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NONTRAUMATIC spontaneous rupture of an apparently normal spleen, considered by some as an impossibility, is indeed a rarity. Ask-Upmark 1 studied a total of 120 cases of rupture of the spleen, and it included only 2 cases in which the history was absolutely negative regarding trauma. One of the cases concerned a 43 year old man in whom the ruptured spleen was macroscopically normal. No microscopic examination was made. The other case was that of a 30 year old man. The ruptured spleen weighed 250 Gm., and it contained no coagula. The microscopic examination showed hyalinization of the arterioles and increase of stroma. Ask-Upmark concluded that a spontaneous rupture of a normal spleen is possible, explaining it on a basis of a functional lienal apoplexy. Zuckerman and Jacobi 2 reported a case of genuine spontaneous rupture of a normal spleen in a 29 year old woman, with a report of

The aim of general system theory, by common agreement, is to promote the unity of science through the integration of findings across disciplines. The aim of this paper is to outline a way to extend the theory beyond the sciences to embrace the unity of knowledge in general. The extended theory includes not only what scientists investigate but also the fields of learning that are cultivated by philosophers and theologians.

A case of acute coronary occlusion due to an embolus from an old thrombosis of the femoral vein in the presence of a patent foramen ovale is reported. There were no associated arterial or endocardial changes. The factors in its production are discussed briefly.

In the differential diagnosis of tumors, experience has shown how little one can depend on purely clinical methods for accuracy. Transillumination, x-ray examination, or x-ray in combination with the injection of radiopaque substances or air have been discussed in the past, particularly in connection with the diagnosis of breast tumors. In the final analysis, however, we must turn to the pathologist, for his corroborative evidence is by far the most important. How to obtain this evidence with the least danger to the patient is the problem. Of the methods in use, we have the frozen-section biopsy, various types of punch biopsy, and aspiration biopsy. Without going into a discussion of the merits of each one at the present time, it will be conceded that, until now, the aspiration biopsy has been the simplest and least traumatizing. Its general acceptance, however, has been hampered considerably by the fact that, save in the hands of a very few, it has failed to yield material for a positive diagnosis with s...

It has been widely assumed that student drug users are differ ent from non-using students, and certain terms, such as "alien ated," have been employed to characterize the drug users. But until recently, little empirical research has ben done to specify the exact differences between the two groups. This study com pares drug users and non-users sampled from the student body of a private high school in New York City. The two groups are compared across five areas of social involvement: family, school, religion, peer group, and politics. The drug users are found to be less involved than the non-users in family, school, and religion, but more involved in cultural activities with peers and more in volved in politics. Studies conducted in other parts of the country have reported similar findings, indicating that a general pattern of differences between drug users and non-users is emerging.

WITHOUT going into a lengthy discussion on the significance of a positive skin reaction to tuberculin and its limitations, it is fair to state that few laboratory tests are as satisfactory and as widely used by the medical profession. Any additional contribution to the safety and efficiency of the test should be of value. It is well known that the allergic response to tuberculoprotein, as indicated by the intensity of the reaction to tuberculin, varies in different persons. Thus, a given amount of tuberculin may elicit a mildly positive reaction in one subject and yet, in a more sensitive person, . . .

This study reports pregnancy outcomes for 105 addicted women enrolled in New York Medical College's Pregnant Addicts and Addicted Mothers Program. Three classes of variables are examined: prenatal care variables, obstetrical outcomes, and neonatal outcomes. As a first step, percentage distributions are shown for all variables within each class. With respect to the second and third classes, comparisons are made when possible to findings reported elsewhere on heroin-addicted, methadone-maintained, and drug-free populations. Zero-order correlations are then shown for the prenatal care variables versus the neonatal outcomes. It is found that the mother's number of prenatal medical visits correlates significantly with the neonate's gestational age at birth and birth weight, and that her methadone dose at time of delivery correlates significantly with the neonate's withdrawal status. The effect of the prenatal care variables on the two key neonatal outcomes--gestional age at birth and birth weight--is then examined via a stepwise regression analysis. It is found that two of the variables--gestional duration at first prenatal visit and number of prenatal visits--together account for 18.5% of the variance in birth weight and 26.9% of the variance in gestational age at birth, while maternal methadone dose has virtually no effect on these outcome measures. The findings indicate that better neonatal outcomes are associated with the mother's joining the program relatively early in pregnancy and coming in relatively often for prenatal care.

In the years that have elapsed since the invention of the Vim-Silverman biopsy needle, there has been ample time and opportunity to use it under various conditions, and from time to time, in the literature1and in personal communications to me, it has become apparent that certain improvements were desirable. To understand the importance of the improvement about to be described it will be necessary to review briefly the technique of needle biopsy as it is now performed with the original needle. The skin is prepared with a suitable antiseptic and anesthetized with procaine hydrochloride. A sharp-pointed scalpel is used to pierce the skin, and the outer needle with a stylet in place is introduced through the skin and advanced into the tissue up to the surface of the suspected tumor. The stylet is then withdrawn and the inner split needle is introduced in its place and advanced its

Most members of our society, if they see fit, may readily do the two things that this paper is about: They may move from place to place, and they may drink alcoholic beverages. Either of these two options, depending on how it is exercised, may have profound consequences for personal lives and for social fabrics. Therefore, whether or not migration and alcohol use tend to be connected in any way seems an important practical question. This exploratory inquiry will lead us to some hypothetical answers to that question and to some issues of method and theory that emerge along the way

To the Editor:— In the April 29, 1943 issue of the New England Journal of Medicine is a report on the incidence of appendicitis in 29,802 cases of the common contagious diseases, which was written by Dr. M. Goodman and me. Since that time, there have appeared articles in various journals with single case reports of appendicitis complicating communicable diseases. The authors do not mention our study and present the facts as something new and stimulating in medicine. For example, inThe Journalof Dec. 23, 1950, the article by Dr. F. Schaar contains a single case report of mumps complicated by acute appendicitis. The author refers to only nine similar cases in the literature, dating from 1903. We reported in our series from the Willard Parker Hospital, New York, 8 cases of this type in our mumps group during a period of only five years. I do not mean