emergency medical technicians to make sure that they really were justified in their intubation attempts.
by
Roger E. Alberty, MD The Portland Clinic
Portland, Ore
In Reply.\p=m-\We completely agree with Dr Alberty that too often inexperienced persons attempt intubation that is completely unnecessary. In the past, many persons reached our hospital using a simple oral airway with self-inflating bag. Some patients had, in fact, been supported for several hours coming from rural Colorado. Thus, intubation should be attempted only by those with requisite experience, and emphasis should be placed on simpler and safer methods of respiratory support in situations where training may not be adequate. This point was stressed in our monograph Intensive and Rehabilitative Respiratory Care (Philadelphia, Lea &
Febiger Publishers, 1974, p 16).
Thomas L. Petty, MD John L. Stauffer, MD University of Colorado Medical Center Denver
Munchausen Variant
Syndrome:
A New
To the Editor.\p=m-\In 1975 we reported in these pages (231:22, 1975) "Major Munchausen," who later appeared at the University of Kansas Medical Center and in March 1977 at Wilmington, Del. Fort Collins, Colo, has been blessed with a new variant of the Munchausen syndrome, a man who has an open admission pass to any hospital in the United States. He appeared at Poudre
Valley Memorial Hospital in June 1977 stating he had Wolff-Parkinson-White (WPW) syndrome and severe chest and back pain. His history was changeable, including cardioversion in Phoenix, Ariz (not confirmed by phoning), and admission in Las Vegas in December 1976 with normal coronary arteriography. Also, recent history was given of an alleged head injury on an oil crew in Wyoming and transfer to a neurosurgeon in Salt Lake City and a neurologist in Fort Collins, Colo. Previous physicians were contacted and indicated that he made undue requests for pain medications, although he had a basically friendly and
intelligent demeanor.
His ECG pattern fits the WPW
syndrome with a PR segment of 0.14 sec, a QRS complex of 0.10 but with
definite ô wave, and ventricular
com-
plexes of normal propagation. He
cardiac medications. A meperidine shot was given only on admission, with the patient evidencing much grimacing and thrashing to the nurses, but all further complaints of pain were treated with intravenous diazepam. Serial ECG and enzymes showed no changes, and his pain was atypical. The patient was informed that no acute cardiac problem was found, and he quietly agreed to dis¬ missal. The patient can be physically identified as a muscular, 33-year-old white man with a blue and red serpent and cross tatoo on his arm and two elaborate, cross-shaped, homemade tatoos on the left anterior side of his chest and his left forearm. The insurance information he gave was not confirmed, and our unpaid hospital bill was $2,160.20 (for this and prior head injury admission). The editorial entitled "The Immortal Baron" in The Journal (230:90, 1974) emphasized the need for Munchausen cases to reach definitive psychiatric care. I would add that there is tremen¬ dous financial drain (the bills are almost invariably upaid) in dealing with such a patient who reaches the emergency room with a history and findings that cannot be safely turned down. S. E. Hyler, MD, is interested in conducting research on Munchausen syndrome to emphasize its early diag¬ nosis, to trace movement of patients, and to establish it as a recognized psychiatric entity to increase research and therapy. Dr Hyler is interested in receiving individual case reports and can be contacted for his research ques¬ tionnaire at 5620 Netherland Avenue, Riverdale (Bronx), NY 10471. received
no
sclerosis have elevated levels of measles antibodies in their serum and cerebrospinal fluid.4 Optic neuritis in dogs with chronic distemper shows changes such as pallor of the discs similar to the findings in human patients with severe demyelinating disease such as MS. There is no firm evidence that human beings get distemper or measles from dogs. Likewise, dogs do not get measles from humans or from being inoculated with live measles virus; they do acquire antibodies protective
against distemper. Distemper is not contagious for humans, and multiple sclerosis is not a contagious disease and does not occur in epidemics or zoonoses as does distemper in dogs. John M. Adams, MD, PhD Harold D. Snow, DVM UCLA Medical Center
Los Angeles Imagawa DT: Immunological relationship between measles and distemper viruses. Proc Soc Exp Biol Med 96:240, 1957. 2. Adams JM, Snow HD: Viral demyelinating encephalitis and old dog encephalitis possible relationship to distemper, measles and demyelinating disease of man. Cal
1. Adams JM,
Vet 27:8-10, 1973.
