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SUTURE OF THE FAUCIAL PILLARS FOR HÆMORRHAGE FOLLOWING TONSILLECTOMY.
745
Sept. 9th, 1907, the Board issued a revised General Order relating to cholera, yellow fever, and plague on ships arriving foreign ports to apply and have effect throughout England and Wales, except as regards Bristol and Gloucester, Harwich and Ipswich, and Liverpool and Manchester, the revisions having been introduced chiefly to secure the observance of principles embodied in the Paris Convention of 1903. The main principles on which the regulations have proceeded are that a report with regard to infected vessels arriving from foreign ports should be made to the sanitary authority of the place of arrival, that infected vessels should be temporarily detained pending visitation by the medical officer
from
of health, who may order the further detention of the vessel, the removal of persons suffering, or suspected to be suffering, from plague, cholera, (,r yellow fever, and the adoption of steps to free the vessel from causes of infection. He may also take such other action as is expedient for the purpose of tracing the further movements of persons allowed to leave the vessel. The regulations in 1907 were made more stringent so as to include" suspected"as well as "infected " ships, and gave to the medical officer of health the power of prohibiting the landing of any person unless he is satisfied as to his name, intended place of destination, and address at that place, placing upon any such person the further obligation that if within five days he changes his address he must notify the new address to the medical officer of health. At the time of writing it is reported that the visit of some Russians from Odessa to the relics of San Nicola di Basi has now introduced the disease into SouthEastern Italy, and several deaths have occurred in the province of Apulia. All Russian ports on the Black Sea and Sea of Azov, including ports on the rivers running into either sea, are officially declared to be infected with Asiatic cholera, and sanitary measures will be applied to any vessel which left any of these ports since August 12th.
SUTURE
OF THE FAUCIAL PILLARS HÆMORRHAGE FOLLOWING TONSILLECTOMY.
FOR
possibility of serious and even fatal haemorrhage after tonsillectomy must be borne in mind, even when there is no history of a tendency to hæmorrhage. In the Boston Medical and Surgical Journal of July 21st Dr. H. H. Gilpatrick states that three cases of severe haemorrhage which have come THE
under his observation have convinced him that firm and complete approximation of the faucial pillars by suture is the most efficient means of controlling the haemorrhage. But the difficulty of the operation is so great that he recommends it only as a life-saving measure after ordinary methods have failed. The difficulty is due to the small space in which the work must be done, to failure to obtain a view of the lowest portion of the pillars, where the suture must begin if it is efficient, and to the tying of knots. The difficulty of tying the knots in his first two cases led Dr. Gilpatrick to secure the sutures with perforated shot in the last case. This method, which appears to be new, proved both easy and efficient. The operation usually has to be done without anaesthesia and the condition of the patient is often such that none is needed. Dr. Gilpatrick prefers Rose’s position, in which the patient’s head is but little elevated above the chest-an important point in an exsanguine patient. At the same time less blood and mucus are likely to be inhaled. A good light is necessary. The jaws must be opened to the full extent and the tongue kept on the floor of the mouth. This is best done with the Whitehead self-retaining gag with attached tongue depressor. A small round-pointed fish -hook-shaped needle is threaded with black linen or silk about 18 inches long. A long-shaped Mayo needle-holder may be used.
Vhen the suture is
ready the pharynx is quickly wiped ordinary right-angled tongue depressor is itroduced so that its tip presses against the base of he tongue at the lowest point of the faucial pillars nd away from the side operated on. This gives a view of ut
and
an
point where the needle should be first inserted. The oint of the needle is carried behind the posterior pillar and s introduced forwards through-both pillars, taking enough issue to ensure its not tearing out. The needle is pulled hrough, leaving the tail of the suture sufficiently long to each beyond the incisors, where it is twisted with the main ortion of the suture between the thumb and forefinger. A perforated shot is now slipped over the needle and tail of the suture and the shot is grasped in the jaws of the needlellder. One hand holds the suture taut, while the other, grasping the needle-holder, forces the shot against the point of suture and crushes it upon the thread. The tail of the suture is now forced been two convenient teeth and the shread is passed as a continuous suture, with intervals of a quarter of an inch, to the other ends of the pillars. When bhe last suture has been drawn tight the head and tail of bhe suture are twisted together and secured with another perforated shot as before. If the ends of the thread are left long and secured to teeth the possibility of the shot dropping into the larynx in case the suture should break or tear out is obviated. The advantages of this method are the ease of application, the short time required, and the security with which the bleeding is controlled. As soon as the suture is passed through the pillars the second tongue depressor may be removed, for the placing of the shot does not require the tongue to be held out of the way. he
THE
DAILY VARIATION OF BODY TEMPERATURE IN HEALTH.
