| Show r ri r 0 I How I Jt N I t Son I I i j 1 Medical Science Explains ns Just cr ir r What Led to t the Shockingly t r fi F b bt Sudden Tragedy That Has t tk s f Vy t sA F Fr Fh r h Sli the Whole Nation Grieved S i V dr P Y Yr r t a r rt t 9 v 5 t 1 I a s1 V i i b s ev y t v 1 t 1 i f U t r J y Ayi r yi i it itt r l ry af A Ar Ae e to r A I Ito Y Yr YA r i U n l 1 i a y r I a 8 Y o r rY e r 1 I r re w e iC C u 4 elks i nr w a t r si i A af f y Na t o N NA SY k f s f a N t a i ow 65 r 1 a w e 4 I Pi a m 1 j rs s 7 e er r o th h y 9 S c a y 4 t I F t i iy c sY ft eh y yr r i J I 1 4 1 J D 4 r 7 a i 4 r Jv S y r q 5 F Yeti dpi s W e ej j a a r C Cs s s 1 pAr y V Nj G w wr r q y ti tir ti'S r I S 'S t a j six v d 4 f h t r rs s i Y sr f Li f n 4 f y h f f a is r t i r d f i tv 9 e l m b Calvin s I t t Coolidge Calvin jr DIAGRAMMATIC C VIEW OF THE LEG GROIN AND LOWER ABDO ABDO- ABDOMEN ABDOMEN MEN SHOWING N G THE LINE OF MARCH AND CHIEF POINTS OF ATTACK OF THE J INVADING ARMY OF BACTERIA The I-The 1 The foot through which the infectious material gained ac- ac access ac access cess to the Coolidge I boys boy's body when an apparently t trivial ri riv v i ia a I blister broke during a tennis game Making 2 2 Making their way directly into the lym lymphatic system the t h he e bacterial b ac t erial invaders start tart their rapid as- as ascent as ascent cent of the leg As 3 3 As if to deceive the physicians as to their real purpose the disease germs send senda a detachment off the main line of march to attack the I 1 t t r It j i 1 y J I J I I Y- Y Yh h w fw t f I p O e The 4 4 The bacteria as as- as 0 eO OJ CU f signed lon to the attack r O Oo 0 o A Aon l diginto on the be leg bone dig 4 o into its it ta sheath and andi i v CD 0 o them themselves e fl selves In in the marrow e G 0 setting up an inflammation mation that makes i an operation nece necessary I sary Meanwhile S-Meanwhile 5 Meanwhile the main body of bac bacteria a teria pre presses II s still higher up the leg r The 6 6 The invaders h following the lym lymphatic system whose unction function is to receive tissue juices from the finer blood vessels f move rapidly 1 7 As 7 As they reach the groin they en encounter counter cunter stronger reo re- resistance re resistance than they 4 8 1 0 have itis ave ye yet met but it rP IS is Uto not strong enough h hf I U to turn them back a ao ase se f Z S On 8 On they sueI o w I yZ e e gas go sue sue- sues s f y cess Uy attacking the important important lym- lym eda edar Z 8 os ph tic glands gland in the sl r grom groin and lower abs ab domes domeD tr More 9 9 Mora and more of the glands are sw BACTERIA THAT forced to surrender YS TOOK PART IN IN INTHE The IO-The 10 The THE ATTACK ON progress s of I the the- bacterial tt V THE ILL FATED A TED through the lower tower lower army tt YOUNG MAN MAN MAN- MANFrom abdom abdomen n u i marked From top to bot hot hot- by a nse rise In in the patients patient's patient fever and tom torn the colon ba- ba ba bacillus other unfavorable symptoms callus cillus c the staphylococcus the ll I Again ll-Again lt L l trying to camouflage age the tho and the streptococcus streptococcus as ruin they are spreading through the they look look- under the microscope microscope lymphatic system the bacteria pro pro- Some or all of these made up the in- in in invading duce produce tenderness and muscular spasms pasma vad n army that so quickly routed like eke The those found in appendicitis I Ithe the vital forces of the Presidents President's son A The 12 12 The army now turn turns its march by poisoning his whole system and down the other leg but this move is u causing causing to rage in his body no less leIS quite unnecessary for by thi this time than three diseases disease septicemia Calvin Coolidge jr is dying and acute I i i y M r i r l l r C i r r i kw p pr pIt It k d r I Th b e 2 4 V r The dead boy posing with the President and Mrs Coolidge for his last photograph just a few hours before he was taken to the hospital By ARTHUR C JACOBSON 1 D Editor or The Tho Medical Times OW was It t that the tho Presidents President's How s- s Q promising son eon Calvin Coolidge I sQ death to lr Jr r owed his untimely such an apparently insignificant thing as a small blister bUster on his foot foot The blister was vas engendered by the heat and friction ol ot a tennis shoe ahoe worn during play without stockings The wearing of clean stockings would have afforded some protection against the tho entrance of some of ot the infectious ma material tens that is likely to be present in any anymore anymore anymore more or less soiled and used tennis shoe As it was such infectious mate mate- mate mate-lial lIal did gain entrance to the boys boy's system system tem tear through tho the breaking of the tho blister a strenuous tennis game What happened then The bacterial burglars did not tarry long in this vestibule of a precious human body They made their way dIrectly into the lymphatic circulation climbing by that of the young mara mans leg WilY way up Into the glands of ot the tha groin grom To gain gam entrance entra to the blood stream Itself from