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SUBCUTANEOUS EMPHYSEMA ORIGINATING DURING PARTURITION.
551
Pepys, that if he had a failing in life itadmission to 100, and she was readily delivered, overweening passion for chicken broth.with the aid of instruments, of a fully developed Sir William’s besetting propensity seems to be a !stillborn child. The appearance of the patient was passion for desiring the Members of the College of very striking, the curves of the neck being almost Surgeons to take off their hats !/ Let him take a obliterated by the swelling, which gave her a curious lesson from an anecdote of the ancestor of the frog-like aspect. Dr. Gilbert at first ascribed this to Prince de Levi." This ancestor, the article con- cedema from straining or from nephritis threatening tinues, is represented in a pedigree from the Flood eclampsia; but examination of the chest gave the downwards as standing next the Virgin Mary, from key to the mystery, for crepitant sounds were heard whose mouth a scroll issues inscribed with the everywhere until obliterated by firm pressure with legend, " Mon cousin, mettez le chapeau." Sir the stethoscope. This crepitancy was traceable William’s punctiliousness in the matter of hats was over the whole of the face and neck, even into the evidently xegarded as absurd by a generation that eyelids and lobes of the ears, and downwards as far not only in Parliament, but in many places of assem- as the level of the nipples and to the inferior angles blage kept on its hat partly to avoid draughts, partly of the scapulae. It appeared earlier and extended also to assert the independence of free-born further on the right side than on the left. There Englishmen. To us it would appear strange to was some respiratory distress with frequent cough see a learned assembly hat on head. Quite in the lasting two days after delivery, but examination of the chest revealed no evidences of pneumothorax manner of a past age was Blizard’s stately procedure after the judicial hangings of the time. or other pulmonary lesion. The emphysematous The College owned a house in Cock-lane, whither areas were slightly tender, probably from distension " the surgeons’ mob," so often referred to in the of the skin. It appears from monographs of writers Newgate Calemdclr, were in the habit of bringing who have collected records of cases, numbering over the corpses of criminals, newly hanged at Newgate. a hundred altogether, that the condition owes its Sir William Blizard, when President of the College origin to rupture of air vesicles at the’root of the of Surgeons, we learn from Dr. Norman Moore, lung, the air escaping beneath the visceral pleura Sir Lucas
was
an
attended at this house in full Court dress to receive the bodies from the hangman; and the contrast between the President’s elaborate costume and formal manner and the surly shabbiness of the executioner has been described by Professor Owen, who witnessed the scene, as ghastly but almost ludicrous. Owen’s father-in-law, William Clift, Hunter’s famous assistant, and Conservator of the Hunterian Museum of the College, also describes these scenes, and has left to posterity, in the College library, a number of curious water-colour sketches of the hanged subjects. During many years at the close of his long life Blizard used to return to his country house at Brixton, after the College examinations were over, well armed with pistol and hanger. Guthrie, the sardonic army surgeon, who was twice President of the College, one day found the sword in the secretary’s office, and remarked to Sir William that it did not appear to be often drawn and must be getting rusty. Whereupon, the ancient President flourished the sword and cried " " Well out, I am ready to face the devil with it." then, Sir William," came the droll answer, " in that case I think you should certainly have it put in your coffin." At his advanced time of life Sir William Blizard had begun to fail as an operator, and it was even hinted that patients died because of his lack of skill. There was point in Guthrie’s sarcasm, which rings so strangely in our ears to-day, that " Wakley’s agitation for medical senile coroners was greatly owing to Blizard’s failures and the deaths therefrom resulting." The Wakley in question, the founder of THE LANCET, was coroner for Middlesex.
e
to the anterior mediastinum and thence to the neck and chest. Some writers, however, seem to think the lesion lies in the upper reaches of the respiratory tract. The patients are always primiparae, and there is a history of strong straining efforts during labour, favoured by resistance, as in the case of a large child or a small pelvis. Pain is sometimes noted in the region of the seventh or eighth rib. Recovery is the invariable rule. THE
RATIONAL USE OF TUBERCULIN.
