674 APPENDIX 



assistants, as these latter are usually careless, and fresh supplies of 

 instruments may require months to obtain. 



.Ml metal goods should be well plated, vaselined, and well packed 

 in a tin-lined soldered case for dispatch. The Customs authorities 

 usually open them and leave them open, but protection has been afforded 

 for the ocean passage. " Air-tight " boxes are not usually air-tight, 

 air escapes about the fastenings owing to expansion from heat, and is 

 usually reabsorbed in a moist condition when the atmosphere becomes 

 cool. All cases should be tin-lined and well soldered. 



^^e]vet-lined cases of instruments are only welcomed by cockroaches 

 and other insects. 



The anaesthetic of choice is chloroform. Although given by native 

 assistants over thousands of administrations very few accidents occur. 

 Ether is used at the Ancon Hospital, Panama, a fresh small tin being 

 opened for each case. Tropical workers as a rule find that ether 

 evaporates too quickly. Chloroform should be dispatched in glass 

 bottles, with glass stoppers well .sealed. Cork perishes, and unsealed 

 glass stoppers become loose in transit. 



Intraspinal ansesthesia is coming to the fore. Boyd and Young 

 report on over 6,000 cases at the Santo Tomas Hospital, Panama Canal 

 Zone. It was used for all operations below the umbilicus and sometimes 

 for the upper abdomen. The mixture was Stovaine o'l grm.. Sodium 

 chloride, o'l grm. in i c.c. of distilled Avater. Five c.c. were usuallv 

 given for operations of half an hour or less. Anaesthesia is complete in 

 three and a half minutes and lasts fifty to sixty minutes. It was preceded 

 by an injection of morphia. Cases showing a low blood-pressure from 

 shock following loss of blood were excluded. 



The sepsis of wounds is much more prevalent in the Tropics than in 

 Europe, as conditions are much less perfect and operations are carried 

 out in theatres open to air currents. 



The treatment of fractures is difficult. The patients are usually 

 restless, the skin is moist, and may be shed in cases requiring prolonged 

 extension. Adhesive plaster i.s. seldom adhesive, and plaster-of-Paris 

 seldom hardens sufficiently. 



One is often consulted as to when the spleen should be removed. 

 The writer follows Cantlie's list : — 



(i) Rupture of the spleen. 



(2) Primaiy hydatids. 



(3) ,, malignant growth. 



(4) M abscess. 



(5) >» massive tuberculosis of the spleen. 



(6) Chronic splenic anaemia. 



(y) ,, hsemolytic (splenic) jaundice. 

 (8) Banti's disease. 



SOME COMPARATn^E NORMAT. TE^FPERATURKS. 



Man 37'oO C. Cow 39"=^.^ C. ' 



Cat 38-80 C. Sheep 39-600. 



Dog 39-20 C. Pigeon 42-0° C. 



Goat 39-30 C. Duck 42-2O q 



Rabbit 39-50 C. Chicken ... 42-5O C. 



