Days Of Pompeii Research Articles

Tracheostomy: Present day indications and technics

0 NE OF THE oldest surgicaI procedures for sustaining Iife under emergency conditions is that of tracheostomy; we find it first mentioned by AscIepiades of Dithyma in 124 B.C. [I]. There is further mention of this operation in the days of Pompeii by a daring and capabIe surgeon, PauI of Agenia in 6go A.D. [2]. Coming to somewhat more modern times, Armond Trousseau was the first to perform tracheostomy in Paris, and for his brilIiant treatise on the subject, he received the coveted prize of the Academy of Medicine [3]. This procedure proved to be of such worth that American physicians were rapid to adopt its use and a number of pioneers in this country are listed in our historica writings. With this ancient background, it is obvious that the operation is no new story in medicine, nor is it our intention to suggest anything that might Iead to a comphcation of the simpIe methods of this very oId operation of opening the windpipe. Recent experience, however, pfompted the recording of present day uses of a modaIity sometimes considered appIicabIe onIy ih the direst of emergencies, as a Iast gasp procedure. The experience of ourseIves and many others [4-71 in the past decade does in no way suggest that “something new had been added,” but rather that “something oId has been expanded.” The broader use of tracheostomy in situations more Iifesustaining rather than actuaIIy Iife-saving seems worthy of consideration. The performance of this operation in the hospita1 bed, x-ray department, or in areas otherwise not surgicaIIy adapted seems to us rareIy necessary. We are not inclined to agree with recent reports in which the favored IocaIe was at the bedside [8]. Signs, symptoms and prodroma1 warnings are suffIcientIy we11 estabhshed to permit ampIe time for forma1 scheduIing of this operation in the surgica1 amphitheater where the operation can be done under idea1 surroundings and with the frequentIy needed support of our anesthesioIogy coIIeagues. This phiIosophic attitude with reference to respiratory probIems of this type admittedIy pIays a major roIe in surgica1 judgment and in the handIing of each individual patient. If, in our consuItative evaIuation of a given case, tracheostomy is a subconscious suggestion, in most instances evidence is probabIy sufficient to warrant immediate pIanned surgery. It is with these precepts in mind that we wouId Iike to present this cIinica1 experience. Our series incIudes that of the writers, thoracic surgica1 attendings, genera1 surgeons and residents in hospitaIs Iocated throughout the greater East Bay Area. These procedures were performed during a five year period from JuIy 1957 through June 1962 and totaIIed 461 cases. TabIe I, Iists the indications for which tracheostomy was performed in this series. The deaths, al1 but five of which were beIieved due to the underlying pathoIogy, wiII be discussed Iater.

A Quartet of Pompeian Pastiches

SHORTLY AFTER the excavation of Pompeii began in earnest about 1790, so-called Pompeian or Etruscan styles in architecture, interior decoration, and furniture swept across Europe and America. Everyone knows such examples of the fashion as Syon House near London (as redecorated by the Adam brothers) and Schliemann's home in Athens (which is now the Greek Supreme Court). Few people recall, however, that in addition to countless Pompeian rooms and Pompeian garden houses and fake Pompeian ruins, four serious attempts were made in four different countries to build a reproduction of a complete Pompeian villa. All four of these seem to owe something to the tremendous vogue of Bulwer-Lytton's The Last Days of Pompeii, which was published in 1834. Though all four obviously have much in common, each is interestingly shaped by the distinctive characteristics of the country in which it was built. Thus the history of these buildings and the differences between them make an amusing and revealing study. The first of these modern Pompeian villas was to have been the private museum of an amateur archaeologist king. Not content with reproducing in Munich the Athenian Propylaeum and a host of Renaissance buildings, Ludwig I of Bavaria in 1842 began erecting a Pompejanum in his castle garden at Aschaffenburg. Here he intended to display the objets d'art and house-furnishings his excavators had dug up at Pompeii and elsewhere. Unfortunately, before his plan was completed, Ludwig was forced to abdicate because of the scandal of his affair with the dancer Lola