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recommended by Professor Brauer is described in Iconsiderable detail. Tracheotomy having been per-formed, a long, soft rubber catheter, fitting quiteloosely in the tracheotomy tube, is attached to an

oxygen cylinder. An air filter is interposed as wellas a contrivance for keeping the oxygen moist whenthe insufflation has to be continued for a long time.The supply of oxygen is graduated by bubbling it

through an antiseptic solution before the catheter isintroduced into the trachea. When the end of thecatheter reaches the bifurcation of the trachea or oneof the bronchi it provokes coughing, and thus helps toclear the respiratory passages and facilitate respiration.As long as the escape of oxygen is not too rapid thelungs cannot be over-distended, for gases can easilyescape between the cather and the loosely fittingtracheotomy tube, as well as by the larynx. An addi-tional advantage of this procedure is the opportunity itaffords for the escape of CO2, which is otherwise aptto collect in the upper respiratory passages. It is

interesting to note that Professor Brauer is so doubtfulas to the value of atropine in morphine poisoning thathe does not prescribe it in severe cases. His attitudetowards this remedy is much the same as that voiced byProfessor Cushny in the 1905 edition of his " Text-bookof Pharmacology," in which he refers to the " long andweary dispute as to the value of atropine."

THE TREND OF FOOD PRICES.

THE Economic Review for April 22nd prints a table ofgreat value, comparing the retail price of food in manycountries during the last seven years, taking the year1914 as the basis. The month of July has been chosenfor the comparison, the figures are the official indexnumbers taken from the International Lrxbo2ar Review,and we reproduce them substantially, omitting a fewexceptions and qualifications which hardly affect theircomparative value.

Man does not live by bread alone, and in theDominions personal apparel has long been relativelymore costly than at home. But when it comes to thepinch it is the actual cost of essential foodstuffs aspurchased that determines economic stress, and thetable is instructive in this regard.

STAB WOUND OF BOTH VENTRICLES:

RECOVERY.

IN his Bradshaw lecture 1 own the Surgery of theHeart, on Dec. llth, 1919, Sir Charles Ballance tabulated152 cases of operations on the pericardium and heartperformed for injuries. No wound of both ventricleswas mentioned by him, but two cases of doublewound of right ventricle and auricle and of rightventricle alone were cited, both fatal. Dr. E. M.Freese has recently reported the following remark-able case of recovery after a stab wound ofboth ventricles. A coloured man was stabbed at

1 THE LANCET, 1920, i., 1, 73, 134.2 Journal of the American Medical Association, Feb. 19th.

8 P.M., and brought to hospital at 8.30 unconscious.I Respirations were feeble and shallow, and no pulsewas perceptible in radial or carotid arteries. Thepupils were widely dilated and the skin was bathedin cold perspiration. A spot of blood on the shirtover the heart indicated the site of the wound,which was 1 in. long, and in the fourth interspace 2 in.to the left of the sternum. Only. a small amount ofblood had escaped, not enough to account for the stateof the patient. The area of cardiac dullness wasmuch increased. The diagnosis of wound of theheart with haemorrhage into the pericardium seemedevident. There was no haemoptysis. The chest waspainted with tincture of iodine, and under lightether anaesthesia, with the wound as the centre,a U-shaped incision was made with the base out-wards. The skin and pectoral muscles were turnedback, the fourth and fifth costal cartilages werecut through, and the corresponding ribs carefullyseparated from the pleura for about three inches, andthen divided with bone forceps and turned outwards.This gave a very satisfactory exposure, and the woundin the pericardium, from which there was a smallstream of blood, was at once seen. The wound wasenlarged upwards and to the right. The lack of evencarotid pulse was now explained by the pericardiumbeing packed with clot. When this was scooped outthe heart at once began to beat violently, spurtingblood on to the anaesthetist. The heart wound was

instantly plugged with the tip of the left index fingeruntil a suture was passed and tied. This nearlychecked the flow, but it was necessary to use a secondsuture. Much blood was lost during these manipu-lations, but the action of the heart was fair and theanaesthetist could feel the pulse. But it was nowfound that blood was welling up behind the heart.Grasping the heart in the left hand, with index fingerhooked round the apex, Dr. Freese raised the organ so asto expose a wound in the posterior wall nearly as largeas the one closed in the anterior. Owing to the thick-ness of the left ventricle the wound was not bleeding sorapidly. It was closed with two sutures. The heart hadalmost stopped beating and no pulse could be felt. Anintravenous injection of saline solution was given, thepericardium was sponged out and closed by continuoussuture, the ribs were replaced, and the musculo-cutaneous flap was sutured in place without drainage.The patient was taken to his room, where he arrivedat 9.15 ; the foot of the bed was elevated, hot-waterbottles were placed around him, a hypodermic injectionof morphine and atropine was given, and rectal infusionwas started. On reaching his room the pulse was 72,but very small. The after-history was satisfactory ; atno time was there cause for alarm. Bronchitis developedon the second day and was annoying on account ofpainful cough, which was controlled with heroin. Onthe fourth day a loud friction murmur was heard overthe heart (pericarditis). This lasted for two weeks, butthere was never any sign of fluid sufficient to demandinterference. The highest temperature, 102° F., wasreached on the third day, with a pulse of 150. At thistime the bronchitis was most severe. The temperaturerose every afternoon to 100° until the eighteenth day.He was discharged a month after operation. The woundhad long since healed, and there were no physicalsigns. X ray examination showed only some thickeningof the pleura, with perhaps a little enlargement of theheart shadow.

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SPLENOMEGALY.

IN their review of recent work on diseases of thespleen in the May number of Medical Science, Dr.Gordon Ward and Dr. J. D. Rolleston devote severalpages to a consideration of various forms of spleno-megaly which have been lately described by British,French, German, Italian, and American observers. Notthe least interesting of them is the form to whichLuccarrelli has given the provisional title of " warsplenomegaly," having found it in a considerablenumber of soldiers without being able to connectit with any present or past disease such as malaria,enteric fever, spirochaetosis icterohaemorrhagica,