3. Adams JM, Brown WJ, Snow HD, et al: Old dog encephalitis and demyelinating diseases in man. Vet Pathol 12:220-226, 1975. 4. Adams JM, Imagawa DT: Measles antibodies in multiple sclerosis. Proc Soc Exp Biol Med 8:562, 1962. 5. Adams JM: A possible animal model for severe demyelinating diseases of man. N Engl J Med 290:973, 1974.
Harry V. Unfug, MD Fort Collins, Colo
Multiple Sclerosis and House Pets
To the Editor.\p=m-\To clear the air
regarding multiple sclerosis and exposure to house pets (238:854, 1977), it should be pointed out that distemper in dogs is comparable to measles in human similar
beings.1 The
clinical respective hosts. sles are related
two viruses cause illnesses in their
Distemper and meaimmunologically and pathologically. Pathologic changes in multiple sclerosis (MS) such as peri\x=req-\ vascular infiltration with lymphocytes and plasma cells and demyelination are
similar to those seen in old cephalitis.2,3 Patients with
dog
en-
multiple
Downloaded From: http://jama.jamanetwork.com/ by a Karolinska Institutet University Library User on 05/23/2015
Otitis Media Report. \p=m-\Inthe Sept 5 issue of The Journal (238:1032-1033, 1977), the ORIGINAL CONTRIBUTION "Acute Purulent Otitis Media in Children Older Than 5 Years: Incidence of Haemophilus as a Causative Organism" referred to two reports from Scandinavia instead of one. On page 1033, the two sentences beginning in line 22 of column 1 should read as follows: "One recent report from Scandinavia14 has shown a higher incidence of isolates of H influenzae from otitis media than previously reported.12,13 In this series,14 H influenzae was found even in excess of S pneumoniae in otitis media in children older than 5
years." Osmolality Reference. \p=m-\Inthe Sept 12 issue of The Journal (238:1187, 1977), the QUESTION AND ANSWER
concerning serum and urine osmolality determination cited a reference inaccurately in line 13 of the answer.
The correct citation should read N
Engl J Med 290:1184-1187, 1974.
by
Roger E. Alberty, MD The Portland Clinic
Portland, Ore
In Reply.\p=m-\We completely agree with Dr Alberty that too often inexperienced persons attempt intubation that is completely unnecessary. In the past, many persons reached our hospital using a simple oral airway with self-inflating bag. Some patients had, in fact, been supported for several hours coming from rural Colorado. Thus, intubation should be attempted only by those with requisite experience, and emphasis should be placed on simpler and safer methods of respiratory support in situations where training may not be adequate. This point was stressed in our monograph Intensive and Rehabilitative Respiratory Care (Philadelphia, Lea &
Febiger Publishers, 1974, p 16).
Thomas L. Petty, MD John L. Stauffer, MD University of Colorado Medical Center Denver
Munchausen Variant
Syndrome:
A New
To the Editor.\p=m-\In 1975 we reported in these pages (231:22, 1975) "Major Munchausen," who later appeared at the University of Kansas Medical Center and in March 1977 at Wilmington, Del. Fort Collins, Colo, has been blessed with a new variant of the Munchausen syndrome, a man who has an open admission pass to any hospital in the United States. He appeared at Poudre
Valley Memorial Hospital in June 1977 stating he had Wolff-Parkinson-White (WPW) syndrome and severe chest and back pain. His history was changeable, including cardioversion in Phoenix, Ariz (not confirmed by phoning), and admission in Las Vegas in December 1976 with normal coronary arteriography. Also, recent history was given of an alleged head injury on an oil crew in Wyoming and transfer to a neurosurgeon in Salt Lake City and a neurologist in Fort Collins, Colo. Previous physicians were contacted and indicated that he made undue requests for pain medications, although he had a basically friendly and
intelligent demeanor.
