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SUDDEN DEATH FOLLOWING PYELOGRAPHY.
1057 which later, by means of the tympanic branch, become distributed to the parotid. SUDDEN
DEATH
FOLLOWING
PYELOGRAPHY.
preserved in the form of powder; after this it , gradually diminishes. Certain preparations, however, have remained strongly active even after a year or more. The coagulating power of coaguline
is
resists heat to a certain extent, for even after 1 the powder or solution to 95° C. in a water THE practice of taking skiagrams of the pelvis of heating the kidney and the ureter after the injection into bath its activity is still manifest, although someThis necessitates the time and them of some fluid opaque to the X rays is becoming what weakened. so common that it is of importance to note any temperature for sterilisation being reduced to a, minimum. cases in which harmful results have followed or Coaguline promises to be of use in have appeared to follow this method of diagnosis. checking superficial haemorrhages and in bleeding Dr. E. 0. Smith, of Cincinnati, Ohio, has recorded a from viscera, especially the liver, from the nose, case in the Transactions of the American Urological mouth, uterus, and from hæmorrhoids. To ensure a Association, 1913, in which sudden death followed full haemostatic action it is not enough to apply the closely on pyelography. The patient was a woman powder or solution to the bleeding surface since aged 64 years ; she was poorly nourished, but she the blood would wash it away before it had time to complete its coagulating action ; it must be was able to walk into the cystoscopic room without assistance. The bladder was normal, and both kept in situ for a short time with a pledget of cotton ureters were catheterised without difficulty, and or gauze and with slight pressure. The solution be injected into can cavities and some urine was collected from each kidney, and in operation neither specimen was there pus or blood. It was wounds, but for hypodermic use a solution having decided to take a skiagram of the pelvis of the right an insoluble sediment is not suitable. To obviate kidney two days later, and for this purpose 20 cubic this the author found that by incorporating the centimetres of a 10 per cent. solution of collargol coaguline with sugar an opalescent solution could be obtained with water which could be sterilised by were injected through a ureteral catheter by means of a small hand syringe. But little force was used and heating. the injection was stopped as soon as the patient PROVISION OF INSTITUTIONS FOR THE complained of pain. A skiagram was then taken. TREATMENT OF TUBERCULOSIS. six or minutes between the some eight Only elapsed introduction of the cystoscope and its removal, and WE have received from the Local Government five minutes later the patient was dead. At the Board a copy of a memorandum on provision of new necropsy several serious lesions were found to be residential institutions for the treatment of pulmopresent. There were extensive pleuritic adhesions, nary tuberculosis which has been sent to the councils and tuberculous nodules in each lung, and there of counties and county boroughs. The memorandum There was was old disease of the mitral valves. has been prepared with the view of affording local much pus with many gall-stones in the gall- authorities and others further assistance in the bladder, and an abscess beneath the liver com- provision of special residential institutions in Both kidneys municated with the gall-bladder. connexion with permanent schemes for the treatshowed an acute interstitial nephritis superimposed ____
chronic nephritis ; and the right kidney contained collargol in the uriniferous tubules and between the tubules. It is clear from the necropsy that this patient had several other lesions which must have had much influence in determining the fatal issue, but it is also clear that the collargol had damaged the kidney. It is generally agreed that hydrostatic pressure is the best means of injecting collargol into a ureter. on a
A NEW
PHYSIOLOGICAL HÆMOSTATIC.
ATTENTION is drawn in a recent number of Il Morgagni1 to the use of the fibrin ferment of the blood as a valuable haemostatic. This substance is to be found in all the cells of the organism and extracts of all fresh organs contain it. As prepared by Zanoni it exists as a fine powder, of a colour varying from light to dark yellow, slightly unctuous to the touch, and with an odour like that of goose fat. It is slightly hygroscopic and but little changed by light and air, sparingly soluble in water and chloroform, and less still in 95 per cent. alcohol. Aqueous solutions are not limpid, are markedly opalescent, and leave an insoluble residue ; they cannot be filtered since most of the ferment remains on the filter. They must therefore be used as they are. This substance, which Zanoni has named "coaguline," reduces the time required for the formation of blood clot from 15 minutes to 1 minute. In other words, the blood coagulates almost immediately in the presence of coaguline, and this power is retained for at least five to six months when it 1Il
Morgagni,
Anno lvi.,
No. 17, March 22nd, 1914, Milano.
Attention has ment of pulmonary tuberculosis. wisely been drawn to the fact that the planning of the institution will depend on the stage of disease of the tuberculous patients proposed to be admitted to it. A classification of cases of pulmonary tuberculosis is set out arranged from the standpoint of accommodation in residential institutions. Group A contains those cases in which permanent improvement or recovery may usually be anticipated; Group B, cases in which only
temporary, though possibly prolonged, improvement may be anticipated; Group C, advanced cases requiring continuous medical care and nursing;p Group D, cases requiring special observation : (1) patients admitted for the purpose of diagnosiss (2) patients needing to be watched before the best form of continued treatment can be determined. This is a good practical classification, and we also endorse the further statement that the term "sanatorium" should be used to indicate an institution mainly devoted to the reception of patients in Group A, the term " hospital " to indicate an institution provided for the reception of patients in Groups B, C, and D, and the term " combined institution " to indicate an institution devoted to the reception of patients in all four groups. If admissions to a sanatorium were strictly confined to patients suffering from pulmonary tuberculosis who are afebrile and able to take a certain amount of exercise, the results obtained would be more satisfactory than is at present the case. The types of buildings which are suggested are on the whole satifactory, but we do not like the plan of placing the consulting-room, laboratory, and dispensary in the same building and on the opposite side of a,
DEATH
FOLLOWING
PYELOGRAPHY.