which vantage ground they could steal away the patients patient's life was what hat they planned to accomplish The function of or the lymphatic vessels is to receive the tissue juices supplied by the tho finer blood vessels by way ot of nourishment and finally to pour them into a tube known as the thoracic duct whIch conducts them into the great veins of the neck On their nay May back to the blood stream these juices pass known through the many way stations as the lymphatic gln glands ds which act as filters and rectifiers and bacterial sch- sch scavengers engers Now when ben the bacteria stormed storied the lymphatic glands in young Calvins Calvin's groin a great battle ensued These citadels c like the Belgian forts In 1914 temporarily resisted the tho bri- bri brigades bri brigades gades tades and shock troops but were soon forced to surrender for reasons v which shall be bo explained later Meanwhile detachments of ot the J ing army of disease germs had bad dug duff into Inte the or sheath of the leg bone finally entrenching themselves in inthe inthe inthe the bone itself even to the very verg ver mar mar- marrow nar- nar narrow mar marrow row This brought about the Infection whIch figured in the press dispatches as At first however the local signs of ot this condition were not very ery marked and the tha boys boy's constitutIonal constitutional constitutional disturbance seemed ed more attrib attrib- attributable attributable attributable to the trouble in the groin These tactics on the part of of the InfectIOus infectious organisms seem to have been part ot of a malicious strategy which aimed to delude the tho doctors into thinking that the little hWo fellow might have appendicitis The area of ot the lower abdomen imme Imme- immediately above the groin grom both superficial and deep deep displayed tenderness and mus mus- muscular mus- mus muscular muscular cular spasm not unlike that observed In appendicitis But the diagnostic skill shill of the physiCians physicians clans promptly detected this ruse The was waa radically dealt with and the doctors were not deceived about the serious things that were happen happen- happening ing mg in the bloodstream blood str stream stream am and defensIve mechanisms of the boys boy's body While the modern surgeon and bac bac- bacteriologist bacteriologist may not always alwn's be ablo to cope successfully with their bacterIal enemIes they at least have a system of espIonage beside which the secret servo service service ice of any of the worlds world's governments past or ar pre present ent fails falls in impressiveness Nothing sea escapes pes the spies of the path pathologist His sensitive tests reveal to n a the tho reactions of the Invaders and of the attacked Now while all this was going on that little portal of entry the broken blister had apparently ap healed An insignificant cant wound says sas Dr Francis T Stew Stew- Stewart Stewart Stew art art surgeon to the Pennsylvania Hos Hoe Hospital petal pital that has healed may be bo the start starts startIng starting ing log point of even the gravest form of blood poisoning In children such a n dan dan- dancer danger dancer ger seems scenic to reside particularly in tho large bone of the leg Ice I 1 WI The X-ray X is a great aid in the dIagnosIs diagnosis noses of but surgeons are always on the alert to recognize the condItion before there them is sufficient de- de de destruction of bony tissue to show In a picture re In the tho case of ot young Coolidge drainage rama-e rama was as instituted early a aThe The operation consists of making a along along along long incision in the tho soft s soft ft parts ports splitting and turning back the sheath of ot the bone and opening the marrow of ot the bone wIth a trephine gouge or chisel Sufficient clent bone is removed to expose all al the Infected marrow It is sometimes necessary to chisel a agutter gutter in the bone almost from one end to the other The suppurating mar rAar marrow row is removed by g gentle scraping and the wound is irrigated with some anti anti anti- antiseptic septic like Dakins Dakin's solution giving oft off chlorine which is of peculiar value In these cases eases When drainage and chemical sterilization tion fail fall to mitigate the constitutional symptoms amputation may bo be per per- performed performed formed as a saving life measure pro pro- provided provided vided general septic infection ot of an overwhelming oven nature has s not occurred Now in the case of young CalVIn Coolidge the continuation of fever and other grave symptoms after the opera opera- operation operation tion did not mean inefficient drainage as might sometimes be the tho trouble Since the tho infected area had been per perfectly drained these alarming symptoms symptoms symptoms toms meant a poisoning of the whole what system what Is known as a general septIcemia The constitutional S toms simp-toms mp- mp toms grew more severe chills occurred and the blood studies showed that the balance of ot power lay with tho the enemy The insidious mischief began when the bacterial cohorts passed the glands In the groin Like the