Doctors in Cleveland

Unknown anywhere in the world before 1922 is the disease now called granulopenia. During the past three years it killed 1,300 U. S. people, mostly housewives. Physicians, nurses and their families suffered high mortality. Rarely has a poor person died of the disease, rarely a Negro. Finding out why became Dr. Roy Rachford Kracke's job at Emory University, Atlanta. Clever reasoning led him to suspect certain new-fangled pain-killing drugs manufactured from benzamine derivatives of coal tar. Negroes, who seldom complain of minor aches or pains, do not use those drugs. Poor people cannot afford them. Doctors get them as free samples. "We have seen few physicians," said Dr. Kracke last week, "who do not have a package of allonal, amytal compound, peralga, or other such drugs lying on their desk within easy reach. It is easy for the doctor and certainly common practice when members of his family become ill to reach for one of these 'newer and better' drugs with which he has been circularized and detailed."

Experiments showed Dr. Kracke that the pain-killers which he suspected inhibit the production of germ-killing white blood cells in the marrow. A sore throat or a cut finger uses up white cells. No others come from the marrow to replace them. Eventually the body has too few white cells available to fight off the invasion of germs. Along comes a cold, and the granulopenic (poor in white cells) person dies with shocking suddenness.

The drug which most often causes granulopenia in the U. S. is amidopyrine (chemical name: dimethylamrno-phenyl dimethyl pyrazolone). Related drugs which Dr. Kracke also blames are: pyramidon, phenacetine, arsphenamine. neoarsphenamine, amytal compound, allonal, peralga, amidophen. Dinitrophenol causes the rapid oxidization of sugar and fat in the body. This year it killed at least two overeager fat-reducers (TIME, April 30). Dr. Kracke said he feared it would be exploited this winter as a weight reducer.

Dr. Kracke's lecture on the new disease and his exhibit of drugs which cause it was one of the most exciting incidents at Cleveland last week, where the American Medical Association conducted its 85th convention. Other newsworthy presentations included:

