SUTURE OF WOUNDS OF THE HEART.

491 too much a man of science to have attached any significance only exists in Government offices and hospitals. In trades, to his solitary experiment. But the story suffices to show the there is nominally no compulsory retirement, but if an intense earnestness of Pettenkofer as an investigator and the artisan is out of work at the age of 60 he will find hardly any sincerity of his efforts to throw light upon a terrible scourge employer who will give him more work although the same We now know that employer would probably have no hesitation in keeping on a with a view to its prevention. Pettenkofer’s views on sanitation, pure air, and pure water man who had grown up to the age of 60 in his employment. In this way retirement is to a certain extent compulsory, for are correct and since the time when he expressed his views we have had ample practical confirmation of them. None if a man cannot get work he is compelled to cease from will dispute that with the increasing attention that has it. But in the liberal professions we think that compulsory been given to these specific matters the health of the retirement does in many cases result in harm. Supposing people in all parts of the world has improved or that that the 65-year rule had obtained in the Church we should Pettenkofer, though an obstinate sceptic in certain matters, long ago have been deprived of the services of the present was a great sanitarian. Pettenkofer also turned his Metropolitan, a loss which would have been very great. It attention to many physiological problems of the utmost would be undoubtedly difficult to decide without giving His famous researches which established offence as to when a man became unfit, but that some modiimportance. the quantitative relations between the air inhaled and fication should be made in the present inelastic system of exhaled by animals have been proved to be a valuable compulsory retirement is, we think, certain. contribution to our knowledge of the metabolic processes of the animal body. Pettenkofer in conjunction SUTURE OF WOUNDS OF THE HEART. with Voit made some most important observations on THE Medical Record of New York recently contained the effect of muscular exertion upon the consumption an important paper on this subject by Dr. L. L. Hill. of oxygen and the production of carbonic acid. A related research was also conducted by these investigators A wound of the heart may be produced by a stab or by a blow upon the chest, especially after a full meal, when on the functions of particular nutritives in the animal body which involved laying down a theory of meta- the distended stomach pushes the heart upwards and In these researches Pettenkofer worked out forwards and causes a larger area of the organ to come bolism. his now classical method for the estimation of car- in contact with the thoracic wall. When haemorrhage into bonic acid gas in respired air and in the atmosphere. the pericardium is not arrested a fatal result is inevitable, This method, as is well known, depends upon the action of for when the limit of pericardial distensibility is reached carbonic acid upon baryta water, the gas being absorbed the heart is unable to dilate and the cardiac movements are Doubtless his mechanically stopped. Dr. Hill therefore insists that it with the formation of barium carbonate. is the of the surgeon to operate in every case of experiments on the processes of nutrition led him to seek a wound duty of the heart. It is as important to do so asThe Pettenkofer test for means of detecting bile in urine. to a In 45 collected relieve hernia. strangulated biliary acids which he subsequently discovered depended of the heartcases in which caused injuries rupture a train when formation of of colours urine upon the without opening the pericardium a fatal result always with was treated and bile common containing syrup survived as long as 14 hours. Of sulphuric acid. The most marked colour produced was ensued. Only one patient for on heart wounds 41 per cent. have a beautiful purple. The test has since been modified in patients operated as 10 against per cent. of those on whom no various ways, the most improvement being the recovered, was performed. Operators agree that for closing a use of glucose instead of cane sugar. Glucose does not char operation wound in the myocardium interrupted sutures are preferable when dissolved in strong sulphuric acid, whereas cane sugar to continuous sutures. They should be close together and not does, and this occurrence is apt to mask any colour that may involve the enoocardium. Silk is the best material. The be produced. The various schools of hygiene throughout should be similar to that used for intestinal suture. needle Germany contain professors of public health who were should be and tied during diastole. The The suture passed formerly pupils of Professor Pettenkofer. The veteran savant the heart and to facilitate first suture be used to steady may a at and such of life died the age of 83 years great length the passage of others. Ollier was opposed to the use of a was consistent with his precepts. general anaesthetic, but if the pulse was strong and the general condition was good chloroform might be given. Parrozzani THE CRUELTY OF COMPULSORY RETIREMENT. operated in two cases without anaesthesia and observed only A CORRESPONDENT is moved by " the lamented death of slight movement when he cut the skin and when he passed our beloved Qaeen, and upon contemplation of the many sutures into the myocardium. Dr. Hill narrates the two glorious and magnificent achievements of Her Majesty’s following cases. A girl, aged eight years, carried in her waist later years," to write to us upon the subject of the injustice a needle two and a half inches long which was driven into and cruelty of compulsory retirement. There is liberty in her heart in falling against a tree. She was brought to his most things, he says, but in the matter of labour liberty is house with anxious countenance, rapid and weak pulse, and in some quarters positively denied. Our correspondent laboured respiration. The needle had entered the left fifth further points out that the moment a man suddenly ceases intercostal space and the head could be seen moving under from his wonted labour he begins to deteriorate, and the skin with the cardiac pulsations. 10 drops of a 4 per instances a number of men and women who have done good cent. solution of cocaine were injected under the skin and work in old age. There is no doubt that a hard-and-fast an incision an inch in length was made down on the rule of retirement acts in many cases both unjustly and needle, which was extracted with dressing forceps. The injuriously-unjustly because age has nothing to do with wound was immediately closed. Recovery followed. In a man’s capacity for work, and injuriously because in some the second case a man, aged 28 years, received a stab cases the retirement comes when the ripe experience of the in the left fourth intercostal space a little inside the worker is at its best. The old proverb,"A woman is as old as nipple. The limbs became relaxed and the pulse was hardly she looks and a man is as old as he feels," is a very true one, perceptible. The sounds of the heart were indistinct and it is ridiculous to say that no one is fit for work and the area of cardiac dulness was increased. Evidently after 60. Some men are old at 40 while others are fresh the pericardium was filling with blood and the heart’s and juvenile at 80, and the personal equation must never be action would soon be stopped. External haemorrhage was overlooked. Compulsory retirement, so far as we know, slight. The blood was let out by enlarging the opening in.