preserved in the form of powder; after this it , gradually diminishes. Certain preparations, however, have remained strongly active even after a year or more. The coagulating power of coaguline
is
resists heat to a certain extent, for even after 1 the powder or solution to 95° C. in a water THE practice of taking skiagrams of the pelvis of heating the kidney and the ureter after the injection into bath its activity is still manifest, although someThis necessitates the time and them of some fluid opaque to the X rays is becoming what weakened. so common that it is of importance to note any temperature for sterilisation being reduced to a, minimum. cases in which harmful results have followed or Coaguline promises to be of use in have appeared to follow this method of diagnosis. checking superficial haemorrhages and in bleeding Dr. E. 0. Smith, of Cincinnati, Ohio, has recorded a from viscera, especially the liver, from the nose, case in the Transactions of the American Urological mouth, uterus, and from hæmorrhoids. To ensure a Association, 1913, in which sudden death followed full haemostatic action it is not enough to apply the closely on pyelography. The patient was a woman powder or solution to the bleeding surface since aged 64 years ; she was poorly nourished, but she the blood would wash it away before it had time to complete its coagulating action ; it must be was able to walk into the cystoscopic room without assistance. The bladder was normal, and both kept in situ for a short time with a pledget of cotton ureters were catheterised without difficulty, and or gauze and with slight pressure. The solution be injected into can cavities and some urine was collected from each kidney, and in operation neither specimen was there pus or blood. It was wounds, but for hypodermic use a solution having decided to take a skiagram of the pelvis of the right an insoluble sediment is not suitable. To obviate kidney two days later, and for this purpose 20 cubic this the author found that by incorporating the centimetres of a 10 per cent. solution of collargol coaguline with sugar an opalescent solution could be obtained with water which could be sterilised by were injected through a ureteral catheter by means of a small hand syringe. But little force was used and heating. the injection was stopped as soon as the patient PROVISION OF INSTITUTIONS FOR THE complained of pain. A skiagram was then taken. TREATMENT OF TUBERCULOSIS. six or minutes between the some eight Only elapsed introduction of the cystoscope and its removal, and WE have received from the Local Government five minutes later the patient was dead. At the Board a copy of a memorandum on provision of new necropsy several serious lesions were found to be residential institutions for the treatment of pulmopresent. There were extensive pleuritic adhesions, nary tuberculosis which has been sent to the councils and tuberculous nodules in each lung, and there of counties and county boroughs. The memorandum There was was old disease of the mitral valves. has been prepared with the view of affording local much pus with many gall-stones in the gall- authorities and others further assistance in the bladder, and an abscess beneath the liver com- provision of special residential institutions in Both kidneys municated with the gall-bladder. connexion with permanent schemes for the treatshowed an acute interstitial nephritis superimposed ____
chronic nephritis ; and the right kidney contained collargol in the uriniferous tubules and between the tubules. It is clear from the necropsy that this patient had several other lesions which must have had much influence in determining the fatal issue, but it is also clear that the collargol had damaged the kidney. It is generally agreed that hydrostatic pressure is the best means of injecting collargol into a ureter. on a
A NEW
PHYSIOLOGICAL HÆMOSTATIC.
ATTENTION is drawn in a recent number of Il Morgagni1 to the use of the fibrin ferment of the blood as a valuable haemostatic. This substance is to be found in all the cells of the organism and extracts of all fresh organs contain it. As prepared by Zanoni it exists as a fine powder, of a colour varying from light to dark yellow, slightly unctuous to the touch, and with an odour like that of goose fat. It is slightly hygroscopic and but little changed by light and air, sparingly soluble in water and chloroform, and less still in 95 per cent. alcohol. Aqueous solutions are not limpid, are markedly opalescent, and leave an insoluble residue ; they cannot be filtered since most of the ferment remains on the filter. They must therefore be used as they are. This substance, which Zanoni has named "coaguline," reduces the time required for the formation of blood clot from 15 minutes to 1 minute. In other words, the blood coagulates almost immediately in the presence of coaguline, and this power is retained for at least five to six months when it 1Il
Morgagni,
Anno lvi.,
No. 17, March 22nd, 1914, Milano.
Attention has ment of pulmonary tuberculosis. wisely been drawn to the fact that the planning of the institution will depend on the stage of disease of the tuberculous patients proposed to be admitted to it. A classification of cases of pulmonary tuberculosis is set out arranged from the standpoint of accommodation in residential institutions. Group A contains those cases in which permanent improvement or recovery may usually be anticipated; Group B, cases in which only
temporary, though possibly prolonged, improvement may be anticipated; Group C, advanced cases requiring continuous medical care and nursing;p Group D, cases requiring special observation : (1) patients admitted for the purpose of diagnosiss (2) patients needing to be watched before the best form of continued treatment can be determined. This is a good practical classification, and we also endorse the further statement that the term "sanatorium" should be used to indicate an institution mainly devoted to the reception of patients in Group A, the term " hospital " to indicate an institution provided for the reception of patients in Groups B, C, and D, and the term " combined institution " to indicate an institution devoted to the reception of patients in all four groups. If admissions to a sanatorium were strictly confined to patients suffering from pulmonary tuberculosis who are afebrile and able to take a certain amount of exercise, the results obtained would be more satisfactory than is at present the case. The types of buildings which are suggested are on the whole satifactory, but we do not like the plan of placing the consulting-room, laboratory, and dispensary in the same building and on the opposite side of a,