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TRAUMATIC RUPTURE OF THE HEART.
1199 THE PREVENTION
ON Dec. 29th last there
OF LIFE-WASTE. was
incorporated
in the
City of New York a " Life Extension Institute," having for its aim the lengthening of human life and the safeguarding and increase of indiThis end it proposes vidual human efficiency. to achieve by the appointment throughout the land of expert medical. examiners, with fully equipped clinical laboratories in all the larger towns, who will periodically examine the physical condition of its own policy-holders, of all the policy-holders of such life insurance companies as contract with it to do so, and for a small fee of any person not embraced in either of these classes, who may desire it. Schools, industrial establish-
ments, and other associations will also be contracted with, and its aid will be further afforded in cooperation with the anti-tuberculosis, social hygiene, eugenics, and similar movements, and with the health authorities. It is thought that by this means impairments" in the human
machinery will be systematiwhile callydetected they are still remediable, and the .damaged individual directed before it is too late to seek the aid of his medical attendant, who will be furnished with the collaborated findings of the The " Hygiene institute’s experts. Reference Boardof the institute, which is to consist of 100 leading experts on various subjects pertaining to health, contains many names well known to the medical profession at large, among whom may be mentioned Surgeon-General Gorgas, the sanitarian of Havana and the Panama Canal Zone, Dr. William J. Mayo, Professor William H. Welch of Johns Hopkins University, Dr. Harvey Wiley, whose name is associated with the pure food laws in the United States, The -Professor Chittenden, of Yale, and others. individual will benefit by having his attention called to beginning defects while there is yet time to repair the damage. The medical practitioner will find many of his patients directed to seek his care long before they would otherwise have done so, with the advantage of receiving a carefully collaborated physical report by various experts in their respective lines to work on. The insurance companies will have their losses from life-waste reduced as the fire insurance companies have long reduced their losses from fire-waste. It is further hoped that the vast material accumulated by the Hygiene Reference Board may in course of time enable it to furnish data whereby many disputed points in personal hygiene may ultimately be cleared up, The experiment will be watched in this country with interest: the prophecies of its future work. which we haveset out. show its scope to be indeed
swelling over the left saphenous opening was discovered. There was considerable limitation of the movements of abduction and rotation of the left thigh. No examination of the chest was made. The boy was sent to hospital, where a skiagram of the hip and pelvis was taken and showed nothing abnormal. Hot fomentations were applied to the The temperature was haematoma in the groin. 98’6° F., the pulse was 102 and regular, and the respirations were 25. He rested comfortably until about 12 hours after admission. Then he suddenly collapsed, the pulse and respiration became very rapid, and he died in an hour. At the necropsy the pericardium was found bulging forwards, very tense and full. It contained about 500 c.c. of fresh blood and about 200 grammes of dark clotted blood. At the auriculo-ventricular junction on the left side was a perforating slit about 3 millimetres long above the middle of the anterior leaf of the mitral valve. The myocardium and valves were normal. Evidently the heart was ruptured at the time the boy was jumped on, and some haemorrhage took place into the pericardium, which was followed by sealing of the perforation with clot. Some movement probably dislodged this clot, and death resulted from haemorrhage into the pericardium. It is remarkable that the boy was up and about for four days with only the clot sealing the opening. The case illustrates the lesson which will never cease to require enforcing-the necessity for complete examination of a patient. Dr. O’Neill thinks that had this been done at least an approximate diagnosis might have been made. THE ORGANISM
OF
EPIDEMIC
POLIOMYELITIS.
THE discovery that the human disease epidemic poliomyelitis could be transmitted to monkeys opened the way to accurate experimental research
this infection, and many valuable papers have since been written on this subject. The work done at the Rockefeller Institute in New York by Professor Flexner, with the assistance of Dr. Noguchi, Dr. Paul Clark, Dr. Harold Amoss, and Dr. F. R. Fraser, has been largely recorded in the Journal of Experimental Medicine, and it may be useful to summarise the results which they have obtained. The micro-organism which is the infective agent has now been cultivated on artificial media, the method used being that devised by Noguchi for the cultivation of spirochætæ, human ascitic fluid being the basis of the medium, with the addition of small pieces of solid sterile tissue, the culture being kept anaerobic by covering it with a layer of paraffin oil. Thus grown the organisms comprehensive. appear as minute globular bodies arranged in pairs, chains, and clusters, and they can also be demonTRAUMATIC RUPTURE OF THE HEART. strated in the infected tissues by means of IN the Journal of the American Medical Associa- appropriate dyes. Reinoculation of susceptible tion of Feb. 28th Dr. B. J. O’Neill has reported a animals with the cultures has been effected in one case of a very rare accident-traumatic rupture of or two instances, thus fulfilling Koch’s second the heart. A schoolboy, aged 9 years, while playing canon, but failures often occur owing to rapid loss was set on by some older boys, who knocked him of virulence in the organisms when introduced to down and jumped on him. He walked home com- artificial conditions. Their exact biological position plaining of pain in the left groin, remained in bed has not yet been determined-whether they should two days, and then got up and about for four days, be classed with the bacteria or with the mysterious still complaining of pain in the left groin and hip. group of chlamydozoa. Their minute size enables On the seventh day he was taken a distance of them to pass through the pores of a Berkefeld filter. 30 miles by train to Dr. O’Neill, still complaining of Within the body the organisms are visible not only the same symptoms. At no time did he complain in the spinal cord, but also in the brain, vertebral of pain in any other part. He walked from the and Gasserian ganglia, and abdominal sympathetic. station to the office. Examination showed a well- Poliomyelitis is thus not a special disease of developed boy walking with a decided limp and the anterior cornual cells as was previously evidently in considerable pain. Slight redness and supposed, but a general infection of the central ____