important

492 ’the pericardium and the patient’s condition at once improved. ’He recovered though pericarditis followed. To expose the heart for the suture of wounds Dr., Rotter, writing in the Miinchener Medicinisclte Wochenschrift of Jan. 16th, 190J, p. 79, has recommended, as the result of experiments on the cadaver, that an incision commencing ,three-fifths of an inch from the left edge of the sternum be made outwards along the lower border of the third rib for a distance of four inches and a similar incision along the lower border of the fitth rib for about three and one-fifth -inches. The external ends of these incisions are connected by a third one. The incisions include the whole thickness of the thoracic wall and open the left pleural cavity. The fourth and fifth ribs are divided and luxated from their sternal attachments and the whole flap, including the soft parts and the ribs, is turned inwards, like a door on its hinges. The only arteries which have to be ligatured are the intercostals. The lung projects into the wound and is pushed outwards and held aside while the pericardium is opened by an incision extending from the upper and inner to the lower and outer angle of the opening in the thorax. The heart is so completely exposed that even the posterior surface can be Teached. If still more space is required the third rib may be included in the flap. -

THE

PRINCE OF WALES’S HOSPITAL FUND FOR LONDON.

WITH regard to this Fund we learn that the honorary secretaries are authorised to state that there is no intention of making any alteration whatever in the title of Its full title is, it should be remembered, the Fund. " The Prince of Wales’s Hospital Fund for London to Commemorate the Sixtieth Year of the Queen’s Reign." We are glad to have the opportunity of giving publicity to the above statement and are equally pleased to see the decision which has been arrived at. First of all, there is the sentimental reason. As the Preacher remarked, in a slightly different sense, " A good name is better than ointment," and names, without doubt, have a great influence. The title of the Fund could not be altered with any regard to the new position of its Royal founder without doing away with the memorial idea. Secondly, there is the practical side to be considered. The Fund has been known under its old name ever since its inception ; subscribers have got accustomed to the title, large legacies and bequests may have been left to the Fund which if the .name of the Fund were altered would have to be rebequeathed and, therefore, probably legal worries and expenses would have to be entered upon. For all these reasons we are glad to know that the old title will be kept, a title which will ever recall the sympathy of the Heir Apparent with the wants of the poor and needy, as well as the memory of the gentle, kindly monarch so lately entered on her rest to whom sorrow and suffering never appealed in vain. __

A

METHOD OF DISTINGUISHING THE BLOOD OF DIFFERENT ANIMALS.

