Rubber Bag Research Articles

HUMAN LIFE AND DEATH AT HIGH PRESSURES

MEN are exposed to high pressures in a number of circumstances. They may be working in compressed air in a caisson or diving–bell, working under water in a diving dress, or attempting to escape from a sunken submarine. In the latter case it is obviously necessary that the air pressure inside a part of the ship should be equal to that of the water outside before a man emerges. This can be achieved either by flooding a small escape chamber holding only two men, or a whole compartment of the ship. Men have escaped by both these methods. They can rise through the water either holding their breath or breathing from a Davis submarine escape apparatus. The former method is not to be recommended, but it is not quite so hazardous as it sounds, for a lung–full of air at 5 atmospheres contains as much oxygen as a lung–full of oxygen at atmospheric pressure, and will allow a man to hold his breath for more than twice the normal time. The Davis submarine escape apparatus consists of a rubber bag and a soda–lime canister to absorb carbon dioxide. The bag is filled with oxygen from a small cylinder of the compressed gas. It has the advantage over air that it can be used almost to the last dreg. We shall come to its disadvantages later.

Cholecystography: Optimum Voltage

GRAHAM'S (1) original success in visualization of the gall bladder was with tetrabromphenolphthalein. For a year this was used by several workers, given by vein and by mouth, but was soon replaced everywhere by tetraiodophenolphthalein. (Some of the early tetraiodo. preparations had been toxic.) Actual measurements of the densities of shadows produced were apparently not made. Newell (2), in attempting to standardize gall-bladder shadows, made no study of the relation of contrast to tube voltage. He took it to be obvious that one ought to use the lowest practical voltage consistent with exposures short enough to avoid movement, accepting 60 kv. as the best compromise. With the advent of the rotating anode tube, lower voltages have become practical. We, therefore, set about making a set of gall-bladder standards for 50 and 40 kv. To our surprise, the shadows looked the same as at 60 kv. (Fig. 2). Reference to Figure 1 makes this paradox understandable. At 50 kv. constant potential (60 to 70 kv. pulsating) the peak of the x-ray spectrum comes just on the short wave side of the K absorption edge of iodine. At 30 kv. constant potential (say, 40 kv. pulsating) the peak falls right in the trough of selective transparency on the long wave length side of the absorption edge. Having been led thus to the practical conclusion that 70 kv. is as good as 40 for tetraiodo. examinations, we wondered if we might not make the higher voltage show an even better shadow by using a filter selectively absorptive for just those wave lengths in which iodine is selectively transparent. We made some preliminary trials with filters of barium sulphate and of cerium sulphate, but shadows did not appear any better. Then at moderate voltages we tried filters of silver and of molybdenum, hoping to cut off the short end of the spectrum, yet avoid the low efficiency of extremely low tube voltages. This scheme also yielded nothing worth while. Another possibility was to go back to tetrabromphenolphthalein. There is a long range of wave lengths (from 0.92 Å. to 0.37 Å.) for which bromine is more than twice as opaque as iodine (gram for gram). If we use this range of wave lengths, tetrabromphenolphthalein ought to cast better shadows than tetraiodophenolphthalein. Figure 3 confirms this . We could show tetrabrom. in half the concentration needed for tetraiodo. (but only at lowest practical kv. and smallest depth of immersion in water). With care, a visible shadow can be obtained of one-eighth per cent NaBr, while one-eighth per cent NaI remains completely invisible (in a 34 mm. rubber bag in 4 cm. of water). For practical visualization of the gall bladder, tetrabromphenolphthalein will not be better than tetraiodophenolphthalein, unless it proves, on further trial, to accumulate in higher percentage concentration, or to lead to fewer unpleasant reactions. Tetraiodo. by mouth produces unpleasant symptoms of some degree in 60 per cent of patients (3).

