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SYSTOLIC MITRAL MURMURS AMONG RECRUITS.
909
SYSTOLIC
same way, they will have different actions MITRAL MURMURS AMONG other tissues ; if both destroy the liver, one will RECRUITS. also affect the kidney and heart muscle, while the other ON of both sides the Atlantic systolic mitral will injure the suprarenals and the nervous system. have caused uncertainty in the examination There is an enormous diversity of known and unknown recruits and in the discharging and pensioning poisons ; there are enough organs and parts of organsof in the body to furnish by permutations and combina- of soldiers, and they come under discussion in tions specific actions for all of them, and if eventually the military medical journals of both countries, these possibilities are exhausted the introduction of the conclusion arrived at being much the same : variations in degree and kind of injury into the: a mitral systolic murmur by itself is no evidence calculation will supply a niche for anything. It seemsi of heart disease. Dr. K. R. Smith, in the last of the R.A.17.C., discusses the cases known likely, therefore, that the identification of poisons, Journal D.A.]Ell. (disordered action of the heart), whose by the symptoms they produce is a question of refine- as ment of diagnosis. The progress of diagnosis indeed usual symptom is distress upon exertion, the has consisted of the separation of what appeared toI pulse- and respiration-rates being then accelerated, Of the generation of diseases which alae nasi working, and the distress subsiding only be identical. These evidences of distress on exertion are new in the sense that they have never occurred slowly. before there is no serious evidence. Diseases are are named the effort syndrome, they prove an in4. new " only because they have not previously been capacity but not necessarily a disease of the heart. Complaint is usually made of breathlessness, pain in recognised as different from something else. The, the praecordia, exhaustion, faintness, and giddiness, differentiation of arsenical diarrhoea would probably and these symptoms may in many cases be removed , be quickly effected if it were a common disease. We exercises. But these men are to be graduated by that its as characters will remain obscure may hope as unfit for duty if their symptoms are rejected of as those the sweating sickness. associated with attacks of rheumatic fever, with praecordial hyperalgesia, with tachycardia over 120 when recumbent, with objectively severe dyspnoea INTUSSUSCEPTION LIMITED TO THE APPENDIX. on exertion, strongly marked effort syndrome, or INTUSSUSCEPTION limited to the appendix is rare. continuance of symptoms over many years. Systolic In the majority of cases of its involvement in intus- mitral murmurs are of little account. Patients, susception the appendix is carried along with the Dr. Smith says, if invalided for systolic murmurs intussusception incidentally or forms its apex. In the alone, are subsequently nearly always found fit for Medical Journal of Australia of Feb. 25th Mr. R. D. active service, and in fact such men have stood the McIntosh has reported the case of a man, aged 21 years, severest strains of active service without accident. admitted on Nov. 16th, 1921, to the Melbourne Many men, moreover, doing heavy work with energy Hospital under the care of Mr. B. T. Zwar with the and comfort have these murmurs, but if there is diagnosis of subacute appendicitis. On Nov. 1st, cardiac hypertrophy the man must be rejected. while in good health, he noticed a sense of fullness in Lieut.-Colonel Roger Brooke, Medical Corps, U.S. the left epigastrium. Next morning he felt severe colicky Army, discusses, in the Military Surgeon for March, pain, which began in the right iliac fossa and worked 2400 recorded cases of men entered into the service round the abdomen, returning almost to the starting with cardio-vascular symptoms. They were repoint. This pain -recurred daily in attacks lasting examined on discharge. Of 459 accepted with from one to three or four hours. In addition there functional systolic murmur, and 687 with mitral was constant dull pain in the right iliac fossa. About regurgitation without hypertrophy, nine were dis" two hours after the onset of pain he vomited and charged as V.D.H.," 0-8 per cent.but it is noted continued to do so intermittently for over an hour. that of the nine only three have applied for a disability Both types of pain persisted up to admission ; their pension. Of the 2400, 90 were discharged, but it is situation had not changed, but they gradually became held that 60 were discharged through incomplete less severe. The bowels had acted regularly without appreciation of the effort syndrome. A mitral aperients until 16 days before admission, when they systolic murmur is held to be merely functional unless became constipated but were kept open by aperients. it is associated with cardiac hypertrophy, or with The stools were of normal appearance. The tempera- rheumatism, chorea, or tonsillitis, and with accented ture and pulse were normal, but the breath was some- pulmonary second sound, or with the effort syndrome. The abdomen what foul and the tongue furred. moved well with respiration and there was no