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SUTURE OF WOUNDS OF THE HEART.
88 out of the 50 which the building will possibly hold are occupied, and the income of the hospital does not suffice to keep more than that number filled. These are our views and we have heard nothing from those responsible for the policy of an immediate sale that leads us to alter them. We do not say that the committee of has no reason for what it proposes, but we management do say that it is singularly reticent, considering that it is dealing with a public charity. The whole case is one for publicity. Why must the site be sold at all ? Why must it be sold at once ? And if it must be sold at once, why is not its proper price ascertained in the usual way by putting the property up at Tokenhouse-yard ? It is possible that an answer to some of these questions may now be forthcoming, for on Wednesday afternoon last an inquiry into the matter was held at the hospital by the Charity
Commissioners. The inquiry was conducted by Mr. G. S. D. Murray, assistant commissioner, when the strong case for The those opposed to immediate sale was put forward. Charity Commissioners are not likely to sanction any sale upon grounds that will not bear public investigation and free discussion. ____
LACHNANTHES. WE publish an interesting communication thiii week on the chemical and therapeutic properties of lachnanthes, that much-discussed drug in regard to its alleged value in the treatment of tuberculosis. By following well-recognised chemical methods Mr. J. A. Gardner, M.A., F.I.C., has been able already to separate from the extract chemical entities which no doubt under further study will resolve themselves into substances of definite chemical composition. Thus, to quote one instance, a syrup was obtained which on standing for some weeks deposited crystals. The nature of these and other bodies will be elucidated, it is hoped, as a sufficient supply of the material is gained. Lachnanthes evidently consists largely of resinoids and further, perhaps, contains bodies of the nature of alkaloids. At any rate, an aqueous extract of the material is very distinctly toxic and far from any inhibitory action being shown upon the progress of tuberculosis the injection of the extract would seem to ha.sten it. These preliminary results are of sufficient interest to warrant extended inquiry and the indications of further experiments will be awaited with interest. The biological part of the inquiry was undertaken by Dr. Harold R. D. Spitta and Dr. Arthur Latham.
SUTURE OF WOUNDS OF THE HEART. result of the antiseptic method has been the of bringing every region of the body within the field of the operator. In consequence of obvious peculiar difficulties the heart has been the last territory encroached upon by modern surgery. Indeed, the number of operations performed on it are still very few. At the recent annual meeting of the American Medical Association Dr. Harry M. Sherman devoted his "Oration on Surgery"to "Suture of Heart Wounds" and presented a useful summary of our present knowledge of the subject. In 1896 the heart was sutured three times for wounds, in 1897 twice, in 1898 four times, in 1899 11 times, in 1900 three times, and in 1901 nine times. This year two operations have already been reported. All the wounds were punctured or incised except two bullet wounds. The ventricles were injured 32 times, the auricles twice-the right being opened in one case and the left in the other. In most of the cases in which details are given the pleura was wounded and usually there was hæmothorax. The method of operation varied : either a flap of all the tissues of the thoracic wall was turned up or a resection of Three operators used two or more ribs was performed. A
DIRECT
catgut for suturing the heart. In the other instances in which the material is specified silk was used. In most cases the sutures were interrupted, in a few they were continuous. The thoracic Inclusion of the endocardium was avoided. flaps were, of course, replaced ; in seven cases drainage of the pleura and pericardium was performed, in four of the pleura alone. Of the 34 patients five died on the table from hæmorrhage or shock and 10 soon afterwards. These deaths were probably inevitable under any conditions. Of the remaining 19, 13 recovered and six died from sepsis. In not one instance was death due to secondary haemorrhage. Thus the suture of the heart in all the 19 cases was a perfectly The successful operation for the arrest of haemorrhage. symptoms of wound of the heart are an external wound in the pericardium, the general signs of haemorrhage, disturbance of cardiac function, and signs of filling of the The left pleura extends so pericardium and pleura close to the sternum that practically a wound of the heart implies penetration of the pleura. Also in exposing the heart for suture opening of the pleural cavity is unavoidable. In the Münchener Medicinische Wochenschrift of Jan. 16th, 1900, Dr. Rotter has carefully described a method of exposing the heart so completely that even the posterior surface can be reached.1 In it a flap is formed containing the inner ends of the fourth and fifth ribs which are divided and luxated from their sternal attachments. The flap of thoracic wall is turned inwards like a door on its hinges. The subject is of wide practical importance, for suture of the heart, like herniotomy and tracheotomy, is an operation of emergency which any medical man should be prepared to undertake. If haemorrhage into the pericardium is not arrested when the limit of pericardial distensibility is reached the heart is unable to dilate and its movements are
mechanically stopped.
