at each of them and no correlation between the storage temperature and the number of cases could be made out.The butcher who was the source of the staphylococcus causing the outbreak had local treatment for the lesion in his hand, which soon healed. He also had a course of sulphathiazole, and swabs from his nose, throat, and hand are now negative.This experience has shown the value and importance in such outbreaks of close liaison between all interested parties and the necessity for thorough and prompt investigation by a bacteriologist with up-to-date services at his disposal. SummaryAn outbreak of toxic food-poisoning following the consumption of pressed pickled beef sandwiches is described. The evidence showed Staph. pyogenes aureus (phage type 47/47C) to be the cause. Personnel handling food should pay scrupulous attention to personal hygiene and especially to lesions, however slight.Close liaison between all interested parties was an important factor in finding the cause.
all round sense to other methods but even in its most refined standards it is doubtful whether, alone, it serves fully the requirements of the long and severe operations now carried out in the abdomen. Success with inhalational anaesthesia demands a much higher degree of technical dexterity and more fundamental physiological and pharmacological knowledge on the part of the administrator than ever before. In the hands of the. inexperienced there are many things that may go wrong and create dangers that are just as great, if not greater because they are more insidious than those associated with the older, and simpler methods.The observation so often made in the past that the choice of the anaesthetist is more important than the choice of anaesthetic is indeed truer today than ever for the scope for unintentional foolishness and possible disaster has widened considerably.
Two years ago we (Gray and Halton, 1946) expressed the opinion that d-tubocurarine chloride was the curare preparation of choice and were surprised that anmsthesiologists of the United States had preferred a comparatively crude substance. It is gratifying to find that the pure alkaloid is now used almost exclusively in this country and tends to replace intocostrin in the New World. It is unfortunate, however, that the States continue to assay their preparations against an arbitrary standard rather than compute the dosage in mg. of the pure alkaloid. It is even more regrettable and to be deprecated that one firm has introduced a preparation of tubocurarine of different strength to that usual in this country. Such deviations from accepted local custom can only cause confusion and may be dangerous.The history, pharmacology and story of the clinical use of d-tubocurarine chloride have been amply discussed during the last years. This paper, therefore, will be a critical appraisal of the status of this substance in the light of three years' experience of its use in anesthesia. I circulated a questionnaire to all the anmsthetists in the Liverpool district who were using d-tubocurarine chloride for their major abdominal and thoracic surgery. From the replies it would appear that in Liverpool alone close on 8,500 cases had been anesthetized with the aid of this substance up to the end of 1947. Much information accrued from this survey, and, most important, it was evident not one of these other anmsthetists had had a single death which they attributed in any way to d-tubocurarine chloride. Nor had they seen any evidence of an unexpected side-effect.From my own observations on the human, electrocardiogram and from animal experimentation (Gray and Gregory, 1948) it seems quite certain that there is no significant effect produced by d-tubocurarine chloride on the heart. In animals large amounts injected quickly may produce a sudden fall in blood-pressure. In human subjects, although Harroun and her colleagues (1947) have described a slight fall in blood-pressure, I have never been able to observe this and in two cases it did not follow the very rapid injection of doses of the order of 45 mg. Nor did Smith (1947), in the experiment in which he received 500 units of intocostrin, exhibit any alteration in the blood-pressure.There has not been any evidence of kidney or liver dysfunction following the use of tubocurarine nor, in my experience, has there been any hyperglycemia. I have used this substance in diabetic patients without any disturbance of their carbohydrate balance.
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