Roentgenography of the Second Cervical Vertebra by Ottonello's Method

SINCE the description, in 1930, of a method of producing roentgenograms of the entire cervical spine in posterior projection on a single film by Ottonello (1), no information on its use was found in a search of the American literature. As, however, the value of this procedure is considerable, a brief descriptive note, with some suggested modifications, seems warranted. Ottonello's view consists of a roentgenograph taken with the jaw in constant motion vertically, i.e., by opening and shutting the mouth, the other factors being approximately the same as for the ordinary posterior view of the cervical spine. Several complete motions of the jaw must be made, open and shut, during the exposure, and an even, rhythmical motion is essential. In positioning the head, hyperextension of the neck is very important. If the head is flexed, the upper teeth will prevent the proper visualization of the topmost vertebræ. The study is best made in the recumbent position, with as great an F.S.D. as possible. In order to secure enough blackening of the film through the mandible, it is necessary to double the usual exposure, preferably by raising the voltage. This necessitates over-exposure of the remainder of the film, but two methods are available (not described in Ottonello's original communication) to minimize this. The best of these is to place a pure gum rubber bag filled about two-thirds full of water behind the shoulders and lower neck. It is essential that the bag shall not overlap the jaw in the lowest part of its excursion, as this will produce a blank strip across the film. The filtration of the bag will decrease the exposure of the film in the lower cervical area enough to produce a satisfactory visualization. Another means of overcoming the difficulty is to use a filter, the upper third of which is 1 mm. Al, the second third, 2 mm., and the lower third, 3 mm. This is oriented with the thin part over the upper end of the spine. It will accomplish about the same thing as the water bag, but is not, of course, so plastic and is therefore less adaptable. The study is best made stereoscopically, and should, of course, be accompanied by a lateral projection. With this method it is possible to show the second cervical vertebra and all vertebræ below it on the one film. In the writer's experience only the lower portion of the atlas and the dens are generally demonstrated; the upper portion of the atlas is almost never shown; sometimes the dens may also be obscured. Routine employment of this method should be satisfactory whenever there is time available for careful positioning and drilling of the patient; but in a very busy department it will be found less satisfactory, as considerable care is needed to produce uniformly good roentgenograms. As a supplementary examination, however, the study has certain points of superiority to the usual view through the open mouth.

An investigation of the temperatures lethal to some wood-decaying fungi

An account is given of experiments made to determine the time, at certain temperatures, required to kill a number of wood-decaying fungi both in agar culture and also in moist wood blocks. The results are given in tabular form. A new method is outlined for the experimental heat treatment of wood on a small scale, by the use of rubber bags.

Adam Politzer, 1835–1920

ADAM POLITZER, one of the principal founders of otology, was born at Alberti in Hungary on October 1, 1835. He studied medicine in Vienna under Skoda, Rokitansky, Oppolzer and C. Ludwig, and qualified in 1859. In 1861 he was appointed lecturer in otology, and during the following years held a number of appointments in the University of Vienna connected with his speciality, being elected professor of otology in 1895 and director of the otological clinic in 1898. In addition to a textbook on otology first published in 1878, which ran through many editions and was translated into English in 1883 and 1902, he was the author of numerous articles on the anatomy and physiology of the ear and its diseases, especially suppurative otitis media and polypi. In 1864 he helped to found the Archiv fur Ohrenheilkunde, and in 1895 the Austrian Otological Society. The Vienna ear clinic possesses a rich collection of anatomical and pathological specimens of the ear prepared by him. His name is attached to a method of inflation of the middle ear through the Eustachian tube by a pear-shaped rubber bag introduced through the nostril. He died in his eighty-fifth year on August 10, 1920.

