday, January 12, in the Belle- vue-Stratford Hotel, Philadelphia. The meeting of the Middle Section will be held in the Hotel Cleveland, Cleveland, Ohio, on January 15. The Southern Section will meet at the Hotel Sans Souci, Miami Beach, Fla., on January 17. The Western Section meeting will be held January 27 and 28 at the San Fran- cisco County Medical Society Building, 2180 Washington Street, San Francisco. AMERICAN ORTHOPTIC COUNCIL The American Orthoptic Council will present its fourth annual intensive course in Orthoptics in Boston from July 5, 1951 through Aug. 31, 1951. Tuition is $150.00. The course is designed to pre- sent the necessary basic didactic instruc- tion for students together with some prac- tical instruction in order to prepare the student to complete a course of practical training and experience offered at various orthoptic centers over the country. The Council will make an effort to see that all students enrolled in the course have places to complete their practical training following the course. Applicants must be at least 18 years of age, have had a high school education and be sponsored by an ophthalmologist. A few scholar- ships are available to students from the Delta Gamma Fraternity Project. In- quiries and applications should be ad- dressed to the American Orthoptic Coun- cil, Dr. Richard G. Scobee, 640 S. Kings- highway, St. Louis 10; Mo. ASSOCIATION FOR RESEARCH IN OPHTHALMOLOGY The third annual meeting of the Mid- west Section of the Association for Re- search in Ophthalmology will be held at the University Hospitals, Iowa City, Iowa, on Monday, March 19, 1951. The pro- gram will consist of the presentation of scientific papers. On the two days following the meeting, a symposium on "External Diseases of the Eye" will be presented by the Depart- ment of Ophthalmology, University of Iowa. DELTA GAMMA FRATERNITY PROJECT: SIGHT CONSERVATION AND AID TO THE BLIND The Delta Gamma Fraternity has a $1,500 annual fund and a $2,000 revolv- ing loan fund from which smaller scholarship awards are available to those intending to become (1) orthoptic tech- nicians, (2) teachers of partially seeing children, or (3) specialists for blind pre- school children. Anyone wishing to specialize in one of these fields may be eligible for assistance, the amount in each case to be determined by the particular need and costs involved. For further in- formation write to Mrs. Thomas Johnson, 1235 Longfellow, Detroit 2, Mich. Applications for scholarships should be filed four months prior to the start of the desired course. Applicants with basic preparation in teaching, nursing, social work, nursery education, or related fields are eligible to apply. The scholarships are intended only for the courses directly relating to the field of sight conservation and aid to the blind. Candidates are se- lected with the advice of a professional committee which has as chairman, Dr. LeGrand H. Hardy of the American Orthoptic Council. THE ISABELLA WILSON RESEARCH AND EDUCATIONAL FUND FOR FRONTAL SINUS PATHOLOGY The American Academy of Ophthal- mology and Otolaryngology has accepted the management of a special fund to be known as "The Isabella Wilson Research and Educational Fund for Frontal Sinus Pathology," initiated by Dr. Robert H. Fraser of Battle Creek, Mich. The pur- Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 XXVI TRANSACTIONS - NOVEMBER - DECEMBER, 1950 pose of this fund is to pay the clerical help in review of case records from the office of Dr. Likely Simpson of Memphis, Tenn. The estate of Miss Isabella Wilson has contributed $250.00 to this fund, and contributions of not over $10.00 will be accepted from interested physicians and others. OXFORD OPHTIIALMOLOGICAL CONGRESS The next meeting of the Oxford Oph- thalmological Congress will be held in Ox- ford, July 5-7, 1951. The Doyne Lecture will be delivered by Dr. John Foster of Leeds. The two main discussions will be "Ophthalmology and :Psychosomatic Medi- cine" and "The Modern Treatment of Retinal Detachment." Inquiries should be addressed to Dr. Ian C. Fraser, Honorary Secretary, 12 St. John's Hill, Shrewsbury, Shropshire. DISTRICT OF COLUMBIA An exhibit honoring Hermann von Helmholtz, the inventor of the ophthal- moscope, will be displayed under the auspices of the Medical Museum of the Armed Forces Institute of Pathology and the Army Medical Library in the Armed Forces Medical Museum at Ninth and In- dependence Avenue, S. W., for six months beginning Dec. 17, 1950. This date marks the hundredth anniver- sary of Helmholtz' letter to his father de- scribing the instrument which was to enable doctors to see the interior of the human eye for the first time. The Museum's extensive and compre- hensive collection of' ophthalmoscopes, which illustrates the development from the Helmholtz drawings to the modern electrified instrument, will be on display. Included will be the famous Dr. von Graefe's first instrument made by Sydow from the original drawing and given to the Medical Museum by Dr. Harry Fried- enwald just before his death in the spring of 1950. A rare Perrin three-dimensional oph- thalmic atlas will also be on display. It was designed and manufactured about 1870 and extensively used at that early period to train students in ophthalmos- copy. Only three of these instruments are known to exist in this country. The Army Medical Library has loaned many of the books to be shown. Included are many rare volumes, some of them s found in the United States only at the Army Medical Library. Especially note- worthy in this respect are a Russian and two Japanese atlases of ophthalmoscopy, as well as the first printed illustration of the fundus of the eye, prepared by A. C. van Trigt for use in his doctoral dis- sertation soon after Helmholtz' report was made known, and the only published atlas of stereoscopic paintings of the fun- dus. A large number of contemporary American and foreign atlases will also be displayed. ILLINOIS The Chicago Laryngological society held its first meeting of the season Nov. 6, 1950. The program was given by mem- bers of the department of otolaryngology of the Cook County Hospital in Chicago. It consisted of "Tracheotomy in Tetanus," by Drs. Emanuel Herzon and Edwin Killian; "Otogenic Intracranial Complica- tions," by Drs. John Elsen, Elmer A. Friedman, and Norman Leshin; "Sar- coma of the External Auditory Meatus: Case Report," by Dr. Hans Von Leden; "Some Newer Surgical Considerations in Atrophic Rhinitis: Report of Work in Progress," by Drs. Maurice H. Cottle, Jack Allan Weiss, Edward F. Pottorff, and Emanuel Herzon. The Chicago Ophthalmological Society held its regular meeting Nov. 20, 1950. At the afternoon session an instruction hour on "Orthoptics" was conducted by Miss Priscilla Allen, and a clinical pro- gram was presented by the departments of ophthalmology of Michael Reese and Mt. Sinai hospitals. The scientific program in the evening included "Report on the 16th International Congress of Ophthalmol- ogy," by Dr. Derrick Vail; "Optical Com- ponents of the Eye in Relation to Ame- tropia and Aniseikonia," by Dr. William F. Moncreiff; and "Macular Changes in Children from Maternal Rubella," by Dr. Samuel S. Blankstein. Dr. Paul Hurwitz has been appointed to the faculty of the Chicago Medical School as assistant professor of ophthal- mology. The regular monthly meeting of the Chicago Laryngological and Otological Society was held Dec. 4, 1950. The pro- Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 NEWS NOTES XXVII gram consisted of "Experimental Studies of Negative Pressure Produced by Res- piratory Cilia," by Dr. John J. Ballenger, department of otolaryngology, North- western University; and "Surgical Treat- ment of Carcinoma of the Esophagus," by Dr. Charles B. Puestow, department of surgery, University of Illinois. KANSAS Dr. William L. Benedict of Rochester, Minn., delivered the second E. J. Curran Lecture in Ophthalmology at the Univer- sity of Kansas School of Medicine on De- cember 14, 1950. His subject was "Dif- ferential Diagnosis of Exophthalmos." LOUISIANA The Tulane University of Louisiana School of Medicine announces a course in ocular pathology devoted to a study of tumors of the eye, adnexa, and orbit, to be given February 12 through 17, 1951. The fee for the course, which will be lim- ited to an enrollment of 12, is $100. As- sisting the regular staff will be Dr. C. S. O'Brien, Dr. John MeGavic, and Dr. Theo- dore Sanders. From February 1.9 through 24, 1951, a symposium on ocular pharmacology and therapeutics will be held at the Tulane University of Louisiana School of Medi- cine. Enrollment in the symposium will be limited to 150, and the fee will be $100. Drs. Alson E. Braley, Parker Heath, Irving H. Leopold, Robb McDon- ald, Frank W. Newell, and Alan C. Woods will assist the regular staff in conducting the symposium. For further information regarding these courses, write to Dr. James H. Allen, 1430 Tulane Avenue, New Orleans, La. MARYLAND Dr. S. Rodman Irvine has been appoint- ed associate professor of ophthalmology in the Johns Hopkins University School of Medicine for the year beginning Octo- ber 1, 1950 and ending June 30, 1951. MISSOURI A meeting of the St. Louis Ophthalmic Society was held Nov. 16, 1950. The program consisted of "The Role of Hy- perpyrexia in the Management of Eye Disease," by Dr. Bennett Y. Alvis, asso- ciate professor of clinical ophthalmology, Washington University School of Medi- cine; "The Treatment of Ocular Syphilis," by Dr. Leslie C. Drews, associate profes- sor of ophthalmology, St. Louis Univer- sity School of Medicine, and Dr. Gerald Barton (by invitation) ; and "Hyper- phoria: Its Evaluation and Management," by Dr. Richard G. Scobee, assistant pro- fessor of ophthalmology, Washington Uni- versity School of Medicine. The Washington University School of Medicine announces a full time course in orthoptic technology. it will be given annually. The next course begins Sept. .17, 1951, and extends to June 15, 1952. Both didactic and practical training are given in orthoptic technology and a cer- tificate is granted upon successful com- pletion of the course. Tuition is $350.00. Facilities for instruction include the Mo- tility Clinic of the Washington University Clinics and the St. Louis Ophthalmic Lab- oratory, the latter under the direction of Miss- Anita Stelzer. The course is limited to eight students. Applicants must be at least 18 years of age and high school graduates, preferably with at least one year of college. Inquiries and applications should be addressed to Dr. Richard G. Scobee, Director of Graduate Training in Ophthalmology, 640 S. Kingshighway, St. Louis 10, Mo. NEW JERSEY The Section on Eye, Ear, Nose and Throat of the Academy of Medicine of Northern New Jersey met Nov. 13, 1950. Dr. Raymond E. Meek was guest speaker. He spoke on "Recent Advances in Ocular Surgery." The Annual Clinical Conference of the Academy of Medicine was held at the Newark Eye and Ear Infirmary, Dec. 11, 1950. The next meeting of the Section will be held March 12, 1951. Dr. James S. Shipman will be the guest speaker. He will present a paper on "Retinal De- tachment and Some of Its Problems." NEW YORK The regular meeting of the East- ern New York Eye, Ear, Nose and Throat Association was held Nov. 2, 1950. It was "Clinic Day" and a number of in- teresting eye, ear, nose and throat cases were reported. The cases were described, discussed and coordinated by the guest,, Dr. James W. Babcock, clinical professor Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 KXVIII TRANSACTIONS - NOVEMBER - DECEMBER, 1950 of otolaryngology at Columbia Presby- terian Medical Center', New York City. At the evening meeting it was decided to cancel the December meeting, devote the January meeting to home talent, and hold the February meeting in Troy. Dr. Hecker gave a short resume of the E.N.T. highlights of the recent Academy meeting. Dr. Holohan then followed with a similar resume of the eye session there. Dr. Cet- ner presented a color sound film depicting an operation for "Tucking of the Superior Oblique Muscle." Dr. James W. Babcock showed a film and gave a paper on "The Effects of Streptomycin on the Lab- yrinth." He brought out the fact that persons taking streptomycin in large quantity lose the sensitivity of their lab- yrinths, have a positive Romberg, and cannot walk straight with their eyes closed. This drug has been used success- fully in treating some cases of Meniere's syndrome. He described the Hallpike test. This treatment usually results in relief from vertigo in about 10 days, but leaves the patient dependent on his other senses for sense of position and motion. The paper was discussed by Drs. Volk, Hecker, Fierman, Cotner, Freund, and Sulzman. PENNSYLVANIA The thirty-fourth meeting of the West- ern Pennsylvania Eye, Ear, Nose and Throat Society was held at Indiana, Pa., Oct. 26, 1950. Dr. Raymond E. Jordan of Pittsburgh spoke on "Chronic Secretory Otitis Media," and Dr. William Linhart of Pittsburgh presented a paper on "Com- plications and Retinal Changes in Sys- temic Diseases." Word has been received that Dr. F. B. Stevenson of Indiana, Pa., died Oct. 31, 1950. Dr. Stevenson was the organizer and first president of the Western Penn- sylvania Eye, Ear, Nose and Throat So- ciety. A meeting of the Reading Eye, Ear, Nose and Throat Society was held Oct. 25, 1950, at the Wyomissing Club. A study club on "Ocular Therapeutics" was conducted. Instructors were Dr. James H. Parker of Reading and Dr. Joseph V. M. Ross of Berwick. Members who attended the Academy meeting in Chicago were invited to present their impressions of the highlights of the meet- ing. Reports on courses taken at the Chicago meeting were given by Drs. Er- nest H. Dengler, Pottstown; C. Fremont Hall, Phoenixville; Fred R. Perfect, Wyomissing; Samuel A. Phillips, Allen- town; Robert E. Shoemaker, Allentown; and Benjamin F. Souders, Reading. The following officers were elected for the years 1950-51: president, Dr. Roy Deck, Lancaster; first vice-president, Dr. William J. Hertz, Allentown; second vice- president and president-elect, Dr. Harold L. Strause, Reading; treasurer, Dr. Philip R. Wiest, Reading; secretary, Dr. Benja- min F. Souders, Reading; and program chairman, Dr. John E. Keller, Reading. The regular meeting of the Reading Eye, Ear, Nose and Throat Society was held Nov. 15, 1950. Dr. Harvey E. Thorpe, chief of the department of ophthalmology at Montefiore Hospital, Pittsburgh, spoke on "Management of Intraocular Foreign Bodies." A study club on the "Manage- ment of Early Deafness" was conducted by Dr. James E. Landis of Reading, and Dr. C. Fremont Hall of Phoenixville. The Section on ophthalmology of the College of Physicians of Philadelphia held a meeting Nov. 16, 1950. Dr. Parker Heath delivered the thirteenth annual de- Schweinitz lecture, "Tumors of the Iris: Pathology and Treatment " Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 XXIX POSITIONS AVAILABLE POSITIONS AVAILABLE There is an opening in Washington, D. C., for a competent