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THE TREND OF FOOD PRICES.
981 recommended by Professor Brauer is described inI 8 P.M., and considerable detail. Tracheotomy having been per- I Respirations
brought to hospital at 8.30 unconscious. were feeble and shallow, and no pulse formed, a long, soft rubber catheter, fitting quite was perceptible in radial or carotid arteries. The loosely in the tracheotomy tube, is attached to an pupils were widely dilated and the skin was bathed oxygen cylinder. An air filter is interposed as well in cold perspiration. A spot of blood on the shirt over the heart indicated as a contrivance for keeping the oxygen moist when the site of the wound, the insufflation has to be continued for a long time. which was 1 in. long, and in the fourth interspace 2 in. The supply of oxygen is graduated by bubbling it to the left of the sternum. Only. a small amount of through an antiseptic solution before the catheter is blood had escaped, not enough to account for the state When the end of the of the patient. introduced into the trachea. The area of cardiac dullness was catheter reaches the bifurcation of the trachea or one much increased. The diagnosis of wound of the of the bronchi it provokes coughing, and thus helps to heart with haemorrhage into the pericardium seemed clear the respiratory passages and facilitate respiration. evident. There was no haemoptysis. The chest was As long as the escape of oxygen is not too rapid the painted with tincture of iodine, and under light lungs cannot be over-distended, for gases can easily ether anaesthesia, with the wound as the centre, escape between the cather and the loosely fitting a U-shaped incision was made with the base outtracheotomy tube, as well as by the larynx. An addi- wards. The skin and pectoral muscles were turned tional advantage of this procedure is the opportunity it back, the fourth and fifth costal cartilages were affords for the escape of CO2, which is otherwise apt cut through, and the corresponding ribs carefully to collect in the upper respiratory passages. It is separated from the pleura for about three inches, and interesting to note that Professor Brauer is so doubtful then divided with bone forceps and turned outwards. This gave a very satisfactory exposure, and the wound as to the value of atropine in morphine poisoning that he does not prescribe it in severe cases. His attitude in the pericardium, from which there was a small towards this remedy is much the same as that voiced by stream of blood, was at once seen. The wound was Professor Cushny in the 1905 edition of his " Text-book enlarged upwards and to the right. The lack of even of Pharmacology," in which he refers to the " long and carotid pulse was now explained by the pericardium being packed with clot. When this was scooped out weary dispute as to the value of atropine." the heart at once began to beat violently, spurting to the anaesthetist. The heart wound was with the tip of the left index finger This nearly until a suture was passed and tied. checked the flow, but it was necessary to use a second Much blood was lost during these manipusuture. lations, but the action of the heart was fair and the anaesthetist could feel the pulse. But it was now found that blood was welling up behind the heart. Grasping the heart in the left hand, with index finger hooked round the apex, Dr. Freese raised the organ so as to expose a wound in the posterior wall nearly as large as the one closed in the anterior. Owing to the thickness of the left ventricle the wound was not bleeding so rapidly. It was closed with two sutures. The heart had almost stopped beating and no pulse could be felt. An intravenous injection of saline solution was given, the pericardium was sponged out and closed by continuous suture, the ribs were replaced, and the musculocutaneous flap was sutured in place without drainage. The patient was taken to his room, where he arrived at 9.15 ; the foot of the bed was elevated, hot-water bottles were placed around him, a hypodermic injection of morphine and atropine was given, and rectal infusion was started. On reaching his room the pulse was 72, but very small. The after-history was satisfactory ; at no time was there cause for alarm. Bronchitis developed on the second day and was annoying on account of painful cough, which was controlled with heroin. On the fourth day a loud friction murmur was heard over the heart (pericarditis). This lasted for two weeks, but there was never any sign of fluid sufficient to demand The highest temperature, 102° F., was interference. reached on the third day, with a pulse of 150. At this time the bronchitis was most severe. The temperature rose every afternoon to 100° until the eighteenth day. He was discharged a month after operation. The wound had long since healed, and there were no physical signs. X ray examination showed only some thickening of the pleura, with perhaps a little enlargement of the blood
THE TREND OF
FOOD
PRICES.