His ECG pattern fits the WPW
syndrome with a PR segment of 0.14 sec, a QRS complex of 0.10 but with
definite ô wave, and ventricular
com-
plexes of normal propagation. He
cardiac medications. A meperidine shot was given only on admission, with the patient evidencing much grimacing and thrashing to the nurses, but all further complaints of pain were treated with intravenous diazepam. Serial ECG and enzymes showed no changes, and his pain was atypical. The patient was informed that no acute cardiac problem was found, and he quietly agreed to dis¬ missal. The patient can be physically identified as a muscular, 33-year-old white man with a blue and red serpent and cross tatoo on his arm and two elaborate, cross-shaped, homemade tatoos on the left anterior side of his chest and his left forearm. The insurance information he gave was not confirmed, and our unpaid hospital bill was $2,160.20 (for this and prior head injury admission). The editorial entitled "The Immortal Baron" in The Journal (230:90, 1974) emphasized the need for Munchausen cases to reach definitive psychiatric care. I would add that there is tremen¬ dous financial drain (the bills are almost invariably upaid) in dealing with such a patient who reaches the emergency room with a history and findings that cannot be safely turned down. S. E. Hyler, MD, is interested in conducting research on Munchausen syndrome to emphasize its early diag¬ nosis, to trace movement of patients, and to establish it as a recognized psychiatric entity to increase research and therapy. Dr Hyler is interested in receiving individual case reports and can be contacted for his research ques¬ tionnaire at 5620 Netherland Avenue, Riverdale (Bronx), NY 10471. received
no
sclerosis have elevated levels of measles antibodies in their serum and cerebrospinal fluid.4 Optic neuritis in dogs with chronic distemper shows changes such as pallor of the discs similar to the findings in human patients with severe demyelinating disease such as MS. There is no firm evidence that human beings get distemper or measles from dogs. Likewise, dogs do not get measles from humans or from being inoculated with live measles virus; they do acquire antibodies protective
against distemper. Distemper is not contagious for humans, and multiple sclerosis is not a contagious disease and does not occur in epidemics or zoonoses as does distemper in dogs. John M. Adams, MD, PhD Harold D. Snow, DVM UCLA Medical Center
Los Angeles Imagawa DT: Immunological relationship between measles and distemper viruses. Proc Soc Exp Biol Med 96:240, 1957. 2. Adams JM, Snow HD: Viral demyelinating encephalitis and old dog encephalitis possible relationship to distemper, measles and demyelinating disease of man. Cal
1. Adams JM,
Vet 27:8-10, 1973.
3. Adams JM, Brown WJ, Snow HD, et al: Old dog encephalitis and demyelinating diseases in man. Vet Pathol 12:220-226, 1975. 4. Adams JM, Imagawa DT: Measles antibodies in multiple sclerosis. Proc Soc Exp Biol Med 8:562, 1962. 5. Adams JM: A possible animal model for severe demyelinating diseases of man. N Engl J Med 290:973, 1974.
Harry V. Unfug, MD Fort Collins, Colo
Multiple Sclerosis and House Pets
To the Editor.\p=m-\To clear the air
regarding multiple sclerosis and exposure to house pets (238:854, 1977), it should be pointed out that distemper in dogs is comparable to measles in human similar
beings.1 The
clinical respective hosts. sles are related
two viruses cause illnesses in their
Distemper and meaimmunologically and pathologically. Pathologic changes in multiple sclerosis (MS) such as peri\x=req-\ vascular infiltration with lymphocytes and plasma cells and demyelination are
similar to those seen in old cephalitis.2,3 Patients with
dog
en-
multiple
Downloaded From: http://jama.jamanetwork.com/ by a Karolinska Institutet University Library User on 05/23/2015
Otitis Media Report. \p=m-\Inthe Sept 5 issue of The Journal (238:1032-1033, 1977), the ORIGINAL CONTRIBUTION "Acute Purulent Otitis Media in Children Older Than 5 Years: Incidence of Haemophilus as a Causative Organism" referred to two reports from Scandinavia instead of one. On page 1033, the two sentences beginning in line 22 of column 1 should read as follows: "One recent report from Scandinavia14 has shown a higher incidence of isolates of H influenzae from otitis media than previously reported.12,13 In this series,14 H influenzae was found even in excess of S pneumoniae in otitis media in children older than 5
years." Osmolality Reference. \p=m-\Inthe Sept 12 issue of The Journal (238:1187, 1977), the QUESTION AND ANSWER
concerning serum and urine osmolality determination cited a reference inaccurately in line 13 of the answer.
The correct citation should read N
Engl J Med 290:1184-1187, 1974.