ophthalmologist to be associated with ophthalmologist in large private practice and with the George Washington University Medical School. The appointment comprises private prac- tice and teaching, and research if so de- sired by the applicant. Application should be made to Mrs. R. McKenzie Ross, Room 2166 Department of Ophthalmology, George Washington University Hospital, Washington 7, D. C. The Department of Otolaryngology and Oral Surgery at the University of Iowa Medical School will have four residencies available July 1, 1951. Applications should be submitted by Nov. 1, 1950, as the appointments are made Dec. 1, 1950. If you are interested, please write the Department of Otolaryngology and Oral Surgery, University Hospitals, Iowa City, Iowa, for information. Listing of positions available should be sent to W. L. Benedict, M.D., 100 First Avenue Building, Rochester, Minn., by the fifth of the month pre- ceding publication. They should include (1) type of physician wanted (ophthalmologist or otolaryn- gologist; diplomate, resident, etc.) ; (2) type of position to be filled; and (3) whom to write for further information. Unless otherwise requested, listings will be published once only. The Academy will handle no further correspon- dence beyond the listing and assume no responsi- bility. Neither does it endorse or guarantee any of the published listings. The staff of the Lewistown Hospital, Lewistown, Pa., is interested in having a man certified in ophthalmology locate in Lewistown. Lewistown has a population of approximately 16,000 and is located in central Pennsylvania. Lewistown Hospital serves a prosperous agricultural area with a population of approximately 75,000. New construction is under way which will give them a total of 186 beds plus 56 newborn bassinets. The medical staff consists of fourteen active members and thirty-three courtesy members plus two consulting and three honorary members. Write to Mr. Robert A. Kumpf, Adminis- trator, Lewistown Hospital, Lewistown, Pa. Otolaryngologist: A position for a resident is available at the Episcopal Hos- pital, Philadelphia, Pa. For details write Dr. Otto C. Hirst, Episcopal Hospital, Philadelphia 25, Pa. A qualified ophthalmologist and oto- laryngologist is needed in Denison, Texas, a city of 23,000 located on Lake Texoma. The area is industrial and agricultural. A high standard of living is maintained. There is no competition. Professional co- operation is assured if qualifications are adequate. For further information write Dr. Maurice A. Weisberg, Grayson X-Ray and Radium Clinic, Barrett Bldg., Deni- son, Texas. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 DIRECTORY OF OPHTHALMOLOGIC AND OTOLARYNGOLOGIC SOCIETIES INTERNATIONAL INTERN ATIONAI. ASSOCIATION FOR PREVENTION OF BLINDNESS President: Dr. P. Bailliart, 47 Rue de Bellechasse, Paris, France Secretary-General: Dr. A. Churchill, 66 Boulevard Saint-Michel, Paris, 6, France INTERNATIONAL COUNCIL OF OPHTHALMOLOGY President: Prof. F. W. Nordenson Secretary: Dr. Halger Ehlers, Rigshospital, Copenhagen, Denmark INTERNATIONAL ORGANIZATION AGAINST TRACHOMA President: Dr. A. F. MacCallan Secretary: Dr. F. Wibaut, P. C. Hoofstraat 145, Amsterdam, Holland PAN-AMERICAN ASSOCIATION OF OPHTHALMOLOGY President: Dr. Conrad Berens Secretary: Dr. Thomas D. Allen, 122 South Michigan Avenue, Chicago 2, Ill. Tilde and Place: January 7-12, 1952. Mexico City PAN-AMERICAN ASSOCIATION OF OPHTHALMOLOGY, PUERTO RICO CHAPTER President: Dr. Luis J. Fernandez, Box 2206, San Juan 10, Puerto Rico Secretary: Dr. P. Fernandez Place: San Juan P,\N-AMERICAN ASSOCIATION OF OTO-RIIINO-LARYNGOLOGY AND BRONCIIO-ESOPHAGOLOGY President: Prof. Justo Alonso Secretary: Dr. Chevalier L. Jackson, 255 South 17th Street, Philadelphia, Pa. Time and Place: Third Pan-American Congress of Oto-Rhino-Laryngology and Broncho-Esophagology, Havana, Cuba, 1952. FOREIGN President: Dr. G. Zachariah ALL-INDIA OPHTHALMOLOGICAL. SOCIETY Secretaries: Dr. S. N. Cooper and Dr. V. K. Chitnis, Laud Mansion, Queen's Road, Bombay 4, India AUSTRIAN OTOLARYNGOLOGICAL SOCIETY, VIENNA President: Prof. Dr. E. Sehlander Secretary: Doz. Dr. O. Novotny, Vienna IX, Alserstrasse 4, Austria Time and Place: Annually Secretary-General:Dr. M. Appelmans, Avenue Ruelens 179, Louvain Time and Place: January, June and November. Bruxelles BOMBAY OPHTHALMOLOGISTS' ASSOCIATION Chairman: Rotated Conveners: Dr. S. N. Cooper and Dr. B. D. Telang, Laud Mansion 21, Queen's Road, Bombay 4 Time and Place: 7:30 p.m.., third Wednesday of each month. The seven ophthalmic hospitals of Bombay by rotation Honorary Secretary: Mr. F. C. W. Capps, 45 Lincoln's Inn Fields, London W. C. 2, England BRITISH MEDICAL ASSOCIATION, SECTION ON OPHTHALMOLOGY President: Mr. O. G. Morgan Secretary: Mr. A. G. Cross, 27 Harley Street, London W. 1, England CHENGTU OPHTHALMOLOGICAL SOCIETY President: Dr. Eugene Chan Secretary: Dr. D. S. Shen, Eye, Ear, Nose and Throat Hospital, Chengtu, Szechuan, China Place: Eye, Ear, Nose and Throat Hospital, Chengtu, Szechuan, China CHINESE OPHTHALMOLOGY SOCIETY President: Dr. C. H. Chou Secretary: Dr. F. S. Tsang, 221 Foochow Road, Shanghai CHINESE OPIITIIALMOLOGICAL SOCIETY or PEKING President: Dr. G. C. Lin Secretary: Dr. H. L. Chen, Ophthalmological Dept., Peking University Medical School, Peking Time: Bimonthly DEUTSCHE OPHTHALMOLOGISCHE GESELLSCHAFT HEIDELBERG President: Prof. Dr. med. K. Wessely Secretary: Prof. Dr. med. E. Engelking, Heidelberg, Universitats-Augenklinik FACULTY OF OPHTHALMOLOGISTS President: Dr. Frank W. Law, 45 Lincoln's Inn Fields, London, W.C. 2, England Secretary: Dr. J. H. DOggart, F.R.C.S. GERMAN OPHTHALMOLOGICAL SOCIETY President: Prof. W. Lohlein Secretary: Prof. E. Engelking, Heidelberg HUNGARIAN MEDICAL TRADE UNION, SECTION OF OPHTHALMOLOGY President: Prof. I. Csapody Secretary: Dr. E. Galla, Krisztina Kdrut 139, Budapest, Hungary Time and Place: Bimonthly. Second Eye Clinic, Budapest HUNGARIAN OPHTHALMOLOGICAL SOCIETY President: Prof. G. Horay Assistant Secretary: Dr. Stephen de Grosz, University Eye Hospital, No. 1, Illesucca 15, Budapest Secretaries of societies are requested to furnish, the information necessary to make this list complete and keep it up to date. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 DIRECTORY OF SOCIETIES XXXI ISRAEL OPHTHALMOLOGICAL SOCIETY President: Dr. Aryeh Feigenbaum Secretary: Dr. E. Sinai, 9 Bialik Street. Tel Aviv MIDLAND OPHTHALMOLOGICAL SOCIETY President: Dr. F. A. Anderson Secretaries: Dr. P. Jameson Evans, 51 Calthorpe Road Edgbaston, Birmingham 15 England Dr. R. D. Weeden Butler, 18 Highfield Road, 'Edgbaston, Birmingham 15, England Place: Birmingham and Midland Eye-Hospital, Church Street, Birmingham 3, England NEDERLANDSCH OOGHEELKUNDIG GEZELSCHAP President: Prof. A. W. Mulock Houwer Secretary: Dr. T. A. Vos, Laan v. Meerdervoort 394, the Hague NORTH OF ENGLAND OPHTHALMOLOGICAL SOCIETY President: Mr. Jr. S. Arkle Secretary: Mr. W. M. Muirhead, 70 Upper Hanover Street, Sheffield 3, England Time and Place: October to May. Manchester, Leeds, Newcastle, Liverpool, Sheffield and Bradford THE NOVA SCOTIA SOCIETY OF OPHTHALMOLOGY, AND OTOLARYNGOLOGY President: Dr. D. M. MacRae Secretary-Treasurer: Dr. E. I. Glenister, 513 Barrington Street, Halifax, Nova Scotia Time: Four times yearly at dates to be arranged by the Executive OPHTHALMOLOGICAL AND OTOLARYNGOLOGICAL SOCIETY OF ALBERTA President: Dr. C. G. Elder Secretary: Dr. M. R. Marshall, Wells Pavilion, University Hospital, Edmonton, Alberta, Canada OPHTHALMOLOGICAL