THE Economic Review for April 22nd prints a table of great value, comparing the retail price of food in many countries during the last seven years, taking the year 1914 as the basis. The month of July has been chosen for the comparison, the figures are the official index numbers taken from the International Lrxbo2ar Review, and we reproduce them substantially, omitting a few exceptions and qualifications which hardly affect their comparative value.
Man does not live by bread alone, and in the Dominions personal apparel has long been relatively more costly than at home. But when it comes to the
pinch it is the actual cost of essential foodstuffs as purchased that determines economic stress, and the table is instructive in this regard. STAB WOUND OF BOTH VENTRICLES: RECOVERY. IN his Bradshaw lecture1 own the Surgery of the Heart, on Dec. llth, 1919, Sir Charles Ballance tabulated 152 cases of operations on the pericardium and heart performed for injuries. No wound of both ventricles was mentioned by him, but two cases of double wound of right ventricle and auricle and of right ventricle alone were cited, both fatal. Dr. E. M. Freese has recently reportedthe following remarkable case of recovery after a stab wound of both ventricles. A coloured man was stabbed at 2
1 THE LANCET, 1920, i., 1, 73, 134. Journal of the American Medical Association, Feb. 19th.
on
instantly plugged
heart shadow.
-
SPLENOMEGALY. IN their review of recent work on diseases of the in the May number of Medical Science, Dr. Gordon Ward and Dr. J. D. Rolleston devote several pages to a consideration of various forms of splenomegaly which have been lately described by British, French, German, Italian, and American observers. Not the least interesting of them is the form to which Luccarrelli has given the provisional title of " war splenomegaly," having found it in a considerable number of soldiers without being able to connect it with any present or past disease such as malaria, enteric fever, spirochaetosis icterohaemorrhagica,
spleen
brought to hospital at 8.30 unconscious. were feeble and shallow, and no pulse formed, a long, soft rubber catheter, fitting quite was perceptible in radial or carotid arteries. The loosely in the tracheotomy tube, is attached to an pupils were widely dilated and the skin was bathed oxygen cylinder. An air filter is interposed as well in cold perspiration. A spot of blood on the shirt over the heart indicated as a contrivance for keeping the oxygen moist when the site of the wound, the insufflation has to be continued for a long time. which was 1 in. long, and in the fourth interspace 2 in. The supply of oxygen is graduated by bubbling it to the left of the sternum. Only. a small amount of through an antiseptic solution before the catheter is blood had escaped, not enough to account for the state When the end of the of the patient. introduced into the trachea. The area of cardiac dullness was catheter reaches the bifurcation of the trachea or one much increased. The diagnosis of wound of the of the bronchi it provokes coughing, and thus helps to heart with haemorrhage into the pericardium seemed clear the respiratory passages and facilitate respiration. evident. There was no haemoptysis. The chest was As long as the escape of oxygen is not too rapid the painted with tincture of iodine, and under light lungs cannot be over-distended, for gases can easily ether anaesthesia, with the wound as the centre, escape between the cather and the loosely fitting a U-shaped incision was made with the base outtracheotomy tube, as well as by the larynx. An addi- wards. The skin and pectoral muscles were turned tional advantage of this procedure is the opportunity it back, the fourth and fifth costal cartilages were affords for the escape of CO2, which is otherwise apt cut through, and the corresponding ribs carefully to collect in the upper respiratory passages. It is separated from the pleura for about three inches, and interesting to note that Professor Brauer is so doubtful then divided with bone forceps and turned outwards. This gave a very satisfactory exposure, and the wound as to the value of atropine in morphine poisoning that he does not prescribe it in severe cases. His attitude in the pericardium, from which there was a small towards this remedy is much the same as that voiced by stream of blood, was at once seen. The wound was Professor Cushny in the 1905 edition of