WE have received a reprint of a paper published in the Journal of Tro_pical Medicine and Hygiene, by Colonel Matthew D. O’Connell, R.A.M.C., in which it is suggested that the control or regulation of the body temperature of man in health is not the result of a reflex nervous mechanism, but of the daily meteorological changes in environment. This conclusion has been arrived at as a result of some observations on the effect on body temperature of exposure for short periods to an atmosphere artificially heated and humidified in glass houses. He sums up his conclusions by affirming that body temperature increases from 7 A.M. to1 P.M. daily, because during these hours loss of heat from the body by radiation is reduced owing to the increase of the temperature of the air, and because the production of heat in the body is increased by the taking of food. An excessive rise is pre. vented by increased loss due to evaporation owing to the increased drying power of the air, and by conduction and convection owing to the movement of the surrounding air. The rise between 1 P.M. and 6 P.M. is attributed to diminished loss of heat by evaporation owing to the reduced drying power of the air, and also to the increased production from food intake. An excessive rise is prevented by increased loss of heat from radiation, owing to the falling temperature of the air, and increased loss by conduction and convection owing to the movements of the air. The fall of temperature during the night hours is regarded as being due to increased loss of heat by radiation, owing to the fall of atmospheric temperature and to diminished production of heat owing to abstinence from food, an excessive fall being loss by evaporation, owing to the of the air, and diminished loss by convection and owing to the stillness of the conduction that changes in the meteoroWhile admitting atmosphere. logical conditions do influence bodily temperature, we cannot say we are convinced by Colonel O’Connell’s reasoning’
prevented by reduced lessened drying power
Sept. 9th, 1907, the Board issued a revised General Order relating to cholera, yellow fever, and plague on ships arriving foreign ports to apply and have effect throughout England and Wales, except as regards Bristol and Gloucester, Harwich and Ipswich, and Liverpool and Manchester, the revisions having been introduced chiefly to secure the observance of principles embodied in the Paris Convention of 1903. The main principles on which the regulations have proceeded are that a report with regard to infected vessels arriving from foreign ports should be made to the sanitary authority of the place of arrival, that infected vessels should be temporarily detained pending visitation by the medical officer
from
of health, who may order the further detention of the vessel, the removal of persons suffering, or suspected to be suffering, from plague, cholera, (,r yellow fever, and the adoption of steps to free the vessel from causes of infection. He may also take such other action as is expedient for the purpose of tracing the further movements of persons allowed to leave the vessel. The regulations in 1907 were made more stringent so as to include" suspected"as well as "infected " ships, and gave to the medical officer of health the power of prohibiting the landing of any person unless he is satisfied as to his name, intended place of destination, and address at that place, placing upon any such person the further obligation that if within five days he changes his address he must notify the new address to the medical officer of health. At the time of writing it is reported that the visit of some Russians from Odessa to the relics of San Nicola di Basi has now introduced the disease into SouthEastern Italy, and several deaths have occurred in the province of Apulia. All Russian ports on the Black Sea and Sea of Azov, including ports on the rivers running into either sea, are officially declared to be infected with Asiatic cholera, and sanitary measures will be applied to any vessel which left any of these ports since August 12th.
SUTURE
OF THE FAUCIAL PILLARS HÆMORRHAGE FOLLOWING TONSILLECTOMY.