SOCIETY OF AUSTRALIA President: Dr. Arthur H. Joyce Secretary: Dr. Arnold L. Lance, 135 Macquarie Street, Sydney, New South Wales OPHTHALMOLOGICAL SOCIETY OF COPENHAGEN President: Prof. Dr. Holger Ehlers Secretary: Dr. Carl Johan Moellenbach, Rigshospitalets oejenafdeling, Copenhagen 0, Denmark Place: Rigshospitalets oejenafdeling OPHTHALMOLOGICAL SOCIETY OF EGYPT President: Dr. Ibrahim Ahmad Mohammad Secretary: Dr. Mahmoud Lutfi, Ophthalmic Hospital, Giza Time and Place: Annual meeting during March. Summer meeting during August. Dar El Hekmah, 42 Kasr El Ainy Street, Cairo, Egypt OPHTHALMOLOGICAL SOCIETY OF HOSPITAL DE NUESTRA SENORA DE LA LUz Chairman: Dr, Manuel J. Icaza y Dublan Secretary: Dr. Jorge Meyran, Ezequiel Montes 135 M6xico, D. F. Time and Place: Second Friday of each month. hospital de Neustra Senora de la Luz OPHTHALMOLOGICAL SOCIETY OF NEW ZEALAND President: Dr. L. S. Talbot Secretary: Dr. W. J. Hope-Robertson,"Kelvin Chambers, 16 The Terrace, Wellington Time and Place: Annually. Auckland, Wellington, Christchurch and Dunedin alternately OPHTHALMOLOGICAL SOCIETY OF SOUTH AFRICA President: Dr. L. Staz Secretary: Dr. J. Guillaume Louw, 901 Dumbarton Ilouse, Adderley Street, Cape Town, South Africa Time: Annually OPHTHALMOLOGICAL. SOCIETY OF THE UNITED KINGDOM President: Mr. M. H. Whiting Honorary Secretaries: Mr. A. G. Cross and Mr. A. J. B. Goldsmith, 45 Lincoln's Inn Fields, London W. C. 2, England Time and Place: 1951 Congress of the Society, March 29-31, London OXFORD OPHTHALMOLOGICAL CONGRESS Master: Dr. F. A. Anderson Hon. Secretary and Treasurer: Ian C. Fraser, F.R.C.S., Red Roofs, Kingsland, Shrewsbury Time and Place: First week of July 1951, Oxford PHILIPPINE OPHTHALMOLOGICAL AND OTOLARYNGOLOGICAL SOCIETY President: Dr. Geminiano de Ocampo Secretary-Treasurer: Dr. Carlos V. Yambao, Philippine General Hospital, Manila POLISH OPHTHALMOLOGICAL SOCIETY President: Prof. Dr. W. Kapuscinski Secretary: Dr. S. Topolski, Piusa 38, Warsaw, Poland Time and Place: Every two years-summer. Ophthalmic Clinic, Oczki 6, Warsaw ROYAL SOCIETY OF MEDICINE, SECTION of OPHTHALMOLOGY President: Montague Hine, F.R.C.S. England H Secretaries: H. E. Hobbs, F.R.CS., 129 F.R.C.S., Harley I Street , Street, London, London, England SAO PAULO SOCIETY OF OPHTHALMOLOGY President: Dr. Durval Prado Secretary: Dr. Rubens Belfort Mattos, Rua B. Stapetininga, 29 F-3? andar, Sao Paulo, Brazil SCOTTISH OPHTHALMOLOGICAL CLUB President: Dr. E. H. Cameron Secretary: Dr. John Marshall, 11 Clairmont Gardens, Glasgow, C.3, Scotland Time and Place: Last Saturday of March and October, Edinburgh and Glasgow, in rotation SOCIEDAD ARGENTINA DE OFTALMOLOGIA President: Dr. Diego M. Arguello Secretary: Place: Pedro Third Wednesday Nocito, of every month. Buenos Aireegenos Aires, Argentina Time and Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 XXXII TRANSACTIONS - NOVEMBER - DECEMBER, 1950 President: Dr. Italy Martini SOCIEDAD CHILENA DE OFTALMOLOGIA Secretar : Dr. Adrian Araya Costa, Renaca, no. 34, Santiago, Chile Place: Santiago SOCIEDAD COLOMBIANA DE OFTALMOLOGIA Y DE OTORRINOLARINGOLOGIA President: Dr. Jorge Suarez-Hoyos, Carrera 5a, no. 13-39, Bogota, Colombia Secretary: Dr. Francisco krango Time and Place: Second Tuesday of each month. Club Medico SOCIEDAD CUBANA DE OFTALMOLOGIA President: Prof. Lorenzo Comas Secretary: Dr. Heriberto Buch Granados, Calle B No. 668 ent. 27 y 29 Vedado, Habana, Cuba Time and Place: First Thursday bi-monthly. Malecon No. 61 Bajos, 1 avana, Cuba SOCIEDAD MEXICANA DE OFTALMOLOGIA President: Dr. Teodulo M. Agundis Secretary: Dr. Jose Luis Arce, Viena 3.5, Mexico D. F., Mexico Time and Place: 8:30 p.m., first Tuesday of each month, Gral. PRIM 47 SOCIEDAD DE OFTALMOLOGIA DE CORDOBA Chairman: Dr. Roberto Obregon Oliva Secretary: Dr. Alberto Urrets Zavalia (hijo), 27 de Abril 255, Cordoba, Argentina SOCIEDAD DE OFTALMOLOGIA DE GUADALAJARA President: Dr. Elias Mendoza Gonzalez Secretary: Dr. Jose Martin del Campo, Av. Juarez 211, Desp. 314, Guadalajara, Jal. Place: Edificio Lutencia Despacho 101 SOCIFDAD DE OFTALMOLOGIA DEL LITORAL President: Dr. Juan Manuel Vila Ortiz, Cordoba 1915, Rosario, Argentina Secretary: Dr. Carlos M. Soto Time and Place: Last Sunday in every month. Rosario SOCIEDADE BRASILEIRA DE OFTALMOLOGIA President: Dr. Natalicio de Farlas Secretary: Dr. Ismar Pereira? Praca Floriano 55, 5? andar, Rio de Janeiro, Brazil Time: Third Friday of every month from April to December SOCIEDADE DE OFTALMOLOGIA DEL NORTE President: Dr. Jorge Luis Castillo Secretary Dr. Felix Berman, San Lorenzo 345, Tucuman, Argentina Place: Mendoza 421, Tucuman SOCIEDADE DE OFTALMOLOGIA DE MINAS GERAIS President: Prof. Hilton Rocha Secretary: Dr. Oswaldo Carvalho Place: Belo Horizonte, Minas Gerais, Brazil SOCIEDADE DE OFTALMOLOGIA E OTORINOLARINGOLOGIA DE Rio GRANDE DO SUL President: Dr. Luiz Assumpcao Osorio Secretary: Dr. Fernando Voges Alves, Caixa Postal 928, Porto Alegre, Rio Grande do Sul SOCIEDADE DE OTO-RING-LARINGOLOGIA DO RIO DE JANIERO President: Dr. Aloysio Novis Secretaries: Dr. Rubens Cabral, Rua Paissandu 73, Rio de Janeiro, Brazil Dr. Mairelles Vieira SOCIEDADE DE OFTALMOLOGIA E OTO-RHINO-LARYNGOLOGIA DE BAHIA President: Dr. Theonilo Amorim, Barra Avenida, Bahia, Brazil Secretary: Dr. Adroaldo de Alencar SOCIETA OFTAI.MOLOGICA ITALIANA President: Prof. Giuseppe Ovio Secretary: Prof. E. Leonardi, Piazza degli Eroi, 11 Roma, Italy Place: Roma Piazza degli Eroi 11 SOCIETE BELGE D'OPHTALMOLOGIE President: Dr. L. Weekers Secretary-General: Dr. M. Appelmans, 179 avenue Reulens, Louvain, Belgium Time: Last Sunday of February, June and November SOCIETE FBANCAISE D'OPIITALMOLOGIE Secretary-General: Dr. Edward Hartmann, Hospital Lariboisiere, Paris 10, France SOCIETY OF SWEDISH OPHTHALMOLOGISTS President: Prof. S. Larsson Secretary: Dr. K. O. Granstrom, Sodermalmstorg 4, Stockholm, Sweden SOUTHERN OPHTHALMOLOGICAL SOCIETY, ENGLAND President: R. Lang, M.R.C.S. Hon. Secretary and Treasurer: Nigel Cridland, D.M., D.O., 25 Craneswater Park, Southsea, England NATIONAL AMERICAN ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. J. Mackenzie Brown Executive Secretary-Treasurer: Dr. William L. Benedict, 100 First Avenue Building, Rochester, Minn. Time and Place: October 14-19, 1951, Chicago AMERICAN ASSOCIATION OF EYE, EAR, NOSE AND THROAT SOCIETY SECRETARIES President: Dr. Kenneth L. Craft Secretary-Treasurer: Dr. Daniel S. DeStio, Highland Building, Pittsburgh 6, Pa. AMERICAN LARYNGOLOGICAL ASSOCIATION President: Dr. Gordon B. New Secretary: Dr. Louis H. Clerf, 1530 Locust, Philadelphia 2, Pa. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 DIRECTORY OF SOCIETIES XXXIII AMERICAN LARYNGOLOGICAL, RIIINOLOGICAL AND OTOLOGICAL SOCIETY, INC. President: Dr. Louis H. Clerf Secretary: Dr. C. Stewart Nash, 708 Medical Arts Building, Rochester 7, N. Y. EASTERN SECTION Vice-President: Dr. Harry P. Schenck Secretary: Dr. Francis W. Davison, Geisinger Memorial Hospital, Danville, Pa. MIDDLE SECTION Vice-President: Dr. Clarence W. Engler Secretary: Dr. Walter H. Theobald, 307 North Michigan Avenue, Chicago 1, Ill. SOUTHERN SECTION: Vice-President: Dr. Charles C. Grace Secretary: Dr. James W. McLaurin, Raymond Building, Baton Rouge 6, La. WESTERN SECTION: Vice-President: Dr. Lewis F. Morrison Secretary: Dr. Harold Boyd, 1136 West Sixth Street, Los Angeles, Calif. AMERICAN MEDICAL ASSOCIATION, SCIENTIFIC ASSEMBLY, SECTION ON OPHTHALMOLOGY Chairman: Dr. A, Ray Irvine Secretary: Dr. Trygve Gundersen, 101 Bay State Road, Boston, Mass. AMERICAN MEDICAL ASSOCIATION, SECTION ON LARYNGOLOGY, OTOLOGY AND RHINOLOGY Chairman: Dr. James M. Robb Secretary: Dr. Sam H. Sanders, 1089 Madison Avenue, Memphis 3, Tenn. AMERICAN OPHTHALMOLOGICAL SOCIETY President: Dr. John H. Duunington Secretary-Treasurer: Dr. Maynard C. Wheeler, 30 West 59th Street, New York 19, N. Y. Time and Place: Eighty-seventh annual meeting, June 7-9, 1951, Greenbrier Hotel, White Sulphur Springs, W. Va. AMERICAN OTOLOGICAL SOCIETY President: Dr. Kenneth Day Secretary: Dr. John R. Lindsay, 950 East 59th Street, Chicago 37, Ill. AMERICAN SOCIETY OF OPHTHALMOLOGIC AND OTOLARYNGOLOGIC ALLERGY President: Dr. George E. Shambaugh, 7r. May Building, Pittsburgh 22, Pa. Secretary-Treasurer: Dr. Joseph W. H ampsey, 806 ASSOCIATION FOR RESEARCH IN OPHTHALMOLOGY, INC. Chairman: Dr. Walter H. Fink Secretary-Treasurer: Dr. James H. Allen, 1430 Tulane Avenue, New Orleans, La. CANADIAN MEDICAL ASSOCIATION, SECTION ON OPHTHALMOLOGY President: Dr. R. G. C. Kelly Secretary: Dr. J. Clement McCulloch, 380 Medical Arts Building, Toronto, Ontario CANADIAN OPHTHALMOLOGICAL SOCIETY President: Dr. it F. Nicholls Secretary: Dr. J. F. A. Johnston, 174 St. George Street, Toronto, Ontario CANADIAN OTOLARYNGOLOGICAL SOCIETY President: Dr. W. J. McNally Secretary: Dr. Jules Brahy, 361 Sherbrooke Street East, Montreal 18, Quebec NATIONAL SOCIETY FOR THE PREVENTION OF BLINDNESS, INC. President: Mr. Mason H. Bigelow Secretary: Dr. Franklin M. Foote, 1790 Broadway, New York 19, N. Y. REGIONAL ARK-LA-TEX OTO-OPHTHALMIC SOCIETY President: Dr. W. Griffin Jones Secretary: Dr. Frank L. Bryant, 2622 Greenwood, Shreveport, La. Time and Place: First Monday of month, October through May. Shreveport Club HAWAII EYE, EAR, NOSE AND THROAT SOCIETY Chairman: Dr. Ogden D. Pinkerton Secretary: Dr. John P. Frazer, 1133 Punchbown Street, Honolulu, T. II. Time and Place: Third Thursday of each month (dinner meetings). Pacific Club, Honolulu INTER-MOUNTAIN OTO-OPIITIIALMOLOGI CAL SOCIETY President: Dr. Homer E. Smith Secretary: Dr. George B. Ely, 115 East South Temple Street, Salt Lake City, Utah Time and Place: Third Monday of each month, September through May. University Club, 136 Easl South Temple, Salt Lake City LOUISIANA-MISSISSIPPI OPHTHALMOLOGICAL AND , OTOLARYNCOLOGICAL SOCIETY President: Dr. S. B. Carruthers Secretary: Dr. Edley H. Jones, 1301 Washington Street, Vicksburg, Miss. Time and Place: May 14, 1951, Mississippi Gulf Coast NEW ENGLAND OPHTHALMOLOGICAL SOCIETY President: Dr. Benjamin A. Sachs Secretary: Dr. Garrett L. Sullivan, 101 Bay State Road, Boston 15, Mass. Time and Place: Third Wednesday of each month. November through April. Massachusetts Eye and President: Dr. Robert L. Goodale Secretary-Treasurer: Dr. Burton E. Lovesey, 76 Bay State Road, Boston 15, Mass. Time and Place: Quarterly. Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston PACIFIC COAST OTO.OPHTHALMOLOGICAL SOCIETY President: Dr. Augustus B. Dykman Secretary-Treasurer: Dr. Howard P. House, 1136 West Sixth Street, Los Angeles 14, Calif. SAGINAW VALLEY ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. William B. Hubbard Secretary: Dr. Frank A. Ware, 514 Genesee Bank Bldg., Flint, Mich. Time and Place: Second Tuesday evening of each month, except summer months. Bancroft Hotel, Saginaw a Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 XXXIV TRANSACTIONS - NOVEMBER - DECEMBER, 1950 SIOUX VALLEY EYE AND EAR ACADEMY President: Dr. James Reeder, Jr. Secretary-Treasurer: Dr. W. P. Davey, 627-632 Frances Building, Sioux City, Iowa SOUTHERN MEDICAL ASSOCIATION, SECTION ON OPHTHALMOLOGY AND OTOLARYNGOLOGY Chairman: Dr. Alston Callahan Secretary: Dr. Edley H. Jones, 1301 Washington Street, Vicksburg, Miss. WISCONSIN-UPPER MICHIGAN SOCIETY OF OPIITIIALMOLOGY AND OTOLARYNGOLOGY President: Dr. James K. Trumbo Secretary: Dr. G. L. McCormick, 650 South Central Avenue, Marshfield, Wis. Time and Place: May 1951. Wausau, Wis. STATE ARKANSAS STATE MEDICAL SOCIETY, EYE, EAR, NOSE AND THROAT SIECTION President: Dr. C. G. Hinkle Secretary: Dr. K. W. Cosgrove, 113 East Capitol Avenue, Little Rock, Ark. CALIFORNIA MEDICAL ASSOCIATION, EYE, EAR, NOSE AND THROAT SECTION Chairman: Dr. George F. Keiper, Jr. Secretary: Dr. Maurice W. Nugent, 2007 Wilshire Blvd., Los Angeles 5, Calif. COLORADO OPHTHALMOLOGICAL SOCIETY President: Dr. J. Leonard Swigert Secretary: Dr. James C. Strong, 227 Sixteenth Street, Denver, Colo. Time and Place: Every third Saturday. Colorado Medical Center COLORADO OTOLARYNGOLOGICAL SOCIETY President: Dr. Guy W. Smith Secretary: Dr. Terry J. Gromer, 110 Metropolitan Building, Denver, Colo. Time and Place: 6:30 p.m.;, first Saturday evening of each month. Oxford Hotel, Denver FLORIDA SOCIETY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. W. Jerome Knauer Secretary-Treasurer: Dr. Charles C. Grace, 145 King Street, St. Augustine, Fla. GEORGIA SOCIETY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. Lester A. Brown Secretary: Dr. Braswell E. Collins, 701 Elizabeth Street, Waycross, Ga. Time and Place: First Friday and Saturday of March. General Oglethorpe Hotel, Savannah, Ga. INDIANA ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. E. W. Dyar Secretary-Treasurer: Dr. Al. S. Harding, 308 Hume Mansur Building, Indianapolis, Ind. IOWA ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. Byron Merkel Secretary: Dr. Carl A. Noe, 601.611 Highley Building, Cedar Rapids, Iowa KANSAS STATE MEDICAL SOCIETY, SECTION ON OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. N. L. Francis Secretary: Dr. W. D. Pitman, First National Bank Building, Pratt, Kan. MICHIGAN STATE MEDICAL SOCIETY, SECTION ON OPHTIIALMOIOGY AND OTOLARYNGOLOGY Chairman: Dr. J. E. Croushore (Otolaryngology) Co-Chairman: Dr. J. C. Gemeroy (Ophthalmology) Secretary: Dr. R. W. Teed, 215 South Main, Ann Arbor, Mich. (Otolaryngology) Co-Secretary: Dr. F. B. Heckert, 1105 Bank of Lansing Building, Lansing, Mich. (Ophthalmology) MICHIGAN TRIOLOGICAL SOCIETY President: Dr. William D. Irwin Secretary: Dr. V. E. Cortopassi, 324 South Washington Avenue, Saginaw, Mich. Time: Second Thursday of November, December, March, April and May MINNESOTA ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. Malcolm C. Plunder SecretaryTreasurer: Dr. Frank Adair, 822 Lowry Medical Arts Building, St. Paul 2, Minn. Time and Place: Second Friday of each month, November through May. Alternating, Minnesota Club, St. Paul, and Minneapolis Club, Minneapolis MONTANA ACADEMY OF OTO-OPHTHALMOLOGY President: Dr. W. L. Forster Secretary-Treasurer: Dr. F. D. Hurd, Medical Arts Building, Great Falls, Mont. Time and Place: Semi-annually. Summer, Bozeman; mid-winter, Diamond S Ranchotel, Boulder NORTH CAROLINA EYE, EAR, NOSE AN)) THROAT SOCIETY President: Dr. G. M. Billings Secretary: Dr. MacLean B. Leath, 529 North Main Street High Point, N. C. Time and Place: Annually, beginning second Monday in September. OREGON ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. Max Simons Secretary: Dr. Richard S. Fixott, 1020 Southwest Taylor Street, Portland 5, Ore. Time and Place: Third Tuesday each month September through May. Old Heathman Hotel, Portland PENNSYLVANIA ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. Jay G. Linn Secretary: Dr. Daniel S. DeStio, Highland Building, Pittsburgh 6, Pa. Time and Place: May 17-20, 1'951. Galen Hall, Wernersville, Pa. PUERTO RICO MEDICAL ASSOCIATION, SECTION ON OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. Luis J. Fernandez Secretaries: Dr. Ricardo F. Fernandez, P.O. Box 