IN view of the doubts which at present exist as to the value of tuberculin in the treatment of pulmonary and other forms of tuberculosis, a reasoned explanation of the basis of such a procedure by one of the leaders of tuberculin therapeutics deserves In the February issue of the careful study. Edinburgh Medical Journal Professor Edmond Beraneck, of Neuchatel, explains the ideas on which his method is founded. The means of defence against the tubercle bacillus may, he states, be divided into two parts-the antibacterial substances and the process of elimination of necrosed tissue and cicatrisation of the part. The cells respectively concerned may be called the " protective and the " reparative respectively, and rational treatment must be directed to stimulating especially the protective elements. This may be done by educating the cells by inoculation of attenuated or dead bacilli or their toxins. Now the bacilli growing in the body already produce toxins, and it is irrational merely to inject more of these; yet, according to the prevailing theory of the essential unity of all SUBCUTANEOUS EMPHYSEMA ORIGINATING tuberculins and tuberculous toxins, this is what is DURING PARTURITION. done by injecting tuberculin. Professor Beraneck Ia the Attsti-ala,,;ian Medical Gazette for Dec. 27th, holds that the poisons formed in the body differ 1913, Dr. H. Gilbert, of Adelaide, records an example from those obtained in culture media. In support of an unusual complication of labour, which, though of his view that such differences may exist he alarming to the patient, is of little prognostic shows that the toxins present in his broth cultures import. His patient, a primipara, aged 22, was of the bacilli are soluble in water, whereas those admitted to hospital after being in labour almost which he extracts with orthophosphoric acid from 48 hours. Six hours after her admission he was the bodies of the bacteria are not. The latter are called to the hospital because the pains were going precipitated by neutralising their solution while off and the patient’s face and neck were swelling up the former are not, and a precipitate forms on rapidly. The pulse-rate had risen from 88 on mixing the two solutions. The essential points
injured
.
Pepys, that if he had a failing in life itadmission to 100, and she was readily delivered, overweening passion for chicken broth.with the aid of instruments, of a fully developed Sir William’s besetting propensity seems to be a !stillborn child. The appearance of the patient was passion for desiring the Members of the College of very striking, the curves of the neck being almost Surgeons to take off their hats !/ Let him take a obliterated by the swelling, which gave her a curious lesson from an anecdote of the ancestor of the frog-like aspect. Dr. Gilbert at first ascribed this to Prince de Levi." This ancestor, the article con- cedema from straining or from nephritis threatening tinues, is represented in a pedigree from the Flood eclampsia; but examination of the chest gave the downwards as standing next the Virgin Mary, from key to the mystery, for crepitant sounds were heard whose mouth a scroll issues inscribed with the everywhere until obliterated by firm pressure with legend, " Mon cousin, mettez le chapeau." Sir the stethoscope. This crepitancy was traceable William’s punctiliousness in the matter of hats was over the whole of the face and neck, even into the evidently xegarded as absurd by a generation that eyelids and lobes of the ears, and downwards as far not only in Parliament, but in many places of assem- as the level of the nipples and to the inferior angles blage kept on its hat partly to avoid draughts, partly of the scapulae. It appeared earlier and extended also to assert the independence of free-born further on the right side than on the left. There Englishmen. To us it would appear strange to was some respiratory distress with frequent cough see a learned assembly hat on head. Quite in the lasting two days after delivery, but examination of the chest revealed no evidences of pneumothorax manner of a past age was Blizard’s stately procedure after the judicial hangings of the time. or other pulmonary lesion. The emphysematous The College owned a house in Cock-lane, whither areas were slightly tender, probably from distension " the surgeons’ mob," so often referred to in the of the skin. It appears from monographs of writers Newgate Calemdclr, were in the habit of bringing who have collected records of cases, numbering over the corpses of criminals, newly hanged at Newgate. a hundred altogether, that the condition owes its Sir William Blizard, when President of the College origin to rupture of air vesicles at the’root of the of Surgeons, we learn from Dr. Norman Moore, lung, the air escaping beneath the visceral pleura Sir Lucas