FOR
possibility of serious and even fatal haemorrhage after tonsillectomy must be borne in mind, even when there is no history of a tendency to hæmorrhage. In the Boston Medical and Surgical Journal of July 21st Dr. H. H. Gilpatrick states that three cases of severe haemorrhage which have come THE
under his observation have convinced him that firm and complete approximation of the faucial pillars by suture is the most efficient means of controlling the haemorrhage. But the difficulty of the operation is so great that he recommends it only as a life-saving measure after ordinary methods have failed. The difficulty is due to the small space in which the work must be done, to failure to obtain a view of the lowest portion of the pillars, where the suture must begin if it is efficient, and to the tying of knots. The difficulty of tying the knots in his first two cases led Dr. Gilpatrick to secure the sutures with perforated shot in the last case. This method, which appears to be new, proved both easy and efficient. The operation usually has to be done without anaesthesia and the condition of the patient is often such that none is needed. Dr. Gilpatrick prefers Rose’s position, in which the patient’s head is but little elevated above the chest-an important point in an exsanguine patient. At the same time less blood and mucus are likely to be inhaled. A good light is necessary. The jaws must be opened to the full extent and the tongue kept on the floor of the mouth. This is best done with the Whitehead self-retaining gag with attached tongue depressor. A small round-pointed fish -hook-shaped needle is threaded with black linen or silk about 18 inches long. A long-shaped Mayo needle-holder may be used.
Vhen the suture is
ready the pharynx is quickly wiped ordinary right-angled tongue depressor is itroduced so that its tip presses against the base of he tongue at the lowest point of the faucial pillars nd away from the side operated on. This gives a view of ut
and
an
point where the needle should be first inserted. The oint of the needle is carried behind the posterior pillar and s introduced forwards through-both pillars, taking enough issue to ensure its not tearing out. The needle is pulled hrough, leaving the tail of the suture sufficiently long to each beyond the incisors, where it is twisted with the main ortion of the suture between the thumb and forefinger. A perforated shot is now slipped over the needle and tail of the suture and the shot is grasped in the jaws of the needlellder. One hand holds the suture taut, while the other, grasping the needle-holder, forces the shot against the point of suture and crushes it upon the thread. The tail of the suture is now forced been two convenient teeth and the shread is passed as a continuous suture, with intervals of a quarter of an inch, to the other ends of the pillars. When bhe last suture has been drawn tight the head and tail of bhe suture are twisted together and secured with another perforated shot as before. If the ends of the thread are left long and secured to teeth the possibility of the shot dropping into the larynx in case the suture should break or tear out is obviated. The advantages of this method are the ease of application, the short time required, and the security with which the bleeding is controlled. As soon as the suture is passed through the pillars the second tongue depressor may be removed, for the placing of the shot does not require the tongue to be held out of the way. he
THE
DAILY VARIATION OF BODY TEMPERATURE IN HEALTH.
WE have received a reprint of a paper published in the Journal of Tro_pical Medicine and Hygiene, by Colonel Matthew D. O’Connell, R.A.M.C., in which it is suggested that the control or regulation of the body temperature of man in health is not the result of a reflex nervous mechanism, but of the daily meteorological changes in environment. This conclusion has been arrived at as a result of some observations on the effect on body temperature of exposure for short periods to an atmosphere artificially heated and humidified in glass houses. He sums up his conclusions by affirming that body temperature increases from 7 A.M. to1 P.M. daily, because during these hours loss of heat from the body by radiation is reduced owing to the increase of the temperature of the air, and because the production of heat in the body is increased by the taking of food. An excessive rise is pre. vented by increased loss due to evaporation owing to the increased drying power of the air, and by conduction and convection owing to the movement of the surrounding air. The rise between 1 P.M. and 6 P.M. is attributed to diminished loss of heat by evaporation owing to the reduced drying power of the air, and also to the increased production from food intake. An excessive rise is prevented by increased loss of heat from radiation, owing to the falling temperature of the air, and increased loss by conduction and convection owing to the movements of the air. The fall of temperature during the night hours is regarded as being due to increased loss of heat by radiation, owing to the fall of atmospheric temperature and to diminished production of heat owing to abstinence from food, an excessive fall being loss by evaporation, owing to the of the air, and diminished loss by convection and owing to the stillness of the conduction that changes in the meteoroWhile admitting atmosphere. logical conditions do influence bodily temperature, we cannot say we are convinced by Colonel O’Connell’s reasoning’
prevented by reduced lessened drying power