James Grant

Post-inoculation Poliomyelitis

Oxygen can be introduced into the blood stream by this method, and the extrapulmonary addition is of benefit to dogs made anoxic by a reduction of oxygen in the inspired air. The site of return of artificially arterialized blood is of great importance, and should be either into a central vein or into an artery close to the heart. For these reasons it is felt that the heart-lung machine is now ready for clinical trials in selected cases of extreme cardio-respiratory dysfunction. In those patients in whom derangement of pulmonary function is the chief symptom, it may be advantageous to return the arterialized blood into a central vein, thus greatly simplifying the cannulation and making the surgical intervention a relatively minor one. Though no shunting of blood around the heart would occur in this technique, it is possible that the improved oxygenation would reduce the demands on the heart, and secondarily reduce its work. Where the myocardium is primarily involved it is suggested that continuous venesection with return of arterialized blood into the arterial circulation will relieve the heart of part of its burden.

The Problems of Diphtheria

Diphtheria is of venerable antiquity, but its history really begins with its delineation in 1855 by Bretonneau and Trousseau, who incidentally had previously introduced tracheotomy for laryngeal diphtheria. In 1883 Klebs identified and Loeffler confirmed the causal role of the diphtheria bacillus, and five years later Roux and Yersin demonstrated the exotoxin, which Von Behrng used in 1890 to produce an antitoxic serum from guinea-pigs. In 1894 the excellent results with Rouxs horse antitoxin in the treatment of diphtheria in Paris brought about the adoption of serotherapy in London, where the customary dosage of 2,000 to 4,000 units of antitox:n subcutaneously procuced a fall in the case mortality of diphtheria from 23% in 1894 to roughly 8% in 1905. The principle of passive immunization through a small dose of antitoxic serum was soon established. Attempts at the active immunization of human beings by injections of toxin finally led to the use of a mixture of toxin and antitoxin for this purpose by Von Behring in 1913, in which year Schick published his famous skin test with diluted toxin. We now know that the presumably susceptible positive reactor has a blood antitoxin content below 0.01 unit per ml., and that antitoxin concentration is above this in the negative reactor.

Iron Content of Infant Milk Foods.

that all suture materials be steeped in a 1/2,000 solution of Chlorhexidine ? I would like to point out that all surgical catgut supplied by British manufacturers is sterile and preconditioned for use, and that immersion in chlorhexidine, particularly if it is an aqueous solution, could have an. effect on the plybonding leading to separation of the plies and perhaps to premature or delayed absorption-not to mention loss of strength, since most catgut has an affinity for moisture and will absorb it until a peak saturation point is reached with subsequent loss of tensile strength. Some non-absorbable sutures like silk are serum-proofed by the manufacturers for partly obvious reasons, and one of these is to reduce intercellular reaction when implanted. What will happen to this proofing after immersion in chlorhexidine, or indeed what will happen to the silk ? Will it continue to fragment after due period of implantation and be absorbed by inclusion into the mononuclear phagocyte, or remain unencapsulated-a mechanical irritating body ? Investigation studies on the use of chemicals when used in connexion with suture materials have been regretfully inadequate and in my opinion detailed histological studies in animals are necessary to determine the effect that Chlorhexidine could -have on them and wound healing before the acceptance of Mr. Fowlers recommendations.-I am, etc.,