was
an
attended at this house in full Court dress to receive the bodies from the hangman; and the contrast between the President’s elaborate costume and formal manner and the surly shabbiness of the executioner has been described by Professor Owen, who witnessed the scene, as ghastly but almost ludicrous. Owen’s father-in-law, William Clift, Hunter’s famous assistant, and Conservator of the Hunterian Museum of the College, also describes these scenes, and has left to posterity, in the College library, a number of curious water-colour sketches of the hanged subjects. During many years at the close of his long life Blizard used to return to his country house at Brixton, after the College examinations were over, well armed with pistol and hanger. Guthrie, the sardonic army surgeon, who was twice President of the College, one day found the sword in the secretary’s office, and remarked to Sir William that it did not appear to be often drawn and must be getting rusty. Whereupon, the ancient President flourished the sword and cried " " Well out, I am ready to face the devil with it." then, Sir William," came the droll answer, " in that case I think you should certainly have it put in your coffin." At his advanced time of life Sir William Blizard had begun to fail as an operator, and it was even hinted that patients died because of his lack of skill. There was point in Guthrie’s sarcasm, which rings so strangely in our ears to-day, that " Wakley’s agitation for medical senile coroners was greatly owing to Blizard’s failures and the deaths therefrom resulting." The Wakley in question, the founder of THE LANCET, was coroner for Middlesex.
e
to the anterior mediastinum and thence to the neck and chest. Some writers, however, seem to think the lesion lies in the upper reaches of the respiratory tract. The patients are always primiparae, and there is a history of strong straining efforts during labour, favoured by resistance, as in the case of a large child or a small pelvis. Pain is sometimes noted in the region of the seventh or eighth rib. Recovery is the invariable rule. THE
RATIONAL USE OF TUBERCULIN.
IN view of the doubts which at present exist as to the value of tuberculin in the treatment of pulmonary and other forms of tuberculosis, a reasoned explanation of the basis of such a procedure by one of the leaders of tuberculin therapeutics deserves In the February issue of the careful study. Edinburgh Medical Journal Professor Edmond Beraneck, of Neuchatel, explains the ideas on which his method is founded. The means of defence against the tubercle bacillus may, he states, be divided into two parts-the antibacterial substances and the process of elimination of necrosed tissue and cicatrisation of the part. The cells respectively concerned may be called the " protective and the " reparative respectively, and rational treatment must be directed to stimulating especially the protective elements. This may be done by educating the cells by inoculation of attenuated or dead bacilli or their toxins. Now the bacilli growing in the body already produce toxins, and it is irrational merely to inject more of these; yet, according to the prevailing theory of the essential unity of all SUBCUTANEOUS EMPHYSEMA ORIGINATING tuberculins and tuberculous toxins, this is what is DURING PARTURITION. done by injecting tuberculin. Professor Beraneck Ia the Attsti-ala,,;ian Medical Gazette for Dec. 27th, holds that the poisons formed in the body differ 1913, Dr. H. Gilbert, of Adelaide, records an example from those obtained in culture media. In support of an unusual complication of labour, which, though of his view that such differences may exist he alarming to the patient, is of little prognostic shows that the toxins present in his broth cultures import. His patient, a primipara, aged 22, was of the bacilli are soluble in water, whereas those admitted to hospital after being in labour almost which he extracts with orthophosphoric acid from 48 hours. Six hours after her admission he was the bodies of the bacteria are not. The latter are called to the hospital because the pains were going precipitated by neutralising their solution while off and the patient’s face and neck were swelling up the former are not, and a precipitate forms on rapidly. The pulse-rate had risen from 88 on mixing the two solutions. The essential points
injured
.