Surgery of Lung Tuberculosis

CARL H. GELLENTHIEN, M. D. Valmora, New Mexico PULMONARY TUBERCUBY LOSIS spreads by one of four methods: 1. Bronchogenic—a spilling of the sputum and pus into uninvolved lung areas. 2. Contiguity—by direct contact and extension. 3. By the blood stream. 4. By the lymphatics—and the lymph flow is largely dependent on the movement of the lung. Surgery of pulmonary tuberculosis is based on: 1. The principle of producing lymph stasis by immobilizing the lung and so preventing the spread of the disease. 2. On the idea that by having the lung collapsed, a bronchogenic spread or spilling of the sputum is less apt to occur. 3. On the principle that cavities will heal more readily if the cavity walls can be approximated. 4. That if a diseased lung can be made to rest, it will perhaps heal. Lack of space prevents a full discussion of the different surgical methods, many of which are of questionable merit. The procedures, however, which have widespread acceptance and are known to be of established value with a superior background of experience, are artificial pneumothorax, intrapleural pneumolysis, phrenic neurectomy and thoracoplasty. The various surgical methods are: I. The direct compression of the lung by the injection of some substance into the pleural cavity. a. Artificial Pneumothorax—the injection of sterile air or nitrogen into the pleural space. b. Oleothorax—the injection into the pleural space of either olive oil or liquid paraffin to which two to five percent of oil of gomenol has been added. Gomenol is an essential oil distilled from melaleuca viridiflera, a species of myrtle. It is not toxic or irritating and is bactericidal for common pathogenic micro-organisms. c. Intrapleural Pneumolysis—the division of adhesions with the cautery under d i r e c t v i s i o n thoracoscope or by open through the operation. d. Extrapleural Pneumolysis—stripping the parietal pleura from the chest wall in the desired area and packing the space with solid paraffin, wax, pectoral muscle or a rubber bag. II. Paralysis of the diaphgram on the affected side. To limit respiratory movement and produce compression of the lung by forcing the diaphgram up on the affected side, through abdominal pressure. a. Phrenic Nerve Interruption—Temporary—Permanent. III. Direct reduction in size of half of the thorax by removing portions of the ribs. a. Extrapleural Thoracoplasty — Complete—Partial. 1. Paravertebral—the excision of a segment from the posterior end of each rib as close to the transverse process of the vertebra as possible and including all ribs except the twelfth. This is the operation most commonly done. 2. Subscapular—this differs from the paravertebral in the greater length of rib removed and the non-interference with the eleventh rib. This operation is not commonly done. Besides the increase in shock, the regeneration of bone and later fixation of the ribs is usually incomplete, making it necessary for the patient to wear a support for the rest of his life. 3. Antero-lateral costectomy — removal of enormous segments of ribs. 4. Parasternal — the resection of the cartilages and anterior ends of the first to the fifth ribs. Usually from two to nine centimeters is removed subperiosteally. The chest is then firmly collapsed with adhesive until it has become fixed in the collapsed position. IV. Paralysis of half of the thorax on

Respiratory Exchange of Oxygen and Carbon Dioxide During Rebreathing from a Rubber Bag

During rebreathing from a rubber bag, the nose being compressed with a spring clip so that the lungs and bag form a closed system, O2 and CO2 diffuse across the pulmonary epithelium, the direction and rate of diffusion depending on the relative tensions of these gases in the blood and alveolar air. This process has been studied in 18 experiments in 2 normal young men. After the subject had sat in a chair for 10 minutes, the metabolic rate was determined. The subject then expired through a side tube to residual air (an alveolar sample being taken) and then rebreathed from the rubber bag 9 times in 22.2 seconds, being guided by spoken directions from an accurately timed phonograph record. Each inspiration emptied the bag and each expiration was as deep as possible. During the rebreathing alveolar samples were drawn into evacuated tubes at the end of breath No. 3, 6, and 9, dividing each experiment into 3 intervals of 8.0, 7.0, and 7.2 seconds in the order named.The results of the experiments are presented i...

Influence of Closed Intestinal Loop Strangulation on Volume of the Combined Digestive Secretions.