IN the Deutsche Mediciniqche Wochenschrift of Feb. 7th Stabsarzt Dr. Uhlenhuth describes some experiments which he has made with human blood and also with that of a number of the lower animals, the result being that he believes that he has discovered a specific reaction for human blood and also for that of the common fowl, the horse, and the ox. The process of testing for ox-blood is described by him at length as follows. At intervals of from six to eight days about 10 cubic centimetres of defibrinated ox-blood were injected into the peritoneal cavity of a rabbit and after about five such injections the blood serum of the animal was ,fit for use. In the next place samples of the blood of a

number

of different animals were diluted with about 100 much ordinary water, making pale red solutions of about an equal depth of colour. The insoluble stroma Of each was removed either by subsidence or filtration. of the clear solutions thus obtained about two cubic centimetres were put into test-tubes of about a quarter of an inch in diameter, and then mixed with an equal quantity of a solution containing 1-6 per cent. common salt-i.e., It is twice the strength of physiological salt solution. essential to use this particular salt solution, for the normal serum of the rabbit mixed with plain water gives rise to a turbidity which might interfere with the recognition of the specific turbidity. With physiological salt solution the addition of rabbit’s serum never causes turbidity. Dr. Uhlenhuth employed in his experiments both human blood and also that of the ox, horse, ass, pig, sheep, dog, cat, stag, fallow-deer,

times

as

hare, guinea-pig, rat,

mouse, rabbit, common fowl, goose, and pigeon. To each of the test-tubes there was now added from a tube drawn to a fine point six or eight drops of the serum of the rabbit which had been injected with the blood of the ox, whereupon there was seen in the solution of ox-blood a distinct turbidity which was very evident by transmitted sunlight. The contents of all the other tubes remained perfectly clear. In course of time the turbidity increased and ultimately a copious flocculent deposit fell to the bottom. Normal rabbit’s serum causes no turbidity in solutions of ox-blood. By the addition of a few drops of serum from the injected rabbit it was therefore possible to recognise ox-blood. In a precisely similar manner injections of human blood were given to rabbits, and serum from the animals was added to the 19 specimens of blood above mentioned, the result being that the solution of human blood, and that alone, became turbid and threw down a deposit. All the other solutions remained perfectly clear. Normal rabbit’s serum causes no turbidity in solutions of human blood. This reaction, therefore, enabled human blood to be distinguished with certainty from the other kinds of blood above mentioned. The reaction Wa’3 extremely delicate, only traces of blood being required for the determination of the species of animal to which it belonged. By it Dr. Uhlenhuth succeeded in recognising samples of human blood, ox-blood, and horse-blood which had been allowed to dry on a board and after four weeks were dissolved in physiological salt solution for the purpose of examination. His experiments were made in the Hygienic Institute of the University of Greifswald. If his conclusions are verified the reaction will obviously be of great use in medico-legal

turkey-cock,

inquiries. THE WHITE

-

CROSS LEAGUE AND QUACKERY.

WE have received from the White Cross League two excellent pamphlets, entitled, " Quacks and their Advertise-

ments,"published at the offices of the League, 7, Dean’s-yard, with a view of protecting young persons and others from the machinations of a dangerous class of impostors. The particular quacks aimed at are those who trade upon the ignorance and fears of youth, who begin by alluring their victims by advertisements of cures for supposed sexual weakness or sexual disorders, and "remediesfor conception, and who end by extorting large sums of money either by selling sham, and possibly dangerous, medicines, or by the simpler and more lucrative process of blackmail. The pamphlets in question are not intended for the perusal of those liable to fall into the hands of the sexual quack, but are rather for the instruction and guidance of parents, clergymen, and others from whom the word of warning should most effectively come, but who are often silent simply because their observation has not been aroused, while their knowledge of the dangers to be feared and of the means of guarding against them is insufficient. We