- Email: [email protected]
THE USE OF CARBON DIOXIDE IN OBSTETRICS
1234 that in sourness, sweetness, and so forth, we dealing with biologically false values, dictated the criteria of pleasantness and unpleasantness by instead of good and bad. One could, with difficulty, visualise a world safe for pedestrians in which sight was unimportant for self-preservation, and in which the idea of the eye as a distance receptor was quite foreign to the mentality of those carrying out research on vision. It is unfortunate that the lower animals are incapable of yielding information about their sensations ; so many organs are known which have relinquished their original function and taken over a new one, that it seems highly probable that those special senses which we can do without have acquired, in the course of evolution, a fresh significance.
bility
may be
Walzer’s indirect method, in which the effect of the suspected substance is observed on an area of the skin of a normal person into whom some of the
THE USE OF CARBON DIOXIDE IN OBSTETRICS
THE value of carbon dioxide, given with oxygen newly born infants who need resuscitation, is well established although the practice is comparatively recent. Now we are presented with evidence1 to show that the same gases are effective remedies for two of the most formidable complications of pregnancy, post-partum eclampsia and haemorrhage. The case reports are impressive and demonstrate the striking results of inhalation of a mixture of 10 per cent. COwith 90 per cent. oxygen by patients unconscious and convulsive. Post-partum haemorrhage has been treated by a mixture of 5 per cent. CO2 with 95 per cent. oxygen; this is stated to have promptly controlled the bleeding in 25 consecutive cases.
to
The author regards this mixture of great prophylactic value and gives it as a routine immediately after delivery, to maintain the tone of the uterine muscle. Since doing so in the last two years he has met with no undue bleeding from the placental site. He maintains that the proper use of CO2 and oxygen " prevents and controls a condition after the
accepted but inadequate measures have failed," and points out that Yandell Henderson suggested the use of carbon dioxide for stimulation of the uterine muscle so long ago as 1909. A mild degree of shock can so diminish the oxidation of lactic acid, present presumably to excess in the tissue of the fatigued uterus, that an acid base imbalance destroys the muscle cell tone. Its effect in correcting this and the acapnia due to hyperpnoea at the end of delivery is the probable explanation of the advantageous results which follow post-partum inhalations of CO2 and oxygen. ATOPY AS A CAUSE OF EPILEPSY
THE idea that epileptic fits may be allergic reactions is no new one. Many attempts have been made to track down and remove offending proteins or to carry out specific or general desensitisation in epileptic patients, and the results have not been very encouraging. Dr. Jonathan Forman, however, who is lecturer on diseases due to allergy in the Ohio State University, thinks there is a small but definite group of cases in which atopy-by which he means inherited allergic tendencies-is a dominant factor in the epilepsy, and which can be cured by anti-allergic measures.2 The four criteria in the diagnosis of these cases are a family history of atopic manifestations, a similar personal history, eosinophilia before
during the attacks, and positive reactions to tests for protein sensitiveness in the skin. For identification of the offending substance Forman favours
or
1 McCormack, R. M. : Anæsth. and Analges., SeptemberOctober, 1934, p. 213. 2 Arch. Neur. and Psychiat., September, 1934, p. 517.
patient’s
serum
has been
injected. Specific
treat-
removal of the offending substance from the diet or environment. Specific "desensitisation," a term to which Dr. Forman objects, is not likely to be successful in the case of foodstuffs, which are the commonest offenders. Nonspecific treatment includes the alteration of the physiochemical balance by various drugs or by vitamin A, and the removal of unfavourable factors. Among the latter Forman includes fatigue, climate, malnutrition, constipation, and focal endocrine and emotional disorders. He gives an account of a few cases which have yielded happy results in his hands, but the method should obviously be reserved for those cases of idiopathic epilepsy in which the diagnostic criteria are present and treatment along the usual lines has failed.
ment is best effected
by
AGRICULTURAL RESEARCH IN its first report1 the Agricultural Research Council deals with the period from July, 1931, to Sept. 30th, 1933. This is the third research department created by order of the Privy Council, and like the other two-the Medical Research Council and the Department of Scientific and Industrial Researchit is responsible directly to a committee of the Privy Council and with its two fellows is designed to cover the whole field of scientific research in this country supported by Government grants. Of the members of the Council, which meets under the chairmanship of Lord Richard Cavendish, two-thirds are appointed for qualifications in the basic sciences underlying agriculture and one-third on account of general
experience and interest in agriculture. The subjects with which the Council is concerned being so numerous and varied, six standing committees were set up to survey and consider problems under different headings. To most of these committees were added from outside the Council one or two specialists on the subject concerned. For many purposes the committee on soils and plant nutrition has collaborated with one the on plant physiology, breeding, and disease ; committee on animal diseases with others on animal nutrition and breeding, dairying, and animal products; a sixth standing committee on economics remaining distinct. Other more specialised committees were also formed, and since research on animal diseases was regarded as urgently needed, in view of the large increase in the animal population projected by the Government, that aspect of the Council’s work has claimed a large share of attention. Committees have been set up to promote research on tuberculosis in conjunction with the Medical Research Council, on Brucella abortus infections in man and animals, on Johne’s disease in cattle and sheep, on braxy and allied diseases of sheep, on diseases of swine and on fowl paralysis. The work of the foot-and-mouth disease research committee has also come under review. That the intimate connexion between human and animal disease both on the clinical and the pathological side has been constantly kept in mind is shown by the constitution of these committees. The agricultural problems concerning plants and animals, in relation to nutrition and to agents of infection, are opportunely brought together at a time when our knowledge of foods is rapidly advancing and diseases due to viruses are taking an increasingly important place in the study of infective processes. 1 Cmd. 4718.