2206, San Juan 10, Puerto Rico (Ophthalmology) Dr. Carlos E. Munoz MacCormick, P.O. Box 604, San Juan, Puerto Rico (Otolaryngology). Time and Place: Bimonthly. Puerto Rico Medical Association Building SOUTH CAROLINA SOCIETY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. William M. Carpenter Secretary-Treasurer: Dr. Roderick Macdonald, Rock Hill, S. C. TENNESSEII STATE ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. Sam H. Sanders Secretary-Treasurer: Dr. Roland H. Myers, 1720 Exchange Building, Memphis, Tenn. Time: Annually Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 DIRECTORY OF SOCIETIES XXXV TEXAS SOCIETY OP OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. V. R. Hurst Secretary: Dr. John L. Matthews, 414 Navarro Street, San Antonio 5, Texas Time and Place: December 1950. Dallas VIRGINIA SOCIETY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. Charles A. Young Secretary-Treasurer: Dr. Peter N. Pastore, Box 25, Medical College of Virginia Station. Rich- mond 19, Va. WEST VIRGINIA ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. Garnett P. Morison Secretary: Dr. Melvin W. McGehee, 425 Eleventh Street, Huntington 1, W. Va. ACADEMY OF MEDICINE OF NORTHERN NEW JERSEY, SECTION ON EYE, EAR, NOSE AND THROAT Chairman: Dr. William F. Krone Secretary: Dr. Francis J. Grant, 1224 Salem Avenue, Hillside, N. J. Time and Place: 8:45 p.m., second Monday of the month. The Academy of Medicine, 91 Lincoln Park, South, Newark AKRON ACADEMY or OPIITIIALMOLOGY AND OTOLARYNGOLOGY President: Dr. C. R. Anderson Akron, Ohio Secretary-Treasurer: Dr. A. L. Peter, 406 Akron Savings and Loan Building, Time and Place: 6:30 p.m., first Monday in January- March, May and November. Akron City- Club ATLANTA EYE, EAR, NOSE AND THROAT SOCIETY President: Dr. Lester A. Brown Secretary-Treasurer: Dr. James T. King, 384 Peachtree Street N.E., Atlanta 3, Ga. Time and Place: 7:30 p.m., fourth Monday of each month, October to May. Academy of Medicine BIRMINGHAM EYE, EAR, NOSE AND THROAT SOCIETY President: Each member, in alphabetical order. Birmingham, Ala. Secretary: Dr. David A. McCoy, Woodward Building, Time and Place: 6:30 p.m., second Tuesday of each month, September through May. Thomas Jefferson Hotel BOSTON CITY HOSPITAL AURAL AND OPHTHALMIC ASSOCIATION President: Dr. Joseph Nerbonne Secretary: Dr. Benjamin Riseman, 41 Bay State Road, Boston 15, Mass. BROOK:.YN OPIITIIAI.MOLOGICAL SOCIETY President: Dr. Mortimer A. Lasky Secretary-Treasurer: Dr. Louis Freimark, 256 Rochester Avenue, Brooklyn 13, N. Y. December, February and April. Medical Society Time and Place: : 8 p.m., third, 1313 Thursday dn Avenue of BUFFALO OPIITIIALMOLOGIC CLUB President: Dr. Arthur L. Bennett Secretary: Dr. Herbert R. Reitz, 446 Linwood Avenue, Buffalo, N. Y. Time and Place: Second Thursday of each month, October through May. Park Lane CENTRAL ILLINOIS SOCIETY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. Harold R. Watkins Secretary-Treasurer: Dr. Philip R. McGrath, 843 Jefferson Building, Peoria, Ill. CENTRAL NEW YORK EYE, EAR, NOSE AND THROAT SOCIETY President: Dr. Cecil B. Hert Secretary-Treasurer: Dr. James L. McGraw, 619 University Building, Syracuse, N. Y. CIIATTANOOGA EYE, EAR, NOSE AND THROAT SOCIETY Chairman and Secretary: Dr. Willard 1-1. Steele, Jr., 552 McCallie Avenue, Chattanooga, Tenn. Time and Place: 6:30 p.m.,,fourth Thursday in each month, October through May. Mountain City Club CHICAGO LARYNGOLOGICAL AND OTOLOGICAL SOCIETY President: Dr. Oliver E. Van Alyea Secretary: Dr. Lawrence J. Lawson, 636 Church Street, Evanston, Ill. CHICAGO OPIITUAI.MOIOGICAL SOCIETY President: Dr. J. Robert Fitzgerald Secretary-Treasurer: Dr. Gail E. Soper, 636 Church Street, Evanston, 111. Time and Place: 7:30 p.m., third Monday of each month, October to May. Chicago-Illini Union, 715 Presidium: Dr. Donald J. Lyle, Dr. -Karl W. Ascher, Dr. Josef D. Weintraub Secretary: Dr. Josef D. Weintraub, 715 Provident Bank Building, Seventh and Vine Streets, Cincinnati, Ohio Time and Place: Second Wednesday night of month, November through May. University Club, Fourth President: Dr. G. Leslie Miller Secretary-Treasurer: Dr. Webb P. Chamberlain, Jr., 7405 Detroit Avenue, Cleveland, Ohio Time and Place: Second Tuesday of November, January, February and April. Statler Hotel, Cleveland COLLEGE OF PHYSICIANS OF PHILADELPHIA, SECTION ON OPHTHALMOLOGY Chairman: Dr. Wilfred E. Fry Jenkintown, Pa. Clerk: Dr. M. Luther Kauffman, Medical Arts Building, J Time and Place: 8:15 p.m., third Thursday of every month, October through April. College of Phy- President: Dr. W. B. Wilkinson 1, Texas Secretary: nd Place: First Tuesday Winborn, of Medical 1 moArts Building, nth. Melrose Dallas Hotel Time and MOINES ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. J. H. McNamee Des Moines, Iowa Secretary-Treasurer: Dr. H. H. Gurau, 213 Bankers Trust Building, Time and Place: 6:00 p.m., fourth Monday of each month, September through May. Des Moines Club Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 XXXVI TRANSACTIONS - NOVEMBER - DECEMBER, 1950 President: Dr. Cecil Lepard DETROIT OPHTHALMOLOGICAL SOCIETY Secretary: Dr. Arthur P. Wilkinson, 947 Fisher Building, Detroit 2, Mich. Time and Place: Second Monday of each month, November through April. Wayne County Medical Society DETROIT OTO-LARYNGOLOGICAL SOCIETY President: Dr. B. F. Glowacki Secretary-Treasurer: Dr. John R. Birch, 1010 Maccabees Building, Detroit 2, Mich. Time and Place: Third Wednesday of each month, September to May. Wayne County Medical Society Building EAR, NOSE AND. THROAT CLUB OF ST. Louis Chairman: Dr. Bernard J. McMahoD Secretary: Dr. Harry N. Glick, 1504 Grand Boulevard, St. Louis, Mo. Time and Place: Third Wednesday in November, January, March and May. University Club Bldg. EASTERN NEW YORK EYE, EAR, NOSE AND THROAT ASSOCIATION President: Dr. Byron H. Porter Secretary-Treasurer: Dr. E. Martin Freund, 762 Madison Avenue, Albany 3, N. Y. Time and Place monthly : 8 p.m., first Thursday of month, October to June. Albany, Troy, Schenectady, rotating FORT WORTH EYE, EAR, NOSE AND THROAT SOCIETY President: Dr. W. H. McKenzie Secretary: Dr. C. Keith Barnes, 921 Neil P. Anderson Building Fort Worth 2, Texas Time and Place: 6:30 p.m., first Friday of each month, except July and August. All Saints' Hospital HOUSTON ACADEMY OF MEDICINE, OPHTHALMOLOGICAL AND OTO-LARYNGOLOGICAL SECTION President: Dr. Lyle Hooker Secretary: Dr. Claude C. Cody, III, 1304 Walker Avenue, Houston 2, Texas Time: Second Thursday of each month, October through June INDIANAPOLIS OPHTHALMOLOGICAL AND OTO-LARYNGOLOGICAL SOCIETY President: Dr. Edwin D. Dyar Secretary-Treasurer: Dr. J. Lawrence Sims, 809 Hume Mansur Building, Indianapolis 4, Ind. Time and Place: 6:30 p.m., second Thursday of each month, November to May. Indianapolis Athletic Club President: Dr. John McLeod KANSAS CITY SOCIETY OF O. O. R. L. Secretary: Dr. James W. May, 1016 Rialto Building, Kansas City, Mo. Time and Place: Third Thursday of the month, November through May. Hotel President, 14th and Baltimore LONG BEACH EYE, EAR, NOSE AND THROAT SOCIETY President: Dr. Edmund D. Godwin Secretary: Dr. James V. Keipp, 110 Pine Avenue, Long Beach 2, Calif. Time and Place: 6:00 p.m., monthly, September through May. Seaside Memorial Hospital Los ANGELES OPHTHALMOLOGICAL SOCIETY President: Dr. Deane C. Hartman Secretary: Dr. Daniel B. Esterly, 104 North Madison Avenue Pasadena 1, Calif. Time and Place: First Thursday of each month, September through June. Los Angeles County Medical Society Building, 1925 Wilshire Boulevard Los ANGELES SOCIETY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. Alden H. Miller Secretary: Dr. Victor Goodhiil, 2007 Wilshire Boulevard, Los Angeles 5, Calif. Time and Place:. 