an experiment in pooling surgical records

1145

In voluntary emptying of the bladder the course ofeach one of the reflexes is inhibited by cerebralinfluences. The most important inhibition resultsin relaxation of the detrusor. If the stimulus isstronger than the inhibition there results an involun-tary micturition and discharge of urine.

THE PHENOLIPOIDS.

IN THE LANCET of March 27th, 1920, we drewattention to these compounds of carbolic acid,which, according to their discoverer, possess bothantibacterial and antitoxic properties. Dr. V. C.Piazza, of the University of Palermo,l has now madefurther researches on these bodies and has produced13 different compounds of phenol with yolk of

egg (lecithin) cholesterin cerebral substance andcamphor. He has worked out their chemicalrelations and biological properties when injectedinto the veins or peritoneal cavity of rabbits. Themost suitable of them for medical purposes are

Phenolipoids II, J, and N, composed of phenolcholesterin and camphor, phenol and the ethersoluble lipoid of egg yolk with camphor, and phenoland alcohol soluble lipoid of egg yolk with camphor,respectively. They present several characteristicsin common, being at ordinary temperatures, mostlyof semi-fluid consistence and soluble in ethylic ether,benzol, chloroform, xylol, olive and essential oils.Solutions in chloroform give an emerald-greencolour reaction with concentrated sulphuric acid,changing to a more or less intense red. They are allstable compounds, and exhibit a parasitotropicaction by inhibiting the development of bacteriaafter a certain period of contact, and an antitoxicaction by neutralising typhoid anaphylotoxin andthe toxins of tetanus and diphtheria. The clinicalapplication of these compounds has been takenup by Dr. F. Aliquo,2 who has made experiments on46 rabbits by producing septicaemia with injectionsof virulent cultures of Staphylococcus pyoe7aes aureus,and then observing the action of the phenolipoidson the morbid process produced. The phenolipoidwas administered subcutaneously and in some casesby intravenous injection either at the height of theinfection, or simultaneously with the inoculation ofthe staphylococcus, or else as a preventive measure.These experiments were rigorously controlled andhsemocultures made from blood were taken directfrom the heart ; thus 9 of the rabbits were controls,and of the remaining 37 there were 14 deaths and 23recoveries. From a purely clinical point of view Dr.V. Guercio 3 administered Phenolipoids H and N bysubcutaneous or intramuscular injection in manycases of influenza with pulmonary complications, andclaims that the results obtained were much superiorto those of other methods and in severe and prolongedcases were not only brilliant, but unexpected. It

appears to us that these new compounds deserve’considerable further investigation, both from an

experimental and clinical standpoint ; apparently, inthis country, they have failed to attract the attentionthey seem worthy of. _____

AN EXPERIMENT IN POOLING SURGICAL

RECORDS.

IN the last issue of Acta Chirurgica Scandinav’ica(1921, Vol. LIII., Fasc. V.) there is an editorialnotice which marks a departure from the familiarpaths of medical journalism. The notice beginswith reflections on the present state of affairs, whichpermits of much waste of good material. Valuableobservations often fail to get further than thesurgeon’s note-book or case papers. He may realisethat to publish an interesting case it is desirable forhim to study the literature of the subject, and forthis he may have no time. Or he may defer publica-tion of an interesting case in the hope that a similar

Atti della R. Acad. delle Sc. Med. in Palermo. 1920.2 Annali di Clinica Medica, Anno x., Fasc. iv.

3 Riv. Sanitaria Siciliana, Anno ix., 1921, No. 2.

case may turn up ; this hope may never be realised,and the oblivion to which the first case was tem-porarily condemned becomes permanent. Thereare also innumerable isolated observations over

which it hardly seems worth while to rush intoprint, although when grouped with other observationsthey may be of incalculable importance. With aview to drawing on these hitherto unexploredsources of knowledge the editorial staff of Actaproposes to constitute itself as a clearing housefor odds and ends of surgical information, and oncea year to publish a resume in which the names,addresses, and nationality of the authors of thisinformation will be given. Their contributions willbe sorted out into anatomical or clinical groups, andwill be reproduced in extenso or edited so as to fitin with similar observations from other quarters.It is hoped that the result of these labours will be aconcise as well as a comprehensive digest, and thatauthors will gain rather than lose by pooling theirknowledge. This yearly digest is to be published inEnglish and will be supervised by Gunnar Nystrom,surgeon to the Sabbatsberg Hospital in Stockholm.All three Scandinavian countries, as well as Finland,are represented on the staff of Acta, and this noticeis addressed to surgeons of all four countries. Itwill be interesting to follow the evolution of thisscheme, which, if successful, will doubtless be copiedin other countries. Obviously much depends on thetact and judgment with which this surgical pool isstirred, and the sponsors of the scheme are to becongratulated on securing the services of Dr. Nystromfor a very delicate task.

OPERATION FOR STRANGULATED HERNIA INTHE AGED UNDER LOCAL ANÆSTHESIA.

Dr. Martin T. Field has recently made a strongplea for local anaesthesia in operations for strangu-lated hernia in the aged, as it eliminates many of thedangers incurred under general anaesthesia. Statisticsfrom the larger American hospitals show that theoperative mortality incident to acute intestinalobstruction, excluding strangulated hernia, hasnot been greatly reduced in the last 10 or 15 years,while that of strangulated hernia has. This Dr.Field attributes to earlier diagnosis, less manipulation,and operation under local anaesthesia. The last con-dition is particularly suitable for local anaesthesia, as,unlike other forms of obstruction, there is no needto search for the point of obstruction and it isreadily accessible. In cases of inguinal hernia Dr.Field infiltrates the skin and subcutaneous tissue

along the line of incision with 0-5 per cent. ofnovocaine and then plunges the needle down until itovercomes the resistance of the external obliqueaponeurosis. About. ; oz. of solution is depositedbeneath this structure in the position of the ilio-inguinal nerve. A little is also injected in the regionof the external ring. After waiting a few minutesthe incision is carried down to the external oblique.This structure is carefully opened near the internalring and the flaps raised, exposing the ilio-inguinalnerve which lies on the internal oblique muscle.The nerve, which controls nine-tenths of the sensationin this region, is at once blocked by injecting it.The aponeurosis is now cut down through theexternal ring and also above the internal ring,exposing the ilio-hypogastric nerve, which is alsoblocked. The only nerve which can then conveysensation is the genital branch of the genito-crural,which lies in the posterior part of the cord. It canbe blocked later, or the same result can be attainedby injecting the upper part of the cord, care beingtaken not to puncture a vein. No more novoeaineis required, except a little to render the parietalperitoneum insensitive when tying the sac. Theradical operation is then performed, with or withoutremoval of the testicle. In old persons, especiallywith recurrent hernia, the removal of the testicle

1 Boston Medical and Surgical Journal, April 21st.