SPINAL ANESTHESIA IN EGYPT
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1135 nodules present. The temperature chart was typical of an acute endocarditis. On March 7th I performed a veni- puncture into the left median basilic vein, and obtained 5 c.c. of blood. The blood was inoculated into two broth tubes, and from one of these the diplococcus of which I shall speak presently was obtained. The after-history of the patient requires little comment ; gradually the tem- perature subsided, and a fortnight later it had regained the normal level. The heart sounds remained unaltered, and there were none of the later lesions associated sometimes with endocarditis. The patient was removed from the hospital by her relations on March 25th. The diplococcus which I obtained from the patient’s blood stream showed no evidence of having a capsule. In shape each coccus was round, the size being about 0 - 7f.L by 0. 7µ. There was no tendency to chain formation, either in broth or on solid media. The organism showed no evidence of a hilum. It was non-motile. It had neither spores nor flagella. Its thermal death-point was 580 C. This diplo- coccus does not retain the stain by Gram’s method-it is Gram-negative. It stains well with dilute carbol-fuchsin and eosin, less brilliantly with the blue dyes. It is not acid- fast. On nutrient agar the diplococcus grows well at 370 C. and fairly well at 20-220 C. At 420 C. on agar the growth is only slight. The growth on agar has a ground-glass appear- ance, with small translucent separate colonies at the edges of the streak. The organism does not readily die, and will survive on agar for at least 12 weeks without subculturing. The diplococcus will grow both anaerobically and aerobic- ally. It liquefies gelatin. It grows well in broth and peptone water, forming a precipitate ; in peptone water it produces indol at the end of a week’s growth. On Conradi- Drigalski medium and on Rebipelagar the diplococcus grows feebly, forming white, pin-point, translucent colonies. Litmus milk is clotted and turned acid by the diplococcus in 48 hours ; the clot is firm and not honey-combed, and the supernatant whey is clear. The organism ferments glucose, with the production of acid, but no gas. Lacicse, sucrose, maltose, galactose, raffinose, arabinose, mannite, dulcite, inulin, salicin, and dextrin are not affected. The diplococcus is not hasmolytic. The acidity and alkalinity of the culture media do not influence greatly the growth of this micro- organism. It grows well on agar between + 45 and - 60 (Eyre’s scale). Outside these extremes the growth is more feeble. The organism is inhibited by 1 in 40,000 malachite green. This diplococcus does not seem to be very pathogenic. The little girl from whose blood it was obtained was at no time very ill, nor did it produce any ill-effects when injected into guinea-pigs. I have to thank Professor R. T. Hewlett, who . conducted the inoculation experiments for me. At the time of the discovery of the diplococcus I had some thought that it might be the causative organism of scarlet fever, but I may say at once that this is, in all probability, not the case. I undertook a long series of agglutination and complement fixation reactions, using this organism with the blood from many scarlet fever patients, but in all these tests the results were negative. The micro-organism grows fairly well on agar to which has been added 1 in 4000 methylene blue, a medium which inhibits most other cocci. I plated many throat swabs from scarlet fever patients on to this medium, but never once succeeded in isolating this diplo- coccus from such cases. Diplococci have been obtained from the blood and joints of patients suffering from rheumatic fever and acute endocarditis by Poynton and Paine, Ainley Walker Triboulet,3 Beattie,4 and Wassermann. 5 Most of the diplococci described by these writers seem to have been Gram-positive, and differed in other ways from the organism I have isolated. W. v. Lingelsheim,6 in a long paper, describes many varieties of rare Gram-negative diplococci ; but no one of these appears to agree in all respects with the diplococcus which is the subject of this article. My thanks are due to Mr. G. N. A. Hall, who has kindly examined many of the properties of this diplococcus, and helped to verify my observations on it. 1 Poynton and Paine: THE LANCET, 1900, vol. ii., pp. 861, 932. 