6:00 p.m., fourth Monday of each month, September through May. Los Angeles County edical Association Building, 1925 Wilshire Boulevard MEDICAL SOCIETY OF THE DISTRICT OF COLUMBIA, SECTION ON OTOLARYNGOLOGY President: Dr. Victor Alfaro Secretary: Dr. Frasier Williams, 1228 North Irving Street, Arlington, Va. Time and Place: 7:00 p.m., third Tuesday in October, November, March and May. Army and Navy Club, 17th and Farragut Square, N.W. MEMPHIS SOCIETY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY Chairman: Each member, in alphabetical order Secretary: Dr. Sam H. Sanders 1089 Madison Avenue, Memphis, Tenn. Time and Place: Second Tuesday in each month, September through May. Memphis Eye, Ear, Nose and Throat Hospital MILWAUKEE OTO.OPHTHALMIC SOCIETY President: Dr. J. P. Wild Secretary-Treasurer: Dr. Howard High, 324 East Wisconsin Avenue, Milwaukee 2 Wis. 1 Time and Place: 6:30 p.m., fourth Tuesday of each month, October to May. Athletic Club MONTGOMERY COUNTY MEDICAL SOCIETY, SECTION ON EYE, EAR, NOSE AND THROAT President: Dr. Robert A. Bruce Secretary-Treasurer: Dr. L. N. Shroder, 144 West Fourth Street, Greenville, Ohio Time and Place: First Tuesday of November, February, March and May. Dayton Country Club MONTREAL OPHTHALMOLOGICAL SOCIETY President: Dr. Jules Brahy Secretary-Treasurer: Dr. Leo S. S. Kirschberg, 1390 Sherbrooke Street West, Montreal, Que., Canada Time: Second Thursday of October, December, February and April NASHVILLE ACADEMY OF OPIITI{ALMOI.OGY AND OTOLARYNGOLOGY President: Dr. N. B. Morris Secretary-Treasurer: Dr. Herbert Duncan, Bennie Dillon Building, Nashville, Tenn. Time and Place: Third Monday evening of month, October through May. James Robertson Hotel NEW YORK ACADEMY OF MEDICINE, SECTION ON OPHTHALMOLOGY Chairman: Dr. Milton L. Berliner Secretary: Dr. John M. McLean, 525 East 68th Street, New York 21, N. Y. Time and Place: Third Monday of the month, October through May. New York Academy of Medicine NEW YORK SOCIETY FOR CLINICAL OPHTHALMOLOGY President: Dr. Samuel Gartner ry: Dr. Timeta d Place: Leon First ;Monday hof2theCmonth, October eto May. New York N. Y. Academy of Medicine Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 DIRECTORY OF SOCIETIES XXXVII. NUECES COUNTY EYE, EAR, NOSE AND THROAT SOCIETY President: Dr. C. N. Meador Corpus Christi, Texas Secretary: Dr. Rex C. House, 228 Medical-Dental Building, Time and Place: 7:30 p.m., second Monday of each month, October through May. Dusty's, 1739 South Brownlee Street, Corpus Christi, Texas OKLAHOMA CITY ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. C. W. McClure Secretary: Dr. Richard A. Clay, 416 Northwest 13th Street, Oklahoma City Okla. Time and Place: First Tuesday of each month. University Hospital, 800 Northeast 13th Street, Okla- homa City OMAHA AND COUNCIL BLUFFS OPHTHALMOLOGICAL AND OTOLARYNGOLOGICAL SOCIETY President: Dr. Thomas T. Smith SecretaryTreasurer: Dr. G. T. Alliband, 1020 Medical Arts Building, Omaha, Neb. Time and Place: Dinner meeting third Wednesday monthly, October to May. Omaha Club PHILADELPHIA COUNTY MEDICAL SOCIETY, EYE SECTION Chairman: Dr. Alfred Cowan Secretary: Dr. John W. Deichler, 301 South 21st Street, Philadelphia 3, Pa. Time: First Thursday of each month, November through April PHILADELPHIA LARYNGOI.OGICAL SOCIETY President: Dr. Thomas F. Furlong, Jr. Secretary: Dr. John J. O'Keefe, 255 South 17th Street, Philadelphia 3, Pa. PITTS1IURGII ACADEMY or MEDICINE President: Dr. John S. Plumer Secretary: Dr. Samuel D. Evans, 1501-2 Park Building. Pittsburgh 22, Pa. Time and Place: 8:00 p.m., fourth Monday of each month, October through, May. Pittsburgh Academy, President: Dr. Daniel S. DeStio Secretary: Dr. George C. Schein, 634 Washington Road, Pittsburgh, Pa. Time and Place: Bimonthly PUGET SOUND ACADEMY OF OPHTHALMOLOGY AND OTO-LARYNGOLOGY President: Dr. Frank H. Wanamaker Secretary-Treasurer: Dr. Willard F. Goff, 432 Stimson Building, 1215 Fourth Avenue, Seattle 1, Wash. Time and Place: Third Tuesday of each month. Medical-Dental Building, Seattle READING EYE, EAR, NOSE AND THROAT SOCIETY President: Dr. Roy Deck Secretary: Dr. Benjamin F. Souders, 143 North Sixth Street, Reading, Pa. Time and Place: Third Wednesday of each month, September to July (dinner meetings). Wyomissing Club RICHMOND, VIRGINIA, EYE, EAR, NOSE AND THROAT SOCIETY President: Dr. E. W. Perkins Secretary-Treasurer: Dr. J. Warren Montague, 1001 West Franklin Street, Richmond 20 Va. Time and Place: First Tuesday of January, March, May and October. Commonwealth dlub ST. Louis COUNTY MEDICAL SOCIETY, SECTION ON EYE, EAR, NOSE AND THROAT Chairman: Dr. Anderson C. Hilding Duluth, Minn. Secretary: Dr. James P. Tetlie, 626 Medical Arts Building, Time and Place: - 6:00 to 8:00 p.m., preceding the monthly St. Louis County Medical Society meeting. President: Dr. J. M. Keller Secretary: Dr. Benjamin Milder, 539 North Grand Avenue, St. Louis 3, Mo. Time and Place: 8:00 p.m., fourth Friday of each month, October through April, except December. Elliott Auditorium, McMillan Hospital E, EAR, NOSE AND THROAT SAN FRANCISCO COUNTY MEDICAL SOCIETY, SECTION ON Calif. Chairman: Dr. W. E. Borley, 655 Sutter Secretary: None August and December. San Francisco Time and Place: Fourth Tuesday of each month, except July, County Medical Society Building SPOICANE ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY President: Dr. Phil Greene Secretary: Dr. Cornelius E. Hagan, Jr., 508 Old National Bank Building, Spokane, Wash. Time and Place: Fourth Tuesday of each month, September through May. Paulsen Medical and Dental Building SUPERIOR CALIFORNIA EYE CLUB President: Dr. Theodore Holstein, 523 Medico-Dental Building, Sacramento 14, Calif. Secretary: Dr. John Berg Time: Every third Thursday, eight months of the year TORONTO ACADEMY OF MEDICINE, SECTION OF OPHTHALMOLOGY Chairman: Dr. A. Lloyd Morgan Secretary: Dr. Joseph C. Hill, 174 St. George Street, Toronto 5, Ontario, Canada Time and Place: Second Monday night of November, January, February and March. Academy of Medi- cine, Toronto WASHINGTON, D. C. OPHTHALMOLOGICAL SOCIETY President: Dr. Thomas A. Egan Secretary-Treasurer: Dr. Joseph Dessoff, 1726 Eye Etreet Northwest, No. 813, Washington, D. C. Time: January 8, 1951, May 7, 1951, joint meeting with the Baltimore Ophthalmological Society in March 1951 WESTERN PENNSYLVANIA EYE, EAR, NOSE AND THROAT SOCIETY President: Dr. C. E. Imbrie Secretary-Treasurer: Dr. F. E. Murdock, 28% West Scribner Avenue, DuBois, Pa. Time: Biannually. Third Thursdays of May and October WILKES-BARRE OPHTHALMOLOGICAL SOCIETY President: Dr. Vincent Gallizzi Secretary: Dr, Samuel T. Buckman, 70 South Franklin Street, Wilkes-Barre, Pmber. Luzerne County Time anddPlace: cal Society TLibrary, o130each Sou h Flrankklin Streetrough May, Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 HEARING AIDS ACCEPTED BY THE COUNCIL ON PHYSICAL MEDICINE AND REHABILITATION THE AMERICAN MEDICAL ASSOCIATION As of December 1, 1950 Aurex Model F Aurex Model H Mfr. AUREX CORP. 1117 N. Franklin St. Chicago 10 Beltone Mono-Pac Beltone Harmony Mono-Pac Beltone Symphonette Beltone Mono-Pac Model M: Mfr. BELTONE HEARING AID CO. 1450 W. Nineteenth St. Chicago 8 Cleartone Model 500 Cleartone Regency Model Mfr. AMERICAN SOUND PRODUCTS, INC. 2454 S. Michigan Ave. Chicago 16 