distenTHE NUBILE AGE. sion. On palpation, the right iliac region was found tender there and and was a WHEN the Home rigid slightly markedly Secretary, in reply to a question The tenderness in the House of Commons, stated recently that at certain amount of hypersesthesia. and hyperaesthesia extended upwards towards the 12 years of age a girl is at law capable of marriage loin. The urine was normal. The diagnosis was manv were probably surprised. They, no doubt, also inflammation of an appendix which was passing agreed with Mr. Shortt that the age is too low and upwards towards the right kidney, probably retro- ought to be raised, and regretted that such raising csecal and undergoing gangrenous change. Laparo- is likely to be postponed until some measure for the tomy was performed by a muscle-splitting incision revision of the law of marriage generally is introduced. over McBurney’s point. The csecum was found com- By the law as it stands a child of either sex less than pletely fixed by the peritoneal reflexion. The appendix 7 years of age cannot be married. A girl between the could be felt through the caecal wall passing upwards ages’ of 7 and 12 and a boy between the ages of 7 and and outwards towards the right kidney. The caecum 14 cannot contract a valid marriage, but only one was mobilised and it was then found that the appendix which is inchoate or imperfect, depending for its was lying inside it. Corresponding to its base was a future validity in the case of a girl upon her ratifying small dimple.in the csecal wall. The csecum was it when she has attained the age of 12, and in the opened and a gangrenous appendix completely turned case of a boy upon his doing so when he is 14 years inside out, like the inverted finger of a glove, was of age. A boy at 14 and a girl at 12 can marry, but delivered through the opening. The inversion was no one who marries such a child can obtain property definitely limited to the appendix. The base of by so doing, if the parents or guardians have not the appendix was crushed, ligated, and divided. consented to the marriage. Otherwise the consent of The stump was cauterised with carbolic acid the parents is not necessary in order that a marriage and then covered with mucous membrane. The once celebrated may be valid, for the tendency of the opening in the caecum was closed with two law is to respect a marriage which has once taken layers of catgut sutures. The abdominal wall was place, whatever penalties may be incurred by persons closed, drainage being provided. Recovery was guilty of irregularities in connexion with it. " Semper uninterrupted. presumitur pro matrimonio," is the legal maxim
organ in the on
I murmurs
,
,
,
SYSTOLIC
same way, they will have different actions MITRAL MURMURS AMONG other tissues ; if both destroy the liver, one will RECRUITS. also affect the kidney and heart muscle, while the other ON of both sides the Atlantic systolic mitral will injure the suprarenals and the nervous system. have caused uncertainty in the examination There is an enormous diversity of known and unknown recruits and in the discharging and pensioning poisons ; there are enough organs and parts of organsof in the body to furnish by permutations and combina- of soldiers, and they come under discussion in tions specific actions for all of them, and if eventually the military medical journals of both countries, these possibilities are exhausted the introduction of the conclusion arrived at being much the same : variations in degree and kind of injury into the: a mitral systolic murmur by itself is no evidence calculation will supply a niche for anything. It seemsi of heart disease. Dr. K. R. Smith, in the last of the R.A.17.C., discusses the cases known likely, therefore, that the identification of poisons, Journal D.A.]Ell. (disordered action of the heart), whose by the symptoms they produce is a question of refine- as ment of diagnosis. The progress of diagnosis indeed usual symptom is distress upon exertion, the has consisted of the separation of what appeared toI pulse- and respiration-rates being then accelerated, Of the generation of diseases which alae nasi working, and the distress subsiding only be identical. These evidences of distress on exertion are new in the sense that they have never occurred slowly. before there is no serious evidence. Diseases are are named the effort syndrome, they prove an in4. new " only because they have not previously been capacity but not necessarily a disease of the heart. Complaint is usually made of breathlessness, pain in recognised as different from something else. The, the praecordia, exhaustion, faintness, and giddiness, differentiation of arsenical diarrhoea would probably and these symptoms may in many cases be removed , be quickly effected if it were a common disease. We exercises. But these men are to be graduated by that its as characters will remain obscure may hope as unfit for duty if their symptoms are rejected of as those the sweating sickness. associated with attacks of rheumatic fever, with praecordial hyperalgesia, with tachycardia over 120 when recumbent, with objectively severe dyspnoea INTUSSUSCEPTION LIMITED TO THE APPENDIX. on exertion, strongly marked effort syndrome, or INTUSSUSCEPTION limited to the appendix is