-
DISTRIBUTION OF MEDICAL PRACTITIONERS THE UNITED KINGDOM.
IN
A CORRESPONDENT has been making investigations into the distribution of medical practitioners or professors in the following places in the United Kingdom where the greatest number of them are congregated. He finds that the average number of medical persons in those places per 10,000 of the population works out as follows :-Clifton, 36-80 Bournemouth, 24’ 38 ; Harrogate, 21 - 11 ; Cambridge, 21’ 09 ; Westonsuper-Mare, 20’47 ; Bath, 20’07 ; Brighton, 19’51; Edinburgh, 19 - 14 Southport and Birkdale, 17-66 ; Tunbridge
Wells, 17’07; Torquay, 16-65 ; Eastbourne, 15-46 ; Bedford, 15-36 ; Oxford, 14’16; Dublin, 13’83; Scarborough, 13-36 ; Hastings and St. Leonards, 13’ 05 ; Glasgow, 12 80 ; Cheltenham, 12-33; Cork, 10-92; Blackpool, 10-56; Aberdeen, 10-45; Waterford, 9-72; York, 8-86; Plymouth, 8-55; Wakefield, 8-42 ; Limerick, 8-13 ; Newcastle-on-Tyne, 7-91; Cardiff, 7 - 78 Lancaster, 7’ 68 ; Southampton, 7’ 53 ; Londonderry, 7-49; Birmingham, 7-29; Birkenhead, 7-21 Croydon, 7-17 ; Belfast, 6-59 ; Stockport, 6-51 ; Manchester and Salford, 6-41 ; Nottingham, 6’ 38 ; Liverpool, 6-32; Portsmouth, 6’ 02 ; Preston, 6.01; Wolverhampton, 5-94; Leeds, 5 75 ; Derby, 5’57; Bootle, 5-46; Huddersfield, 5-36; Blackburn, 5-33; Northampton, 528; Great Yarmouth, 5’ 26 ; Bradford, 5 - 19 ; Sunderland, 5’11; Halifax, 5-05; Leicester, 5-05; Oldham, 5-02; Norwich, 5’01; Sheffield, 5-01; Paisley, 5-00; Bristol, 4-89; Burnley, 4-84; Hull, 4-65; Rochdale, 4-45; Dundee, 4-40; Middlesbro’-on-Tees, 4-38; South Shields, 4-31; Bolton, 4’16; Walsall, 3-93 ; Leith, 3-67; Gateshead, 3-63; and St. Helens, 3 31. In London there are about 12 medical persons per 10,000 of the population. The 24 cities in the United Kingdom which contain the largest number of medical
practitioners
or 1
professors
are
THE LANCET, Feb.
the
following, placed
16th, 1901, p. 491.
in
Commissioners. The inquiry was conducted by Mr. G. S. D. Murray, assistant commissioner, when the strong case for The those opposed to immediate sale was put forward. Charity Commissioners are not likely to sanction any sale upon grounds that will not bear public investigation and free discussion. ____
LACHNANTHES. WE publish an interesting communication thiii week on the chemical and therapeutic properties of lachnanthes, that much-discussed drug in regard to its alleged value in the treatment of tuberculosis. By following well-recognised chemical methods Mr. J. A. Gardner, M.A., F.I.C., has been able already to separate from the extract chemical entities which no doubt under further study will resolve themselves into substances of definite chemical composition. Thus, to quote one instance, a syrup was obtained which on standing for some weeks deposited crystals. The nature of these and other bodies will be elucidated, it is hoped, as a sufficient supply of the material is gained. Lachnanthes evidently consists largely of resinoids and further, perhaps, contains bodies of the nature of alkaloids. At any rate, an aqueous extract of the material is very distinctly toxic and far from any inhibitory action being shown upon the progress of tuberculosis the injection of the extract would seem to ha.sten it. These preliminary results are of sufficient interest to warrant extended inquiry and the indications of further experiments will be awaited with interest. The biological part of the inquiry was undertaken by Dr. Harold R. D. Spitta and Dr. Arthur Latham.
