Doctors' Signposts

Some 3,800 doctors, specialists in internal medicine, convened in San Francisco last week to swap shoptalk on everything from bedside treatment to basic science. The occasion: the annual meeting of the American College of Physicians. The doctors posted no huge billboards announcing dramatic cures, but they set up a few small signposts pointing in hopeful directions. Items:

THE COMMON COLD. There is no hint yet of either a preventive or a cure for the common cold. Reporting for a University of Illinois team that has made thousands of tests on 2,500 volunteer cold-catchers, Dr. George Gee Jackson suggested that the idea that there is a specific common-cold virus, peculiar to man, had best be abandoned completely. No fewer than 70 viruses have been shown to cause human diseases that run the gamut from the simple common cold (runny nose and other discomforts, but usually no fever) to influenza. Most discouraging for snifflers awaiting a wonder drug: in some people, at some times, viruses of supposedly the relatively harmless, common-cold class may cause disease as severe as influenza, while the more feared influenza viruses may give rise to symptoms no more severe than those of the common cold.

And there are all kinds of intermediates.*

RHEUMATIC DISEASES. Ten years' experience has shown that hormones of the cortisone family, while giving temporary relief, often do as much harm as good in rheumatic diseases. But the Mayo Clinic's famed Dr. Philip S. Hench, pioneer (with Chemist Edward Kendall) in the extraction and use of these products, struck out on a bold new line. The natural pituitary hormone ACTH and the cortisone-type drugs, he said, must be viewed not only as remedies, but also as research tools. His new theory, based on observations of thousands of patients: it is neither a simple excess nor a simple deficit of adrenal hormones that triggers the onset or recurrence of rheumatoid arthritis and related diseases. It is, he asserted, a "turn of the tide"--a change in the circulating hydrocortisone from abnormally high to low levels--that does the damage.

In normal people, he said, the hydrocortisone output goes up sharply in the early morning hours to a peak around 6 a.m., then falls gradually to a nighttime resting level. In a rheumatoid arthritis victim, this pattern is generally reversed. Lacking adaptive ability, the patient reacts with a flare-up of disease when the cortisone tide ebbs. This may happen after delivery to a woman who has been free of arthritis symptoms during pregnancy. The letdown phenomenon is also seen in patients after long-term cortisone treatment.

Dr. Hench challenged his hearers with the defiant statement that they would probably be unable to accept his theory at this stage. But since he suggested that it applied, beyond rheumatoid arthritis, to several disorders such as rheumatic fever, gout, psoriasis and ulcerative colitis, he left them with much to ponder.

MONGOLISM. Now that the number of chromosomes in human cells is established at 46, correcting a long-held error, variations from the normal are showing up in more and more inborn defects. Dr. Malcolm A. Ferguson-Smith of Johns Hopkins reported that in Mongolism, where an extra chromosome has been found, the anomaly appears to be the result of a failure in subdivision, traceable to the maternal egg. In a wide range of sex abnormalities related to hermaphroditism. the number of chromosomes may range from 45 to 48. Among the anomalies, "super females" with three X (female) chromosomes, and a variant with three X chromosomes and one Y (male).

LUNG DISEASE. In addition to an overall increase reported in the breathing disorder known as pulmonary emphysema, an apparently new form has been described in the last few years, said Manhattan's No-belman Dickinson W. Richards. Not yet given a name of its own, it is marked by an apparent wasting away of tissues, resulting in big holes in the lungs (usually the upper lobes). Victims are generally aged 30 to 40, and most have been heavy smokers, but no direct cause-and-effect relationship between smoking and the disease has been shown. Treatment: surgery to remove the diseased part of the lung.

AUTO-ALLERGY. Can a man become allergic to parts of his own body? Yes, said a panel of experts. Two clear-cut types of auto-allergy are firmly established. Both involve the eye and, although rare, can be serious enough to cause blindness. In one, injury (which may result from surgery) causes part of the uvea (the pigmentary layer of tissues in the eye) to be misplaced, and this sets up inflammation. Most remarkably, the sight-threatening reaction develops in both eyes, though only one was injured. The second type results when a fragment of lens tissue is left after an operation for cataract. For this, the eye sometimes has to be removed.

Beyond these, there are a score of conditions in which antibody hunters suspect that auto-allergy plays a role, e.g., multiple sclerosis, rheumatic fever, rheumatoid arthritis, and severe forms of kidney disease. The University of Washington's Dr. Paul P. Van Arsdel Jr. called attention to the appearance of antibodies against their own heart-muscle tissue in victims of heart attacks. When the antibodies appear, they have no effect on the healing of the heart muscle. The consensus: anti bodies will probably appear after protracted damage to any tissues.

*Coeds among the volunteers showed a marked monthly cycle when it came to catching colds: most susceptible as the time of ovulation approached, and again toward the end of the cycle, they were almost completely protected against infection during menstruation. But, like everything else that has been learned about the common cold, this offered no hope for control.

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