H.M. Stationery Office.
Pp. 204.
3s.
bility
may be
Walzer’s indirect method, in which the effect of the suspected substance is observed on an area of the skin of a normal person into whom some of the
THE USE OF CARBON DIOXIDE IN OBSTETRICS
THE value of carbon dioxide, given with oxygen newly born infants who need resuscitation, is well established although the practice is comparatively recent. Now we are presented with evidence1 to show that the same gases are effective remedies for two of the most formidable complications of pregnancy, post-partum eclampsia and haemorrhage. The case reports are impressive and demonstrate the striking results of inhalation of a mixture of 10 per cent. COwith 90 per cent. oxygen by patients unconscious and convulsive. Post-partum haemorrhage has been treated by a mixture of 5 per cent. CO2 with 95 per cent. oxygen; this is stated to have promptly controlled the bleeding in 25 consecutive cases.
to
The author regards this mixture of great prophylactic value and gives it as a routine immediately after delivery, to maintain the tone of the uterine muscle. Since doing so in the last two years he has met with no undue bleeding from the placental site. He maintains that the proper use of CO2 and oxygen " prevents and controls a condition after the
accepted but inadequate measures have failed," and points out that Yandell Henderson suggested the use of carbon dioxide for stimulation of the uterine muscle so long ago as 1909. A mild degree of shock can so diminish the oxidation of lactic acid, present presumably to excess in the tissue of the fatigued uterus, that an acid base imbalance destroys the muscle cell tone. Its effect in correcting this and the acapnia due to hyperpnoea at the end of delivery is the probable explanation of the advantageous results which follow post-partum inhalations of CO2 and oxygen. ATOPY AS A CAUSE OF EPILEPSY
THE idea that epileptic fits may be allergic reactions is no new one. Many attempts have been made to track down and remove offending proteins or to carry out specific or general desensitisation in epileptic patients, and the results have not been very encouraging. Dr. Jonathan Forman, however, who is lecturer on diseases due to allergy in the Ohio State University, thinks there is a small but definite group of cases in which atopy-by which he means inherited allergic tendencies-is a dominant factor in the epilepsy, and which can be cured by anti-allergic measures.2 The four criteria in the diagnosis of these cases are a family history of atopic manifestations, a similar personal history, eosinophilia before
during the attacks, and positive reactions to tests for protein sensitiveness in the skin. For identification of the offending substance Forman favours
or
1 McCormack, R. M. : Anæsth. and Analges., SeptemberOctober, 1934, p. 213. 2 Arch. Neur. and Psychiat., September, 1934, p. 517.
patient’s
serum
has been
injected. Specific
treat-
removal of the offending substance from the diet or environment. Specific "desensitisation," a term to which Dr. Forman objects, is not likely to be successful in the case of foodstuffs, which are the commonest offenders. Nonspecific treatment includes the alteration of the physiochemical balance by various drugs or by vitamin A, and the removal of unfavourable factors. Among the latter Forman includes fatigue, climate, malnutrition, constipation, and focal endocrine and emotional disorders. He gives an account of a few cases which have yielded happy results in his hands, but the method should obviously be reserved for those cases of idiopathic epilepsy in which the diagnostic criteria are present and treatment along the usual lines has failed.
ment is best effected
by
AGRICULTURAL RESEARCH IN its first report1 the Agricultural Research Council deals with the period from July, 1931, to Sept. 30th, 1933. This is the third research department created by order of the Privy Council, and like the other two-the Medical Research Council and the Department of Scientific and Industrial Researchit is responsible directly to a committee of the Privy Council and with its two fellows is designed to cover the whole field of scientific research in this country supported by Government grants. Of the members of the Council, which meets under the chairmanship of Lord Richard Cavendish, two-thirds are appointed for qualifications in the basic sciences underlying agriculture and one-third on account of general
experience and interest in agriculture. The subjects with which the Council is concerned being so numerous and varied, six standing committees were set up to survey and consider problems under different headings. To most of these committees were added from outside the Council one or two specialists on the subject concerned. For many purposes the committee on soils and plant nutrition has collaborated with one the on plant physiology, breeding, and disease ; committee on animal diseases with others on animal nutrition and breeding, dairying, and animal products; a sixth standing committee on economics remaining distinct. Other more specialised committees were also formed, and since research on animal diseases was regarded as urgently needed, in view of the large increase in the animal population projected by the Government, that aspect of the Council’s work has claimed a large share of attention. Committees have been set up to promote research on tuberculosis in conjunction with the Medical Research Council, on Brucella abortus infections in man and animals, on Johne’s disease in cattle and sheep, on braxy and allied diseases of sheep, on diseases of swine and on fowl paralysis. The work of the foot-and-mouth disease research committee has also come under review. That the intimate connexion between human and animal disease both on the clinical and the pathological side has been constantly kept in mind is shown by the constitution of these committees. The agricultural problems concerning plants and animals, in relation to nutrition and to agents of infection, are opportunely brought together at a time when our knowledge of foods is rapidly advancing and diseases due to viruses are taking an increasingly important place in the study of infective processes. 1 Cmd. 4718.
H.M. Stationery Office.
Pp. 204.
3s.