Death and near death from cardiac arrest during the Boston Marathon.

The Boston Marathon has been run for 115 years during which there were three sudden cardiac arrests. The most recent was a near death avoided by rapid cardiopulmonary resuscitation (CPR) and defibrillation. Awareness of the dangers of participating in a marathon, the risk factors associated with sudden death during competition, and the life-saving importance of rapid CPR and defibrillation are essential for participants and event organizers. Available records and reports of the three known cases of cardiac arrest during the Boston Marathon were examined. These cases were identified by representatives of the Boston Athletic Association, which has organized each marathon since its inception. Pertinent literature was reviewed and new information was obtained during interviews of witnesses and rescuers. The data were analyzed in search of shared risk factors for cardiac arrest, death, and the optimal requirements for survival. In 115 years, there were two cardiac deaths and one near death from cardiac arrest. A history of coronary artery disease, advanced age, and prolonged race time are risk factors for sudden cardiac arrest. Rapid application of CPR and defibrillation are essential for survival. Prevention or reduction of life-threatening cardiac incidents during marathon races might be achieved if participants of advanced age or with a history of coronary artery disease seek medical clearance prior to entering an event. Those with coronary risk factors should have a discussion with their physician. Availability of trained personnel and defibrillators are important considerations in marathon planning.

Oliver Wendell Holmes' 1836 doctorate dissertation and his journey in medicine.

Oliver Wendell Holmes' 1836 hand written doctorate dissertation on acute pericarditis was discovered in the archives of the Boston Medical Library 101 years after it was successfully defended. It was then printed as an unabridged monograph with an explanation of its provenance. The dissertation has received little scrutiny since then. Holmes gathered materials for the scholarly work while he was a third and fourth year student at Ecole de Medecine in Paris. His mentor, Pierre-Charles-Alexandre- Louis insisted on the meticulous gathering and recording of every patient's history and findings. Each category of data was given a weighted numerical value of diagnostic importance and the information was placed in a registry. Holmes became a disciple of Louis in gathering data by direct observation and measuring outcomes in a "statistical" fashion. Holmes dissertation on acute pericarditis describes the state of knowledge about the illness in the 1830s. When Holmes and other students who had studied in Paris returned to the United States, they helped turn American Medicine from opinion and strong personal bias toward scientific objectivity. Oliver Wendell Holmes eventually became both a professor of anatomy/physiology and a dean at Harvard Medical School. He is recognized as a leader in medicine and a popular author in America and beyond. In his late and infirmed years, Holmes questioned the wisdom of his unswerving advocacy for the scientific underpinnings of medicine. In retrospect he had overlooked the importance of also advocating that each patient be approached with comforting compassion.