We have reported our findings on the influence of simple duodenal obstruction upon the volume of the combined gastric, biliary, pancreatic, and duodenal secretions. In the present work we have studied the influence of closed intestinal loop strangulation upon these same secretions. Twenty-two fasting healthy dogs were used in the study. All had their salivary ducts ligated. In the first group of animals the duodenum was divided below the entrance of the lower pancreatic duct, a Dragstedt type of intestinal cannula was placed in the proximal duodenum and the cut ends were inverted. A second cannula was placed in the jejunum about 6 to 8 cm. distal to Treitz' ligament. From the duodenal cannula the combined digestive secretions drained into a clean rubber bag. Collections were made every one to 4 hours day and night, measured, and returned by cannula into the jejunum. About 50 cc. of Ringer's solution or tap water were added alternately to the returned secretions. In addition to the fluids mentioned 500 to 1500 cc. of Ringer's solution were given subcutaneously daily to prevent dehydration. The control period lasted from 3 to 7 days. After the animal had fully recovered from the operation and the volume of the secretions had reached a constant level a second operation was performed. The jejunum was divided and the ends inverted just proximal to the jejunal cannula, producing an isolated duodenojejunal loop 15 to 20 cm. long around Treitz' ligament. Following this the collections and replacements were made in the usual manner. When replacement of the secretions was impossible larger amounts of Ringer's solution were given subcutaneously. In the obstructive period vomiting occurred. The volume of vomitus was prorated and added to the amounts of secretion collected.

The Technic of Intravenous Urography

THE diagnostic value of intravenous urography is at present still underestimated, due to the failure to obtain a greater proportion of cases in which the urinary tract is filled and visualized on the film. The causes of the failure of filling of the urinary tract are either faulty technic or anuria, very often the result of an acute renal colic or cystoscopy. In acute renal colic a good readable film is often obtained several hours after the injection of the drug. In the case of cystoscopy, on the other hand, we postpone the injection for three days, or until the normal urinary excretion is established. In order to avoid loss of time, we, therefore, recommend that the intravenous method precede the retrograde method. The secret of success in obtaining a greater number of readable films lies in the method of compression used before the X-ray exposure. The compression is applied over the lower abdomen at a point at which the ureter crosses the common iliac artery. According to Cunningham's “Anatomy,” “The ureters lie in front of the termination of the common iliac arteries at the level of the intertubercular plane and about 1.5 inches from the median plane” (Fig. 1). The apparatus used for compression consists of the following parts (Fig. 2): 1. A small wooden box, 5 × 3 × 1.5 inches, with one side open. 2. A small rubber bag, 4 × 2.5 inches, with a rubber tube attached to it. 3. A monometer, dial type. 4. A rubber bulb, such as used in a sphygmomanometer. 5. A “T” glass connection. The patient is in either the supine or the upright position. The wooden box, holding the rubber bag, is placed, open side down, over the lower abdomen, about 4 inches proximal to the symphysis pubis. The long axis of the box, transverse to the long axis of the body, is held snugly in position by the compression band of the Bucky diaphragm. The three ends of the “T” tube connect, respectively, the rubber tube of the bag, the monometer, and the rubber bulb. The rubber bag is then inflated till a pressure of about 180 mm. of mercury is registered, the pressure being maintained for five minutes, after which an exposure is made. The entire urinary tract proximal to the compression is then invariably filled and a readable film is thus obtained. Another film is exposed immediately after the compression is removed. On the second film the urinary tract distal to the compression is visualized. Technic in Detail, Characteristic Findings The first film is taken before the injection. The exposure is made ventrodorsally with the patient in the horizontal posture on deep expiration. This film demonstrates existing calculi or calcareous deposits which may be obscured by the excreted drug. It also shows the position of the kidney during deep expiration. It is advisable that the patient remain on the X-ray table in the supine position during the injection and until the third exposure is made. Keeping the patient quietly in this position tends to keep the urinary tract filled (Fig. 3).