Shwartzman Antitoxin. Dr. Gregory Shwartzman described an entirely new method of immunization. He filters the bacteria of, say, typhoid, so that he gets nothing but the bacteria's toxins. The toxic filtrate he then injects into a horse's blood stream where it generates antitoxins, which in turn can cure a patient of typhoid or prevent the disease. The Shwartzman method of using only bacterial filtrate differs from the standard method of preparing diphtheria antitoxin, according to which whole diphtheria germs are placed in a horse's blood to create antitoxins and antibodies. Shwartzman sera affect diseases ordinarily hard to handle, as typhoid, ulcerative colitis (often mistaken for amebic dysentery), meningitis. To describe the efficacy of his method Dr. Shwartzman told how he injected typhoid germs into an unimmunized rabbit's skin. Next day he put some typhoid germs in the rabbit's blood. Promptly the spot where he first made the typhoid injection burst into a vicious sore. That did not happen to rabbits who had received typhoid antitoxin first. For his profound work, the A. M. A. gave Dr. Shwartzman, who is head of the Department of Bacteriology in Manhattan's Mt. Sinai Hospital, its gold medal, glad that Russia exiled him, that Rumania where he found haven proved unattractive to a scientist. Mt. Sinai and New Orleans' Charity and U. S. Marine Hospitals are using Shwartzman antitoxin. Heart Disease, most common cause of U. S. deaths, brought forth three significant points: 1) Cholesterol causes hardening of the coronary artery, which supplies blood to the heart muscle. For discovering that, Dr. Timothy Leary of Boston received a prize. Common source of cholesterol is the yolk of eggs. Only animal to eat eggs habitually is man, practically the only creature who suffers from coronary hardening. Perhaps, thinks Dr. Leary, the coincidence covers cause and effect. 2) First to study the size of the heart with a hardening coronary artery were Drs. Morris M. Weiss and Emmet F. Horine of Louisville, who found, contrary to belief, that the "coronary" heart does not enlarge, will not suddenly cease function, that the patient may live indefinitely with care and medical supervision. 3) Alternative symptoms are what the general practitioner should look for, advised Diagnostician Emanuel Libman of Manhattan. People with heart attacks need not necessarily have pain around the heart. They may belch, sweat, complain of indigestion, headache, toothache. Concerning Cancer, the nation's second affliction, and Pneumonia, the third, and Leukemia which is terrifying many a U. S. family, the convention had little to say, and nothing of large importance. There was a symposium on Amebic Dysentery, instructive, but anticlimactic after last autumn's catastrophe in Chicago. Appendicitis. The fact that not one of no Dartmouth students who came with appendicitis to Drs. John F. Gile and John P. Bowler of Hanover, N. H.. died after the operation gave force to the doctors' contention that "in the hands of competent physicians and surgeons appendicitis should not. and usually does not, cause death. Yet because the significance of early symptoms are not appreciated, because of home treatment and delayed surgery, a simple surgical condition progresses to the stage of complications which are ultimately responsible for a tremendous death rate, especially in young persons." Skin & Foods-- Allergy, a peculiar constitutional condition which renders a person liable to almost any irritation, accounted for two odd relations between skin and foods. Dr. Cleveland James White of Chicago traced 32 intractable cases of acne to eating chocolate, milk, wheat, oranges, tomatoes and nuts. Dr. Lewis Webb Hill of Boston found chronic eczema in young children occasionally caused by foods, especially eggs. Dr. Hill ''looked forward to the development of some method of doing away with the condition of sensitivity entirely." Hay fever 6 Crowds. Reaching toward such a goal was Dr. Reuben L. Kahn of the University of Michigan, who last New Year's won the $1,000 prize of the American Association for the Advancement of Science for his work on immunity.* Dr. Kahn's basic hypothesis is that the allergic individual suffers from some disturbance of the immunity-regulating mechanism of the body. Bombardment of micro-organisms may overstimulate immunized tissues and "may keep these tissues so keyed up that, like overzealous policemen, they may spring into inflammatory action against, for example, hay fever pollens which are actually harmless to the body." Perhaps, reasoned Dr. Kahn, the prevalence of allergy today is due to modern civilization with its group contacts in enclosed homes, factories, classrooms and theatres where disease is constantly trying to spread from neighbor to neighbor, where each one's body is constantly warding off disease. Blood, Sweat & Saliva. Blood group tests can be extended to sweat, saliva and semen, said Nobel Laureate Karl Landsteiner of the Rockefeller Institute, father of the science of blood grouping. In tracing a murderer, for example, "the blood group may be determined in a small quantity of dried saliva on the edge of an envelope or on a cigaret stub." Venom 6 Blood. Venom from moccasins controls various types of bleeding and enables the performance of many an operation. But for the most pernicious form of bleeding, hemophilia, snake venom does no good, said Drs. Samuel M. Peck and Harold A. Abel of Manhattan.

Breast v. Bottle. Dr. Clifford G. Grulee, Chicago child specialist, argued: "There is no question but that artificial feeding of infants has made great strides in recent years. It has had such success that in the minds of many physicians and perhaps a large proportion of the laity, there has grown up the idea that artificial formulae safely can replace breast milk without any detrimental results to the child. So far as the authors know this has been based on empiric observations and has not been supported by sufficient evidence to be regarded as in any way proof." On the contrary, bottle babies develop stomach disorders, colds and other infections more easily than breast babies, and they die in greater numbers.

Presidents. Dr. Dean Lewis of Johns Hopkins ended his year's term as A. M. A. president, received a gold medal to commemorate the honorary job. Into office went Dr. Walter Lawrence Bierring of Des Moines, onetime professor at Iowa State and Drake Universities, longtime member of the National Board of Medical Examiners. Elected to succeed President Bierring next year was Dr. James Somerville McLester of the University of Alabama.

*Soon as he received the $1,000 check, Dr. Kahn told friends last week, he endorsed it to Dr. Emanuel Librnan, Manhattan diagnostician (see p. 51), who had loaned him $2.000 to buy an Ann Arbor home.

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