SUTURE OF WOUNDS OF THE HEART. result of the antiseptic method has been the of bringing every region of the body within the field of the operator. In consequence of obvious peculiar difficulties the heart has been the last territory encroached upon by modern surgery. Indeed, the number of operations performed on it are still very few. At the recent annual meeting of the American Medical Association Dr. Harry M. Sherman devoted his "Oration on Surgery"to "Suture of Heart Wounds" and presented a useful summary of our present knowledge of the subject. In 1896 the heart was sutured three times for wounds, in 1897 twice, in 1898 four times, in 1899 11 times, in 1900 three times, and in 1901 nine times. This year two operations have already been reported. All the wounds were punctured or incised except two bullet wounds. The ventricles were injured 32 times, the auricles twice-the right being opened in one case and the left in the other. In most of the cases in which details are given the pleura was wounded and usually there was hæmothorax. The method of operation varied : either a flap of all the tissues of the thoracic wall was turned up or a resection of Three operators used two or more ribs was performed. A
DIRECT
catgut for suturing the heart. In the other instances in which the material is specified silk was used. In most cases the sutures were interrupted, in a few they were continuous. The thoracic Inclusion of the endocardium was avoided. flaps were, of course, replaced ; in seven cases drainage of the pleura and pericardium was performed, in four of the pleura alone. Of the 34 patients five died on the table from hæmorrhage or shock and 10 soon afterwards. These deaths were probably inevitable under any conditions. Of the remaining 19, 13 recovered and six died from sepsis. In not one instance was death due to secondary haemorrhage. Thus the suture of the heart in all the 19 cases was a perfectly The successful operation for the arrest of haemorrhage. symptoms of wound of the heart are an external wound in the pericardium, the general signs of haemorrhage, disturbance of cardiac function, and signs of filling of the The left pleura extends so pericardium and pleura close to the sternum that practically a wound of the heart implies penetration of the pleura. Also in exposing the heart for suture opening of the pleural cavity is unavoidable. In the Münchener Medicinische Wochenschrift of Jan. 16th, 1900, Dr. Rotter has carefully described a method of exposing the heart so completely that even the posterior surface can be reached.1 In it a flap is formed containing the inner ends of the fourth and fifth ribs which are divided and luxated from their sternal attachments. The flap of thoracic wall is turned inwards like a door on its hinges. The subject is of wide practical importance, for suture of the heart, like herniotomy and tracheotomy, is an operation of emergency which any medical man should be prepared to undertake. If haemorrhage into the pericardium is not arrested when the limit of pericardial distensibility is reached the heart is unable to dilate and its movements are
mechanically stopped.
-
DISTRIBUTION OF MEDICAL PRACTITIONERS THE UNITED KINGDOM.
IN
A CORRESPONDENT has been making investigations into the distribution of medical practitioners or professors in the following places in the United Kingdom where the greatest number of them are congregated. He finds that the average number of medical persons in those places per 10,000 of the population works out as follows :-Clifton, 36-80 Bournemouth, 24’ 38 ; Harrogate, 21 - 11 ; Cambridge, 21’ 09 ; Westonsuper-Mare, 20’47 ; Bath, 20’07 ; Brighton, 19’51; Edinburgh, 19 - 14 Southport and Birkdale, 17-66 ; Tunbridge
Wells, 17’07; Torquay, 16-65 ; Eastbourne, 15-46 ; Bedford, 15-36 ; Oxford, 14’16; Dublin, 13’83; Scarborough, 13-36 ; Hastings and St. Leonards, 13’ 05 ; Glasgow, 12 80 ; Cheltenham, 12-33; Cork, 10-92; Blackpool, 10-56; Aberdeen, 10-45; Waterford, 9-72; York, 8-86; Plymouth, 8-55; Wakefield, 8-42 ; Limerick, 8-13 ; Newcastle-on-Tyne, 7-91; Cardiff, 7 - 78 Lancaster, 7’ 68 ; Southampton, 7’ 53 ; Londonderry, 7-49; Birmingham, 7-29; Birkenhead, 7-21 Croydon, 7-17 ; Belfast, 6-59 ; Stockport, 6-51 ; Manchester and Salford, 6-41 ; Nottingham, 6’ 38 ; Liverpool, 6-32; Portsmouth, 6’ 02 ; Preston, 6.01; Wolverhampton, 5-94; Leeds, 5 75 ; Derby, 5’57; Bootle, 5-46; Huddersfield, 5-36; Blackburn, 5-33; Northampton, 528; Great Yarmouth, 5’ 26 ; Bradford, 5 - 19 ; Sunderland, 5’11; Halifax, 5-05; Leicester, 5-05; Oldham, 5-02; Norwich, 5’01; Sheffield, 5-01; Paisley, 5-00; Bristol, 4-89; Burnley, 4-84; Hull, 4-65; Rochdale, 4-45; Dundee, 4-40; Middlesbro’-on-Tees, 4-38; South Shields, 4-31; Bolton, 4’16; Walsall, 3-93 ; Leith, 3-67; Gateshead, 3-63; and St. Helens, 3 31. In London there are about 12 medical persons per 10,000 of the population. The 24 cities in the United Kingdom which contain the largest number of medical
practitioners
or 1
professors
are
THE LANCET, Feb.
the
following, placed
16th, 1901, p. 491.
in