Pneumonia, Roentgenologically Considered

In spite of the great amount of experimental work done on the etiology of the various types of pneumonia, there is still a great deal of uncertainty and controversy concerning many of the basic factors entering into the development of acute lung consolidations. Until these controversial elements, which in great part deal with the mechanical factors of consolidations, are thoroughly understood, they will tend to produce confusion in diagnosis and therapy. I aim to present a few facts from recent experimental work which seem to explain the sequence of events in pneumonic consolidations, and to show how these facts can be utilized to a great degree in the diagnosis, and, to some extent, in judging the future course of a pneumonic infection. A number of articles have recently appeared on experimental and pathologic atelectasis and its subsequent effects on the involved lung tissue. Coryllos and Birnbaum (1) have beautifully demonstrated the ease with which atelectasis of a desired lobe in a dog's lungs may be produced. They introduce, through a bronchoscope, a dilatable rubber bag, and make a study of the results of introducing different organisms to produce specific types of pneumonia. Their conclusion that pneumonia always begins with an atelectasis has much support from roentgenologic evidence. An abbreviated résumé of their remarks follows. “Atelectasis and pneumonia have a common pathogenesis. Incomplete bronchial obstruction leads to emphysema. Complete bronchial obstruction interferes with the ventilation, circulation, and drainage of the involved lung, and atelectasis and cellulitis result. The degree of cellulitis depends upon the virulence of the infecting organism and the duration of the obstruction. Lobar and lobular atelectases, with the resulting lobar and lobular pneumonia, are due to the occlusion of bronchi of different sizes by mucous exudate and bronchial mucosa edema. Whether we have a lobar or lobular atelectasis and pneumonia depends for the most part on the type of organism in the occluding exudate. Organisms producing much edema or thick exudate occlude larger bronchi. “Type IV pneumococcus, present in the main bronchi of 80 per cent of people, is the most common organism causing bronchial edema and obstructing mucous exudate. Less viscid exudates, such as those produced by influenza, staphylococcus, and streptococcus, cause obstruction of smaller bronchi and bronchopneumonia. Abdominal operations, regardless of the type of anesthesia, due to stasis of bronchial secretion, posture, and splinting of the thorax, are apt to initiate bronchial obstruction. Absorption of the air results in atelectasis and subsequent pneumonia. Foreign bodies and bronchial tumors may do the same. The serum exudate, containing antitryptic ferments, continues to obstruct for several days.

A CONFIRMATORY PHYSICAL SIGN IN ASCITES

In cases of ascites, when one side of the abdomen is tapped with the finger and the other side is auscultated, two sounds similar in timing to the normal heart sounds have been observed. The first sound is caused by the sound wave being transmitted through the fluid; the second is the result of the fluid wave crossing the abdomen and striking against the auscultated side. These two sounds are heard more clearly in thin, tense abdomens as opposed to flat, soft, flabby ones and are best heard at the level of the fluid and intestine, as demonstrated by an experiment with a closed rubber bag partially filled with air and water. There seems to be no reference to this auscultatory sign in cases of ascites in any of the standard textbooks on physical diagnosis. It is stated by several of the German writers that, when fluid is injected into

Collection and Analysis of Chicken Urine

In connection with experimental nutrition work with chickens it was thought that an analysis of the urine, in the form in which it is excreted by the kidneys, would aid in solving some of the problems, such as the high concentration of uric acid in the blood in the last stages of avitaminosis A. In order to secure such urine it was necessary to provide some means of separation of the urine and fecal material and also to prevent reabsorption of the soluble part of the urine in the cloaca. In most of the work reported on the analysis of hen urine the separation has been accomplished by operation methods, essentially of two types. In one method an artificial anus is formed in the anterior abdominal wall and the urine and feces are then collected in rubber bags. (Minkowski1, Milroy2, Katayama4, and others.) The other operative procedure consists of insertions .

Dye Excretion by the Pancreas.