2 Ainley Walker: Practitioner, 1903, vol lxx., p. 185. 3 Triboulet: Comptes Rendus de la Société de Biologie, 1897, p. 1000. 4 Beattie: Journal of Pathology and Bacteriology, vol. ix., p. 272. 5 Wassermann: Berliner Klinische Wochenschritt, 1899, p 736. 6 W. v. Lingelsheim: Klinisches Jahrbuch, 1906, vol. xv., p. 373. SPINAL ANESTHESIA IN EGYPT. BY H. E. S. STIVEN, M.A., M.B., B.C. CANTAB., REGISTRAR, KASR-EL-AINI HOSPITAL, CAIRO. SOME extracts from the Kasr-el-Ami Hospital Report for the year 1910 may be of interest to surgeons and anæs- thetists. This hospital is a Government native hospital of about 500 beds. Here is also the Egyptian School of Medicine. The number of in-patients treated in 1910 was 8725. The total number of operations performed was 3205. The most notable feature with regard to operations in 1910 is the great advance which stovaine has made as a routine anaesthetic. In the general theatres the operations under stovaine exceed those under general anxsthesia. The figures are: stovaine, 662 ; general, 599. No untoward results are recorded, and the chief danger seems to be a lowering of the general blood pressure during the opera- tion. In the majority of cases this can be remedied by the administration of adrenalin. Stovaine did not produce its customary effect in at least 16 cases, which, therefore, had to be done under a general anaesthetic. Operations were finished off under chloroform in at least four case9. A successful administration of "high stovaine " was accomplished in 17 cases. In the gynaecological theatre only 19 cases were given a general anaesthetic out of a total of 201 patients operated upon. Details were carefully kept in this theatre, and 175 cases were successfully operated on under stovaine. In 8 cases a general anaesthetic had to be administered after the injection or stovaine, either because of the insufficient anves- thesia produced or to check vomiting when the peritoneum was pulled upon. Eleven cases had a general anaesthetic from the commencement. Seven cases, which I have not counted as having a general anaesthetic, required a little chloroform towards the end of the operation, as the effect of the stovaine was beginning to wear off. The longest time a patient was under stovaine in this theatre without any chloroform being necessary was two hours and a quarter : this was a patient with malignant disease on whom a Wertheim’s operation was being performed: stovaine (0’08gm.) was given at the commencement and repeated half-way through the opera. tion. The average length of time the anaesthesia lasts is about one hour and a quarter, but patients vary consiaeraaiy. The total statistics for anaesthetics in all the operating theatres shows : general anaesthetics, 1604; stovaine, 867 ; local anaesthetics, 633 ; somnoform, 126. The large majority of general anaesthetics is accounted for by the fact that 384 eye operations and 502 operations in the Cushaks (the minor operating theatres attached to the wards) were done under general anaesthesia. ’ I understand that two members of our staff are compiling a paper giving their detailed observations and conclusions. We look forward with interest to its publication. I have to thank Dr. H. P. Keatinge, the director of the Hospital and Medical School, for his permission to publish these notes. PRESENTATIONS TO MEDICAL PRACTITIONERS.- At Port Isaac (Cornwall) on Sept. 30th, Mr. Richard Julyan George, M.D., C.M. Edin., D.P.H.Irel., was presented with a silver table centrepiece and vases, together with an album containing the names of the subscribers, which numbered over 300, on the occasion of his leaving Port Isaac after practising for over 20 years in the district.-At Clovelly (Devon) on Sept. 30th, the members of the Clovelly Mariners’ Union Society presented Mr. Robert Walker, F. R. C. S. Edin., L. R. C. P. Edin., with a substantial cheque on the occasion of his retiring from active work and leaving Clovelly. The members of the Rechabite Friendly Society gave Mrs. Walker a handsome dressing-case.-At the Parish Room, Wotton-under-Edge, Gloucestershire, on Sept. 28th, Mr. James George Boyce, L.R C.P. & S. Irel., was pre- sented with a cheque for .E32, and an illuminated album con- taining the names of 170 subscribers, on the occasion of his leaving the town, after 20 years’ residence, for British Columbia. Mrs. Boyce was presented with a handsome box of gloves.