on
ON Dec. 29th last there
OF LIFE-WASTE. was
incorporated
in the
City of New York a " Life Extension Institute," having for its aim the lengthening of human life and the safeguarding and increase of indiThis end it proposes vidual human efficiency. to achieve by the appointment throughout the land of expert medical. examiners, with fully equipped clinical laboratories in all the larger towns, who will periodically examine the physical condition of its own policy-holders, of all the policy-holders of such life insurance companies as contract with it to do so, and for a small fee of any person not embraced in either of these classes, who may desire it. Schools, industrial establish-
ments, and other associations will also be contracted with, and its aid will be further afforded in cooperation with the anti-tuberculosis, social hygiene, eugenics, and similar movements, and with the health authorities. It is thought that by this means impairments" in the human
machinery will be systematiwhile callydetected they are still remediable, and the .damaged individual directed before it is too late to seek the aid of his medical attendant, who will be furnished with the collaborated findings of the The " Hygiene institute’s experts. Reference Boardof the institute, which is to consist of 100 leading experts on various subjects pertaining to health, contains many names well known to the medical profession at large, among whom may be mentioned Surgeon-General Gorgas, the sanitarian of Havana and the Panama Canal Zone, Dr. William J. Mayo, Professor William H. Welch of Johns Hopkins University, Dr. Harvey Wiley, whose name is associated with the pure food laws in the United States, The -Professor Chittenden, of Yale, and others. individual will benefit by having his attention called to beginning defects while there is yet time to repair the damage. The medical practitioner will find many of his patients directed to seek his care long before they would otherwise have done so, with the advantage of receiving a carefully collaborated physical report by various experts in their respective lines to work on. The insurance companies will have their losses from life-waste reduced as the fire insurance companies have long reduced their losses from fire-waste. It is further hoped that the vast material accumulated by the Hygiene Reference Board may in course of time enable it to furnish data whereby many disputed points in personal hygiene may ultimately be cleared up, The experiment will be watched in this country with interest: the prophecies of its future work. which we haveset out. show its scope to be indeed
swelling over the left saphenous opening was discovered. There was considerable limitation of the movements of abduction and rotation of the left thigh. No examination of the chest was made. The boy was sent to hospital, where a skiagram of the hip and pelvis was taken and showed nothing abnormal. Hot fomentations were applied to the The temperature was haematoma in the groin. 98’6° F., the pulse was 102 and regular, and the respirations were 25. He rested comfortably until about 12 hours after admission. Then he suddenly collapsed, the pulse and respiration became very rapid, and he died in an hour. At the necropsy the pericardium was found bulging forwards, very tense and full. It contained about 500 c.c. of fresh blood and about 200 grammes of dark clotted blood. At the auriculo-ventricular junction on the left side was a perforating slit about 3 millimetres long above the middle of the anterior leaf of the mitral valve. The myocardium and valves were normal. Evidently the heart was ruptured at the time the boy was jumped on, and some haemorrhage took place into the pericardium, which was followed by sealing of the perforation with clot. Some movement probably dislodged this clot, and death resulted from haemorrhage into the pericardium. It is remarkable that the boy was up and about for four days with only the clot sealing the opening. The case illustrates the lesson which will never cease to require enforcing-the necessity for complete examination of a patient. Dr. O’Neill thinks that had this been done at least an approximate diagnosis might have been made. THE ORGANISM
OF
EPIDEMIC
POLIOMYELITIS.
THE discovery that the human disease epidemic poliomyelitis could be transmitted to monkeys opened the way to accurate experimental research
this infection, and many valuable papers have since been written on this subject. The work done at the Rockefeller Institute in New York by Professor Flexner, with the assistance of Dr. Noguchi, Dr. Paul Clark, Dr. Harold Amoss, and Dr. F. R. Fraser, has been largely recorded in the Journal of Experimental Medicine, and it may be useful to summarise the results which they have obtained. The micro-organism which is the infective agent has now been cultivated on artificial media, the method used being that devised by Noguchi for the cultivation of spirochætæ, human ascitic fluid being the basis of the medium, with the addition of small pieces of solid sterile tissue, the culture being kept anaerobic by covering it with a layer of paraffin oil. Thus grown the organisms comprehensive. appear as minute globular bodies arranged in pairs, chains, and clusters, and they can also be demonTRAUMATIC RUPTURE OF THE HEART. strated in the infected tissues by means of IN the Journal of the American Medical Associa- appropriate dyes. Reinoculation of susceptible tion of Feb. 28th Dr. B. J. O’Neill has reported a animals with the cultures has been effected in one case of a very rare accident-traumatic rupture of or two instances, thus fulfilling Koch’s second the heart. A schoolboy, aged 9 years, while playing canon, but failures often occur owing to rapid loss was set on by some older boys, who knocked him of virulence in the organisms when introduced to down and jumped on him. He walked home com- artificial conditions. Their exact biological position plaining of pain in the left groin, remained in bed has not yet been determined-whether they should two days, and then got up and about for four days, be classed with the bacteria or with the mysterious still complaining of pain in the left groin and hip. group of chlamydozoa. Their minute size enables On the seventh day he was taken a distance of them to pass through the pores of a Berkefeld filter. 30 miles by train to Dr. O’Neill, still complaining of Within the body the organisms are visible not only the same symptoms. At no time did he complain in the spinal cord, but also in the brain, vertebral of pain in any other part. He walked from the and Gasserian ganglia, and abdominal sympathetic. station to the office. Examination showed a well- Poliomyelitis is thus not a special disease of developed boy walking with a decided limp and the anterior cornual cells as was previously evidently in considerable pain. Slight redness and supposed, but a general infection of the central ____
on