With a view of perfecting some test whereby the degree of the external secretory response of the pancreas may be accurately measured in man, we have attempted to determine the permeability of pancreatic acinus tissues to certain dyes intravenously administered. We have used dogs, in which the main pancreatic duct has been cannulated and connected to a stoppered rubber bag by means of a Rehfuss tube. In some of our preparations, we have in addition ligated the lesser pancreatic duct, the common bile duct, or both. With such a fistula the pancreas secrete copiously. Our procedure has been to stimulate secretion by means of food or water, and then to inject intravenously from 30 mg. to 60 mg. of dye, depending upon its density, dissolved in 25 cc. of physiological salt solution. The continuous secretion has subsequently been followed at 15 minute intervals for periods of an hour or more, and then at irregular intervals for twenty-four hours. Thus far we have run one or more injections of some 32 dyes, namely, Acid blue, Acid orange, Acid violet, Alizarine blue S., Alkali blue 6B, Aniline blue, Bieberich's scarlet, Bluish eosin, China blue, Congo red, Erythrosin, Hofmann's violet, Indigo carmine, Mendola's blue, Methylene azure I, Methylene blue, Methylene violet, Neutral red, Neutral violet, Orange G crystals, Orange I, Patent blue, Phloxine, Poirrier's blue, Pyrrol blue, Rose Bengal, Thymol sulfonphthalein, Toluidine blue, Tropeolin O, Tropeolin 000 No. 1, Tropeolin 000 No. 2, Trypan blue. Of these, only two have appeared in, the external pancreatic secretion. A heavy dose of methylene blue gives a faint bluish tinge to the secretion at the end of two hours; and a rather heavy dose of methylene violet colors the secretion a distinct reddish violet in from 2 to 3 hours. Methylene violet is toxic in large doses.

THE FILLING AND EMPTYING OF THE GALL BLADDER

As a result of the control of the flow of bile into the duodenum largely by tonus and movements of the duodenum, bile intermittently enters the gall bladder where it is concentrated and undergoes other changes. The gall bladder empties itself of its content through the cystic duct (1) by the washing out of its contents by bile from the liver, (2) by the elasticity or contractile mechanism of its walls, and (3) by variations of intraabdominal pressure due to respiratory movements, contiguous organs, etc. A fourth manner of emptying of the gall bladder is by absorption of a portion of its content through its walls. The gall bladder is never entirely empty but tends to come to a state of partial collapse, when its contents are under minimum pressure. We have been unable to demonstrate rhythmic contractions of the gall bladder due to its musculature. If they are present they may aid but they are not essential for its emptying or filling. Experimentally, in the dog, a rubber bag which was substituted for the gall bladder functioned in a manner very similar to that of the normal gall bladder as shown by cholecystographic studies. The concentrating function, however, was absent.

The control of hæmorrhage after prostatectomy by the use of the inflatable rubber bag. An improved method of retaining the bag

The control of hæmorrhage after prostatectomy by the use of the inflatable rubber bag. An improved method of retaining the bag

Dilatation of Ureter with Rubber Bags in the Treatment of Ureteral Calculi. Presentation of a Modified Operating Cystoscope a Preliminary Report

Dilatation of Ureter with Rubber Bags in the Treatment of Ureteral Calculi. Presentation of a Modified Operating Cystoscope a Preliminary Report

A closed-circuit heart-lung preparation.—Effect of alterations in the peripheral resistance and the capacity of the circulation

Investigations of “resistance” and “capacity” effects in relation to the control which they exert upon the vascular system have been carried out by many physiologists, notably by Weber (1), Volkmann (2), Donders (3), de Jager (4), Bayliss and Starling (5), and L. Hill (6, 7). According to Weber, the rise in arterial blood pressure due to arteriole vaso-constriction is caused by an increase in peripheral resistance and by a diminution in the capacity of the circulation. Bayliss and Starling (5) brought forward evidence in favour of this view and pointed out that the venous pressure was in part determined by a balance between these two factors. In opposition to Weber’s view, L. Hill and Barnard (6) hold that capacity changes have no effect on the venous pressure since the vascular system is not filled to distension. In a later paper L. Hill (7) states that reduction in the capacity of the splanchnic area is of importance in so far as it increases the diastolic filling, and so the output of the heart, but that the mean hydrostatic pressure cannot be considered to contribute to this result. The part played by constriction of the veins in altering the venous and arterial pressure is discussed in a paper by Connet (8) in which a full bibliography is given. In a paper published in the ‘ Journal of Physiology ’ (9) I described a modification of Starling’s heart-lung preparation, in which the blood circuit was converted to a closed system, so as to imitate more closely the conditions ruling in the animal body, while maintaining the various factors fully under control of the experimenter. The arrangement is shown in fig. 1. The blood from the aorta flows through a cannula placed in the brachio-cephalic artery (A), the velocity of flow being recorded by a Pitot tube (B) or by a Henderson’s cardiometer. The peripheral resistance is regulated by a compressible fingerstall (D), a second resistance (D') being inserted for studying the effects of shunt circuits. The blood then passes to the venous reservoir (K) which consists of a rubber bag of approximately 250 c.c. capacity. The distal end of the venous reservoir is connected to the superior vena cava. A finger-stall (C) joined by a side tube to the arterial system represents the elasticity of the arterial sytem ; this finger-stall and the venous reservoir K when enclosed in plethysmographs enable the experimeter to study alterations in the volume of the systemic circulation.