camouflage ot of appendIcitis the tha was like another military diversion intended to confuse the physicians Before the poor lad died his other leg also sho showed ed signs oft of Infection t ably of ot a n nature IS septicemia plus secondary abscesses due to bacteria lodging in various parts of the body Such abscesses are most fre ire frequent frequent quent in the bones Compared with the theda thadas da days s before sciences science's knowledge of anti anti- antiseptics antiseptics is s comparatively rare at atthe atthe the present time but it is especIally prone to follow acute In some of these cases there is more or less destruction of ot the red blood cells which shows itself in m an appearance something like that found in m e II sufferer from jaundice The organisms which figure in such local and general Infections as we have been considering are members ot of either the tho or groups which are pus producing types t pes But many of these infections are ot of mixed character in which are arc found in addition to the foregoing groups cocci cocci and colon bacilli It was some or oe all of these which invaded the Coolidge sons son's system through the breach in his line of ot bodily defense created by the tho blister on his foot oot and quickly put his Vital forces to rout Dr John A Kolmer professors professor of pathology and bacteriology in ra the grad grad- graduate graduate unto school of ot tho the University of Penn Pennsylvania sylvania who was nas one of the tho medIcal attendants of the Coolidge boy treats hIs septic patients with Ith small doses ot of vaccine in the early stages provided they are aro fairly robust It t Ills His decision on this point is always 1 based ba ed upon the general condition of the I patient and the duration of the disease Regarding serum he states that it will do no harm and may do good and that its use should form a part port of the treatment of severe streptococcal infections An extract of the white blood corpuscles may be Injected under the tho skin akin or into the muscles s Finally Dr Kolmer says that occasIonally transfusion of blood may turn the tide in m favor of recovery but thIs is pOt so effective in acute as In pr protracted cases It has been suggested that Professor method of ot treating pernicious pernicious cious anemia might be applied to some cases whore the bone marow is at- at attacked at attacked tacked Using local anesthesia lie he e drills holes near the top and bottom of the bone until he ho has penetrated into the marrow cavity He then passes a stream of medicated fluid through the caVIty thoroughly and more or less continuously ous y washing it out This treatment however would not meet all the surgical conditions usually present in a B case of acute Bute r I Recovery in a case like that of young Coolidge hinges upon the degree of viru viru- virulence virulence lence lento of ot the infective organisms upon the degree of the patients patient's natural re- re resIstance resistance resistance and upon the efficacy of the Inoculations employed to enhance im immunity artificially There Thero are cases in which the viru viru- virulence virulence lence lento of the invading bacteria is such that even vigorous resisting powers are ot of no avail As a rule however proper propel I local and general measures will enable a victim of septic infection to recover It has hae been suggested that it was not so much the virulence of the streptococci cocci overcoming o a normal degree of resIsting power that accounted for the boys boy's death as it was rather a low de- de degree de degree gree of ot vitality The argument for this vIew is that it was the custom of young f Calvin according to press reports to engage In hard work during the summer months For example last summer he was waa em- em employed em in a tobacco factory in a Massa Massachusetts town He Ho would get up at sunrise ride eight miles on his bicycle to his nis work then and and Ithen stack bundles ot of tobacco lea leaves leases es all day quitting at sun drain down sundown and again riding home For thIs work he earned about a B day It is contended that this was bad per per- personal hygiene for any sixteen year sixteen sixteen year old boy not extraordinarily endowed by nature in a physical way and that the young growing lad should have spent those early morning hours w in restful and reinvigorating sleep Jeep We are asked to believe that young Calvins Calvin's contact With the industrial treadmill bore a direct relation to his death and that whatever Spirit of ot thrift and self-confidence self the factory boy may have gained through his fac fec tory experience v was as too dearly paid for with forwith his life This Thia theory seems to us too tural and academic for much tion There is no so way of disproving it now It proving or mayor may or may not have a basis bolSIS of truth Tho The moral for the tho public in the edy tragedy which has trag trag- come to tho the White House IS that any kind of ot break in the skin matter how received should not be as dis no regarded but dealt I wIthas with as a Possible avenue of infection I l r |