rare. continuance of symptoms over many years. Systolic In the majority of cases of its involvement in intus- mitral murmurs are of little account. Patients, susception the appendix is carried along with the Dr. Smith says, if invalided for systolic murmurs intussusception incidentally or forms its apex. In the alone, are subsequently nearly always found fit for Medical Journal of Australia of Feb. 25th Mr. R. D. active service, and in fact such men have stood the McIntosh has reported the case of a man, aged 21 years, severest strains of active service without accident. admitted on Nov. 16th, 1921, to the Melbourne Many men, moreover, doing heavy work with energy Hospital under the care of Mr. B. T. Zwar with the and comfort have these murmurs, but if there is diagnosis of subacute appendicitis. On Nov. 1st, cardiac hypertrophy the man must be rejected. while in good health, he noticed a sense of fullness in Lieut.-Colonel Roger Brooke, Medical Corps, U.S. the left epigastrium. Next morning he felt severe colicky Army, discusses, in the Military Surgeon for March, pain, which began in the right iliac fossa and worked 2400 recorded cases of men entered into the service round the abdomen, returning almost to the starting with cardio-vascular symptoms. They were repoint. This pain -recurred daily in attacks lasting examined on discharge. Of 459 accepted with from one to three or four hours. In addition there functional systolic murmur, and 687 with mitral was constant dull pain in the right iliac fossa. About regurgitation without hypertrophy, nine were dis" two hours after the onset of pain he vomited and charged as V.D.H.," 0-8 per cent.but it is noted continued to do so intermittently for over an hour. that of the nine only three have applied for a disability Both types of pain persisted up to admission ; their pension. Of the 2400, 90 were discharged, but it is situation had not changed, but they gradually became held that 60 were discharged through incomplete less severe. The bowels had acted regularly without appreciation of the effort syndrome. A mitral aperients until 16 days before admission, when they systolic murmur is held to be merely functional unless became constipated but were kept open by aperients. it is associated with cardiac hypertrophy, or with The stools were of normal appearance. The tempera- rheumatism, chorea, or tonsillitis, and with accented ture and pulse were normal, but the breath was some- pulmonary second sound, or with the effort syndrome. The abdomen what foul and the tongue furred. moved well with respiration and there was no distenTHE NUBILE AGE. sion. On palpation, the right iliac region was found tender there and and was a WHEN the Home rigid slightly markedly Secretary, in reply to a question The tenderness in the House of Commons, stated recently that at certain amount of hypersesthesia. and hyperaesthesia extended upwards towards the 12 years of age a girl is at law capable of marriage loin. The urine was normal. The diagnosis was manv were probably surprised. They, no doubt, also inflammation of an appendix which was passing agreed with Mr. Shortt that the age is too low and upwards towards the right kidney, probably retro- ought to be raised, and regretted that such raising csecal and undergoing gangrenous change. Laparo- is likely to be postponed until some measure for the tomy was performed by a muscle-splitting incision revision of the law of marriage generally is introduced. over McBurney’s point. The csecum was found com- By the law as it stands a child of either sex less than pletely fixed by the peritoneal reflexion. The appendix 7 years of age cannot be married. A girl between the could be felt through the caecal wall passing upwards ages’ of 7 and 12 and a boy between the ages of 7 and and outwards towards the right kidney. The caecum 14 cannot contract a valid marriage, but only one was mobilised and it was then found that the appendix which is inchoate or imperfect, depending for its was lying inside it. Corresponding to its base was a future validity in the case of a girl upon her ratifying small dimple.in the csecal wall. The csecum was it when she has attained the age of 12, and in the opened and a gangrenous appendix completely turned case of a boy upon his doing so when he is 14 years inside out, like the inverted finger of a glove, was of age. A boy at 14 and a girl at 12 can marry, but delivered through the opening. The inversion was no one who marries such a child can obtain property definitely limited to the appendix. The base of by so doing, if the parents or guardians have not the appendix was crushed, ligated, and divided. consented to the marriage. Otherwise the consent of The stump was cauterised with carbolic acid the parents is not necessary in order that a marriage and then covered with mucous membrane. The once celebrated may be valid, for the tendency of the opening in the caecum was closed with two law is to respect a marriage which has once taken layers of catgut sutures. The abdominal wall was place, whatever penalties may be incurred by persons closed, drainage being provided. Recovery was guilty of irregularities in connexion with it. " Semper uninterrupted. presumitur pro matrimonio," is the legal maxim
organ in the on
I murmurs
,
,
,