SIMPLIFIED APPARATUS FOR ALVEOLAR CARBON DIOXID DETERMINATION

The use of insulin has excited renewed interest in the study of diabetes. Cases with acidosis have often been treated in localities where there are no facilities for determination of blood carbon dioxid tension. Except in comatose patients, the estimation of alveolar carbon dioxid tension will satisfy all clinical requirements. For this I have found the Marriott apparatus satisfactory. Most of the apparatus is contained in a small box measuring 4 by 13 by 20 cm., which can easily be carried in a consultation bag. In addition, it is necessary to have a rubber bladder, a bulb for filling it with air, a length of rubber tubing, and a bottle containing the color reagent. These extras require additional space, and are sometimes forgotten and left at the office. A satisfactory substitute for the rubber bag is the cuff of an ordinary sphygmomanometer, which may be inflated with the sphygmomanometer air

A NEW DUODENAL TUBE AND TIP

Einhorn, Jutte, Rehfuss, Lyon, Palefski, Kohn and Buckstein are names that are associated with apparatus designed for duodenal intubation and drainage. The Einhorn tip is a small, olive-shaped, fenestrated piece of metal. The Jutte tube has a blind tip with the fenestrations in the body of the tube. The Rehfuss tip is a large, olive-shaped tip, with slits leading to the center of the tip and then to the tube. The Lyon tip is pear-shaped, with slits, much the same as the Rehfuss tip. The Palefski tip is globular, with fenestrations through the body of the tip. The Kohn tube has small rubber bags attached, one at the tip and another in an intermediary position on the tube so as to sequestrate a certain portion of the small intestine when the bags are inflated. The Buckstein tube and bucket is simply a Jutte tube to which a bucket is attached

Studies on lung volume. IV. Investigations on admixture of air in the lungs with other air

Several methods of importance for the study of the physiology and pathology of respiration and circulation require (1) that it is possible to produce full admixture of air within the lungs with other air and (2) that the exact conditions necessary for full mixture can be ascertained in a given case. This and the following paper is a short report of experiments dealing with questions. Technique. 3 liters of oxygen (Allen-Pepys' method) or of hydrogen plus oxygen (Davy-Durig's method) are introduced in a 5 to 6 liter rubber bag. Starting either from full inspiration or full expiration the subject rebreathes uniformly and almost as deeply as possible from the bag a certain number of times. The connection between the mouth and the bag is a 35 cm. long, 2 cm. wide rubber tube and a 3-way stopcock. The frequency of respiration has always been betwen 8 and 20, usually about 10-15 per minute. During the experiments several small samples (15-20 c. c.) of air were drawn (1) from the bag, and (2) from the very last part of the expiration. In the last instance therefore, alveolar air was obtained. The samples were drawn into evacuated recipients without interrupting or interfering with the breathing. By such a procedure (Fig. 1) one can follow the changes in the composition of the air in the two most important places (bag and alveoli) of the closed system during the rebreathing experiment. In the oxygen experiments the changes in the nitrogen percentage were followed and in the hydrogen experiments the changes in the hydrogen percentage were observed. Results. In Table I an example of oxygen experiments are given and in Table II an example of hydrogen experiments. Figs. 2 and 3 correspond to Tables I and II respectively.