Transcript of SPINAL ANESTHESIA IN EGYPT
1135
nodules present. The temperature chart was typical of anacute endocarditis. On March 7th I performed a veni-
puncture into the left median basilic vein, and obtained5 c.c. of blood. The blood was inoculated into two broth
tubes, and from one of these the diplococcus of which I shallspeak presently was obtained. The after-history of the
patient requires little comment ; gradually the tem-
perature subsided, and a fortnight later it had regainedthe normal level. The heart sounds remained unaltered, andthere were none of the later lesions associated sometimeswith endocarditis. The patient was removed from the
hospital by her relations on March 25th.The diplococcus which I obtained from the patient’s blood
stream showed no evidence of having a capsule. In shapeeach coccus was round, the size being about 0 - 7f.L by 0. 7µ.There was no tendency to chain formation, either in broth oron solid media. The organism showed no evidence of ahilum. It was non-motile. It had neither spores nor
flagella. Its thermal death-point was 580 C. This diplo-coccus does not retain the stain by Gram’s method-it isGram-negative. It stains well with dilute carbol-fuchsinand eosin, less brilliantly with the blue dyes. It is not acid-fast.On nutrient agar the diplococcus grows well at 370 C. and
fairly well at 20-220 C. At 420 C. on agar the growth isonly slight. The growth on agar has a ground-glass appear-ance, with small translucent separate colonies at the edgesof the streak. The organism does not readily die, and willsurvive on agar for at least 12 weeks without subculturing.The diplococcus will grow both anaerobically and aerobic-ally. It liquefies gelatin. It grows well in broth andpeptone water, forming a precipitate ; in peptone water itproduces indol at the end of a week’s growth. On Conradi-
Drigalski medium and on Rebipelagar the diplococcus growsfeebly, forming white, pin-point, translucent colonies.Litmus milk is clotted and turned acid by the diplococcus in48 hours ; the clot is firm and not honey-combed, and thesupernatant whey is clear. The organism ferments glucose,with the production of acid, but no gas. Lacicse, sucrose,maltose, galactose, raffinose, arabinose, mannite, dulcite,inulin, salicin, and dextrin are not affected. The diplococcusis not hasmolytic. The acidity and alkalinity of the culturemedia do not influence greatly the growth of this micro-
organism. It grows well on agar between + 45 and - 60
(Eyre’s scale). Outside these extremes the growth is morefeeble. The organism is inhibited by 1 in 40,000 malachitegreen.This diplococcus does not seem to be very pathogenic. The
little girl from whose blood it was obtained was at no time
very ill, nor did it produce any ill-effects when injected intoguinea-pigs. I have to thank Professor R. T. Hewlett, who
. conducted the inoculation experiments for me.At the time of the discovery of the diplococcus I had some
thought that it might be the causative organism of scarletfever, but I may say at once that this is, in all probability,not the case. I undertook a long series of agglutination andcomplement fixation reactions, using this organism with theblood from many scarlet fever patients, but in all these teststhe results were negative. The micro-organism grows fairlywell on agar to which has been added 1 in 4000 methyleneblue, a medium which inhibits most other cocci. I platedmany throat swabs from scarlet fever patients on to thismedium, but never once succeeded in isolating this diplo-coccus from such cases.
Diplococci have been obtained from the blood and joints ofpatients suffering from rheumatic fever and acute endocarditisby Poynton and Paine, Ainley Walker Triboulet,3 Beattie,4and Wassermann. 5 Most of the diplococci described by thesewriters seem to have been Gram-positive, and differed inother ways from the organism I have isolated. W. v.Lingelsheim,6 in a long paper, describes many varieties ofrare Gram-negative diplococci ; but no one of these appearsto agree in all respects with the diplococcus which is thesubject of this article.My thanks are due to Mr. G. N. A. Hall, who has kindly
examined many of the properties of this diplococcus, andhelped to verify my observations on it.
1 Poynton and Paine: THE LANCET, 1900, vol. ii., pp. 861, 932.2 Ainley Walker: Practitioner, 1903, vol lxx., p. 185.
3 Triboulet: Comptes Rendus de la Société de Biologie, 1897, p. 1000.4 Beattie: Journal of Pathology and Bacteriology, vol. ix., p. 272.5 Wassermann: Berliner Klinische Wochenschritt, 1899, p 736.6 W. v. Lingelsheim: Klinisches Jahrbuch, 1906, vol. xv., p. 373.