Dysonic Model No. 1 Mfr. DYNAMIC HEARING AIDS, INC. 1042 Atlantic Ave. Brooklyn 16 Electroear Model C Mfr. AMERICAN EARPHONE CO., INC. 10 E. Forty-third St. New York 17 Gem Model V-35 Gem Model V-60 Mfr. THE GEM EAR PHONE CO., INC. 50 West Twenty-ninth St. New York 1 Maico Atomeer Maico UE Atomeer Maico Quiet Ear Models G & H Mfr. THE MAICO CO., INC. 21 N. Third St. Minneapolis 1 Mears Aurophone Model 200 1947-Mears Aurophone Mode]: 98 Mfr. MEARS RADIO HEARING DEVICE CORP. 1 W. Thirty-fourth St. New York 1 Micronic Model 101 (Magnetic Receiver) Micronic Model 303 Mfr. MICRONIC CO. 727 Atlantic Ave. Boston 11 Microtone T-3 Audiomatic Microtone T-4 Audiomatic Microtone T-5 Audiomatic Microtone Classic Model T9 Microtone Model 45 Mfr. MICROTONE CO. Ford Parkway on Mississippi St. Paul 1 National Cub Model (C) National Standard Model (T) National Star Model (S) National Ultrathin Model 504 National Vanity Model 506 Mfr. NATIONAL HEARING AID LABORA- TORIES 815 S. Hill St. Los Angeles 14 Otarion Model E-1 Otarion Model E-IS Otarion Model E-2 Otarion Model E-4 Otarion Models F-1 & F-2 Mfr. OTARION, INC. 159 N. Dearborn St. Chicago 1 Paravox Models VII and VL (Standard) Paravox Model XT (Extra-Thin) Paravox Model XTS (Extra-Thin) Paravox Model Y (YM, YC & YC-7) (Very small) Mfr. PARAVOX, INC. 2056 E. Fourth St. Cleveland 15 Radioear Permo-Magnetic Multipower Radioear Permo-Magnetic Uniphone Radioear All-Magnetic Model 555 Radioear Model 62 Starlet Mfr. E. A. MYERS & SONS 306-308 Beverly Road Mt. Lebanon Pittsburgh 16 Silver Micronic (Magnetic and Crystal) Models 202M & 202C Mfr. MICRONIC CO. 727 Atlantic Avenue Boston 11 Silvertone Model 103BM Mfr. NATIONAL HEARING AID LABORA- TORIES 815 S. Hill St. Los Angeles 14 Distr: SEARS ROEBUCK & CO. 925 S. Homan Ave. Chicago 7 Silvertone Model M-35 Mfr. MICRONIC CO. 727 Atlantic Ave. Boston 11 Distr: SEARS, ROEBUCK & CO. Chicago 7 Silvertone Model P-15 Mfr. W. E. JOHNSTON MFG. CO. 708 W. Fortieth St. Minneapolis Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 Distr~ SEARS, ROEBUCK & CO. 925 S. Homan Ave. Chicago 7 Solo-Pak Model 99 Mfr. SOLO-PAK ELECTRONICS CORP. Linden St. Reading, Mass. Sonotone Model 600 Sonotone Model 700 Sonotone Model 900 Sonotone Models 910 & 920 Sonotone Model 925 Mfr. SONOTONE CORP. Elmsford, N. Y. Tonemaster Model Royal Mfr. TONEMASTER, INC. 400 S. Washington St. Peoria 2. Ill. Trimm Vacuum Tube Model 300 Mfr. TRIMM DISTRIBUTORS. INC. 400 Lake St. (P.O. Box 489) Libertyville, 111. Unex Model A Unex Midget Model 95 flnex Midget Model 110 Mfr. NICHOLS & CLARK Hathorne, Mass. Super-Fonic Hearing Aid Mfr. AMERICAN SOUND PRODUCTS, INC. 2454 S. Michigan Ave. Chicago 16 Televox Model E Mfr. TELEVOX MFG. CO. 1307 Sansom St. Philadelphia 7 Telex Model 22 Telex Model 97 Telex Model 99 Telex Model 200 Telex Model 1700 Mfr. TELEX, INC. Telex Park Minneapolis I Vacolite Model J Mfr. VACOLITE CO. 3003 N. Henderson St. Dallas 6 Western Electric Model 63 Western Electric Model 64 Western Electric Models 65 & 66 Mfr. WESTERN ELECTRIC CO., INC. 120 Broadway New York 5 Zenith Model 75 Zenith Miniature 75 Mfr. ZENITH RADIO CORP. 6001 W. Dickens Ave. Chicago 39 TABLE HEARING AIDS Aurex (Semi-Portable) Mfr. AUREX CORP. 1117 N. Franklin St. Chicago 10 Precision Table Hearing Aid Mfr. PRECISION ELECTRONICS CO. 5157 W. Grand Ave. Chicago 39 Sonotone Professional Table Set Model 50 Mfr. SONOTONE CORP. Elmsford, N. Y. Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 . Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 AVAILABLE SUPPLIES Pic. OCULAR SURGERY, Conrad Berens and Michel Loutfallah ................ $1.00 CATARACT TYPES, F. C. Cordes .................................. 1.00 SLIT LAMP BIOMICROSCOPY, E. L. Goar et al ........................ 1.00 OUTLINE OF NEURO-OPHTHALMOLOGY, P. J. Leinfelder .............. 1.00 A COMPREHENSIVE DESCRIPTION OF THE ORBIT, ORBITAL CONTENT, AND ASSOCIATED STRUCTURES WITH CLINICAL APPLICATIONS, R. E. McCotter et al .................. 1.00 THE INTERPRETATION OF VISUAL FIELDS, C. W. Rucker ............... 1.00 EXTRINSIC EYE MUSCLES, H. Saul Sugar ............................. 1.00 ENDOGENOUS UVEITIS, A. C. Woods ................................ 1.00 MENIERE'S DISEASE, J. R. Lindsay ................................ 1.00 NONSURGICAL COMPLICATIONS OF OTOLARYNGOLOGIC SURGERY, J. J. Pressman et al ......................................... 1.00 MONOGRAPHS HEARING TESTS, Arthur L. Juers .................................. $0.25 THE EMBRYOLOGY OF THE EAR, NOSE, AND THROAT, 0. E. Van Alyea ........................................... 0.25 REFRACTION DIFFICULTIES, Clarence A. Veasey, Jr . ..................................... 0.50 ABSTRACTS Each set contains the available outlines and briefs of instruction courses as presented at Academy meetings. Unbound. Ophthalmology: 1937, 1938, 1942, 1948 ...................... . . @ $1.50 1949 ....................... 3.50 1950 ...................................... 5.00 Otolaryngology: 1937, 1938, 1939, 1941, 1942, 1947 ............ @ 1.50 1950 ....................................... 4.00 TRANSACTIONS Bound Volumes: Record of meetings held in: 1917-18, 1919, 1920, 1921, 1923, 1924, 1925, 1926, 1927, 1928, 1930, 1932, 1934, 1935, 1936, 1937, 1938, 1939, 1940, 1941, 1942, 1943, 1944 ........................... @ $J.50 1948 bound volume .............................. 4.00 1949 bound volume .............................. 5.00 Subscription: Per year, bimonthly publication ...................... 10.00 Single issue: Before January-February 1950, if available .............. .50 Beginning January-February 1950 ..................... 1.00 Beginning September-October 1950 .................... 2.00 SEND ORDER WITH REMITTANCE TO W. L. Benedict, M.D. 100 First Avenue Building Rochester, Minnesota Approved For Release 2002/07/24: CIA-RDP80-00926AO03000050013-1 aw * DRA LASMA TO 19 T, DETERGENT; it BACTERICIDAL, DEODO * BIBLIOGRAPHY Arch. Otolaryngol., 43:605, 1946. E., E., N., & T. Mo., 26:27, 1947. Laryngoscope, 56:556, 1946. New Eng. J. Med., 234:468, 1946. Annals of Allergy, 4:33, 1946. J. A. Ph., A., (Sc. Ed.) 35:304, 1946. Literature on request. Clinical studies concerned with the use of Glycerite of Hydrogen Peroxide in the treatment of chronic purulent otitis media demonstrated seventeen of twenty-nine patients in complete remission in 14 days and the remainder by the 38th day. The pa- tients studied presented conditions existent for pe- riods of 2 weeks to over 40 years. Previous treat- ment by the usual therapeutic means, including tyrothricin or penicillin, was ineffective in all cases. Constituents: Hydrogen Peroxide 1.446%, Urea (Carbamide) 2.554%, 8-Hydroxyquinoline 0.1%. Dissolved and stabilized in substantially anhydrous glycerol.. . q.s. ad. 30cc. Available on prescription in one-ounce bottle with dropper. Administration: One-half dropperful two to four times daily. ~nlPhna~idna~ PHARMACEUTICAL CORPORATION Approved For Release 2002/07/2t4fpQf9A~8A0i1,33d09fl~60~4a# Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1 THE AMERICAN ACADEMY OF OPHTHALMOLOGY AND OTOLARYNGOLOGY takes pleasure in announcing the new motion picture film THE EMBRYOLOGY OF THE EYE Based on material made available by The Carnegie Institution of Washington, this 16 nun. film in sound and color meets a long-felt need in the teaching of ophthalmology. Per Print - $250.00 Available on one reel or in two parts on two reels W. L. BENEDICT, M.D. 100 First Avenue Building Rochester, Minnesota Approved For Release 2002/07/24: CIA-RDP80-00926A003000050013-1