his " Text-book enlarged upwards and to the right. The lack of even of Pharmacology," in which he refers to the " long and carotid pulse was now explained by the pericardium being packed with clot. When this was scooped out weary dispute as to the value of atropine." the heart at once began to beat violently, spurting to the anaesthetist. The heart wound was with the tip of the left index finger This nearly until a suture was passed and tied. checked the flow, but it was necessary to use a second Much blood was lost during these manipusuture. lations, but the action of the heart was fair and the anaesthetist could feel the pulse. But it was now found that blood was welling up behind the heart. Grasping the heart in the left hand, with index finger hooked round the apex, Dr. Freese raised the organ so as to expose a wound in the posterior wall nearly as large as the one closed in the anterior. Owing to the thickness of the left ventricle the wound was not bleeding so rapidly. It was closed with two sutures. The heart had almost stopped beating and no pulse could be felt. An intravenous injection of saline solution was given, the pericardium was sponged out and closed by continuous suture, the ribs were replaced, and the musculocutaneous flap was sutured in place without drainage. The patient was taken to his room, where he arrived at 9.15 ; the foot of the bed was elevated, hot-water bottles were placed around him, a hypodermic injection of morphine and atropine was given, and rectal infusion was started. On reaching his room the pulse was 72, but very small. The after-history was satisfactory ; at no time was there cause for alarm. Bronchitis developed on the second day and was annoying on account of painful cough, which was controlled with heroin. On the fourth day a loud friction murmur was heard over the heart (pericarditis). This lasted for two weeks, but there was never any sign of fluid sufficient to demand The highest temperature, 102° F., was interference. reached on the third day, with a pulse of 150. At this time the bronchitis was most severe. The temperature rose every afternoon to 100° until the eighteenth day. He was discharged a month after operation. The wound had long since healed, and there were no physical signs. X ray examination showed only some thickening of the pleura, with perhaps a little enlargement of the blood
THE TREND OF
FOOD
PRICES.
THE Economic Review for April 22nd prints a table of great value, comparing the retail price of food in many countries during the last seven years, taking the year 1914 as the basis. The month of July has been chosen for the comparison, the figures are the official index numbers taken from the International Lrxbo2ar Review, and we reproduce them substantially, omitting a few exceptions and qualifications which hardly affect their comparative value.
Man does not live by bread alone, and in the Dominions personal apparel has long been relatively more costly than at home. But when it comes to the
pinch it is the actual cost of essential foodstuffs as purchased that determines economic stress, and the table is instructive in this regard. STAB WOUND OF BOTH VENTRICLES: RECOVERY. IN his Bradshaw lecture1 own the Surgery of the Heart, on Dec. llth, 1919, Sir Charles Ballance tabulated 152 cases of operations on the pericardium and heart performed for injuries. No wound of both ventricles was mentioned by him, but two cases of double wound of right ventricle and auricle and of right ventricle alone were cited, both fatal. Dr. E. M. Freese has recently reportedthe following remarkable case of recovery after a stab wound of both ventricles. A coloured man was stabbed at 2
1 THE LANCET, 1920, i., 1, 73, 134. Journal of the American Medical Association, Feb. 19th.
on
instantly plugged
heart shadow.
-
SPLENOMEGALY. IN their review of recent work on diseases of the in the May number of Medical Science, Dr. Gordon Ward and Dr. J. D. Rolleston devote several pages to a consideration of various forms of splenomegaly which have been lately described by British, French, German, Italian, and American observers. Not the least interesting of them is the form to which Luccarrelli has given the provisional title of " war splenomegaly," having found it in a considerable number of soldiers without being able to connect it with any present or past disease such as malaria, enteric fever, spirochaetosis icterohaemorrhagica,
spleen