SPINAL ANESTHESIA IN EGYPT.
BY H. E. S. STIVEN, M.A., M.B., B.C. CANTAB.,REGISTRAR, KASR-EL-AINI HOSPITAL, CAIRO.
SOME extracts from the Kasr-el-Ami Hospital Report forthe year 1910 may be of interest to surgeons and anæs-
thetists. This hospital is a Government native hospitalof about 500 beds. Here is also the Egyptian School ofMedicine. The number of in-patients treated in 1910was 8725. The total number of operations performed was3205.The most notable feature with regard to operations in
1910 is the great advance which stovaine has made as aroutine anaesthetic. In the general theatres the operationsunder stovaine exceed those under general anxsthesia. Thefigures are: stovaine, 662 ; general, 599. No untowardresults are recorded, and the chief danger seems to be alowering of the general blood pressure during the opera-tion. In the majority of cases this can be remedied bythe administration of adrenalin. Stovaine did not produceits customary effect in at least 16 cases, which, therefore,had to be done under a general anaesthetic. Operationswere finished off under chloroform in at least four case9.A successful administration of "high stovaine " wasaccomplished in 17 cases.
In the gynaecological theatre only 19 cases were given ageneral anaesthetic out of a total of 201 patients operatedupon. Details were carefully kept in this theatre, and175 cases were successfully operated on under stovaine. In8 cases a general anaesthetic had to be administered after theinjection or stovaine, either because of the insufficient anves-thesia produced or to check vomiting when the peritoneumwas pulled upon. Eleven cases had a general anaesthetic fromthe commencement. Seven cases, which I have not countedas having a general anaesthetic, required a little chloroformtowards the end of the operation, as the effect of the stovainewas beginning to wear off. The longest time a patient wasunder stovaine in this theatre without any chloroform beingnecessary was two hours and a quarter : this was a patientwith malignant disease on whom a Wertheim’s operation wasbeing performed: stovaine (0’08gm.) was given at thecommencement and repeated half-way through the opera.tion. The average length of time the anaesthesia lastsis about one hour and a quarter, but patients varyconsiaeraaiy.The total statistics for anaesthetics in all the operating
theatres shows : general anaesthetics, 1604; stovaine, 867 ;local anaesthetics, 633 ; somnoform, 126. The large majorityof general anaesthetics is accounted for by the fact that 384eye operations and 502 operations in the Cushaks (the minoroperating theatres attached to the wards) were done undergeneral anaesthesia.
’
I understand that two members of our staff are compilinga paper giving their detailed observations and conclusions.We look forward with interest to its publication.
I have to thank Dr. H. P. Keatinge, the director of theHospital and Medical School, for his permission to publishthese notes.
PRESENTATIONS TO MEDICAL PRACTITIONERS.-At Port Isaac (Cornwall) on Sept. 30th, Mr. Richard JulyanGeorge, M.D., C.M. Edin., D.P.H.Irel., was presented witha silver table centrepiece and vases, together with an albumcontaining the names of the subscribers, which numberedover 300, on the occasion of his leaving Port Isaac after
practising for over 20 years in the district.-At Clovelly(Devon) on Sept. 30th, the members of the ClovellyMariners’ Union Society presented Mr. Robert Walker,F. R. C. S. Edin., L. R. C. P. Edin., with a substantial chequeon the occasion of his retiring from active work and leavingClovelly. The members of the Rechabite Friendly Societygave Mrs. Walker a handsome dressing-case.-At the ParishRoom, Wotton-under-Edge, Gloucestershire, on Sept. 28th,Mr. James George Boyce, L.R C.P. & S. Irel., was pre-sented with a cheque for .E32, and an illuminated album con-taining the names of 170 subscribers, on the occasion of hisleaving the town, after 20 years’ residence, for BritishColumbia. Mrs. Boyce was presented with a handsome boxof gloves.
