Yandell Henderson

RECOLLECTIONS OF A STREET CORNER PUMP AND THE PROGRESS OF SIXTY YEARS

THIESE recollections center about an old pump on a street corner and some of the boys who used it: particularly one of the boys, Simon Flexner by name. The pump was on the southeast corner of Chestnut and Sixth Streets; the time was about sixty years ago, when I was nine or ten years old, and Simon Flexner just ten years older. Any city of our Midwest or South would do as well; but in fact the place was Louisville, Kentucky. This pump was merely the trunk of a tree-virtually a piece of telegraph pole with its center bored-out-stood up in a well. A long curved metal arm with a knob on the end stuck out to

FOR A BETTER MEANS OF ESTIMATING THE NEED FOR RESTORATION OF THE BLOOD VOLUME

To the Editor:— The benefit of infusion of serum in cases of shock seems now to be established beyond all doubt. Particularly after severe burns, if the loss of serum externally is not to induce a development of shock, restoration of the blood volume is imperative. The question then is How can the surgeon best judge when, how much and how rapidly serum should be administered? It seems now to be generally accepted that failure of the circulation, or shock from decrease of blood volume, is not due to depression of the vasomotor control of the arteries but that the fall of arterial pressure is secondary to the decrease of the venous return: the heart can pump into the arteries no more than the decreased volume that it receives from the veins. It would therefore be more logical and afford an earlier and more quantitative index of a failing circulation

USE OF INHALATIONS OF CARBON DIOXIDE TO PREVENT POSTOPERATIVE PULMONARY COMPLICATIONS

To the Editor: —Less than five years ago Coryllos and Birnbaum, on the basis chiefly of experimental observations, announced the exceedingly important and illuminating doctrine that obstruction of the bronchi is the condition that commonly induces postoperative pulmonary complications. From clinical observations at about the same time Scott and Cutler reported that hyperventilation with carbon dioxide after operations, as recommended by Henderson, Haggard and Coburn, greatly diminishes pulmonary complications. It is this and other clinical demonstrations of the fact that clearing the bronchi tends to prevent subsequent complications which establishes the critical importance of bronchial obstruction. Without this therapeutic or prophylactic benefit, that doctrine would be merely a brilliant hypothesis. There appears to be at present a general acceptance of this doctrine, combined illogically with a failure to realize that doctrine and evidence stand or fall together. This confusion is shown in a paper inThe Journal, January 7, from

Oxygen and Everest

ON the interesting subject of the need for oxygen on Mount Everest, Prof J. Barcroft has made the remark, before Section I of the British Association, that the whole matter is now merely “an engineers problem”: the problem of designing a light and efficient oxygen breathing apparatus. This point of view is ably supported by Prof. Margaria.1 There is, however, something more: namely, the disadvantage of acclimatisation in a man using such apparatus. If it is one of the ‘open circuit’ type, acclimatised breathing causes a huge waste of oxygen and adds correspondingly to the difficulty of transportation. Yet a man dare not relinquish this physiological condition, even if he could. For if he relinquished it, he would die of asphyxia as soon as he took the apparatus off.