Alfred H. Lawton

ST. LOUIS ENCEPHALITIS: AGE ASPECTS OF 1962 EPIDEMIC IN PINELLAS COUNTY, FLORIDA

One of the unusual features of the first known outbreaks of St. Louis encephalitis (SLE) that occurred in Paris, Illinois in 1932 and St. Louis, Missouri in 1933 was the increase with age of the morbidity and mortality rates (1, 2) . This predilection for older people was a t variance with the usual age distribution of other viral encephalitides and most other viral infectious diseases (3-5). In later SLE epidemics, this age preference was not as clearcut; but the areas involved were endemic for the disease and this could have altered the age picture by the presence of increasing numbers of serologically positive, presumptively immune individuals with increasing age and length of residence in the areas (6 ,7) . The Tampa Bay area of Florida had outbreaks of encephalitis in 1959, 1961 and 1962 that were proven to be due to the SLE virus (7-12). Of the fourcounty area, Pinellas County with one-fourth of its population 65 years of age or older was the most severely affected by the epidemics. This afforded an opportunity to review the age aspects of the disease for several reasons. Serologic studies indicated that the population of this area was probably unaffected by SLE until 1959 (8). Therefore, any age relationship of SLE viral infection could be investigated without the complicating factors of accumulated immunity from prior exposure. Also, because of the high concentration of elderly persons, Pinellas County was an unusually favorable area for the demonstration of an age effect. This paper reviews some of the salient age-related findings from the investigations of the 1962 epidemic of SLE in Pinellas County, Florida.

THE ROLE OF MEDICAL EDUCATION IN GERONTOLOGY

Three titles designed to describe concisely the activities of diverse groups of biologists are currently quite popular. These titles are: Human Ecology, Human Development, and Gerontology. No one may have the temerity to suggest that these are synonyms, but it is clear that they have much in common. Each is descriptive of an effort to encompass the total impact of heredity, environment and experience upon the human being a t some selected interval along the life span. All three of these new titles represent responses to the need for bridges of integration between the many disciplines which have grown apart in pyramidal fashion from their common origins in philosophy. Biology, including Medicine, became a specialized interest which occupied the full attention of many philosophers. They sought answers to the questions about normal and diseased life processes. Studies of nature progressed to diverse fields, no longer limited to the unity of science. Philosophy gave rise to the physical and the natural sciences and, in turn, these sciences gave rise to biology, physiology, biochemistry and numerous other disciplines. As the specialized biologists became increasingly adept, their limited fields were subdivided into those dealing with detailed studies of molecules, of atoms, and even of subatomic particles. The more deeply the biologist analyzed, the farther he seemed to remove himself from the problem he meant to solve. The details he studied precluded the recapture of the concept of unified man.

BASIC PERSONALITY TRAITS CHARACTERISTIC OF PATIENTS WITH PRIMARY OBSTRUCTIVE PULMONARY EMPHYSEMA

Marly investigators have attempted to assess the role of psychologic factors in chronic disease. Since chronic obstructive emphysema is becoming increasingly important among the diseases affecting our aging population, a study of a homogeneous group of patients with this condition seemed pertinent. As far as we can determine from a review of the literature, no such report has hitherto been published. There are, however, studies (1-5) showing that bronchial asthma is often associated with such traits as hypersensitivity, marked passivity, effeminateness, emotional immaturity and a feeling of insecurity. In many cases of bronchial asthma, chronic obstructive emphysema is present as a complication. Unfortunately, in most published reports there is no differentiation between this secondary emphysema and primary emphysema not related to bronchial asthma. Thus the crucial selective criteria were not taken into account.

Optimism in the Management of Hip Fracture in Elderly Patients

The present generation of those past age 70 grew up with the idea that a fractured hip meant “the beginning of the end” for the elderly. The results reported here on the treatment of 50 consecutive patients over 70 years of age who had sustained a fractured hip indicate that in this situation the orthopedic surgeon can be an important partner in geriatric medicine. He can improve the functioning and health of this special group of elderly trauma victims through reassuring them that the fracture usually can be successfully treated without undue risk to life. The present improved state of the art of anesthesiology, surgery, and pre‐ and postoperative medical care makes the surgical risk tolerable, and helps to prevent many of the complications that used to occur in elderly patients confined to bed for long periods following hip fracture.

Report of an unusually large ventricular aneurysm.

Abstract The case of a patient with an exceedingly large ventricular aneurysm has been described. A review of the literature indicates that this may be one of the largest aneurysms yet reported.