Post-operative Paralysis of the Brachial Plexus Several instances of post-operative injury to the brachial plexus have been reported recently by Ewing (1950) and by Kiloh (1950), and it seems reasonable that more publicity should be given to such an avoidable complication of surgical operation. The following two patients received a muscular relaxant, but it is considered a fallacy to associate the rising incidence of this complication entirely with the introduction of these drugs. CASE REPORTS Case 1.-A married woman aged 44 had a total hysterectomy performed on March 24, 1949. Anaesthesia was obtained by sodium thiopentone, nitrous oxide, and ether, and relaxation by "flaxedil " given into a right forearm vein, with the arm abducted to 90 degrees. The patient was tilted into a fairly steep Trendelenburg position, with padded shoulder-rests in support. The right arm was abducted for 100 minutes and the Trendelenburg position maintained for 50 minutes. On regaining consciousness the patient complained of generalized weakness of the right arm, with numbness of the right thumb

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BRDIRISH renal function (as usually measured) is impaired in renal disease menstruation will sometimes cause a temporary increase in the degree of impairment. Moreover, I have recently obtained evidence that menst.:uation will sometimes cause temporary impairment of renal function in apparently normal women. It is not unlikely, therefore, that oedema associated with endocrine imbalance results primarily from the effects of such imbalance on renal function. It is difficult to escape the conclusion that the very large group of adult women suffering from " idiopathic " oedema of the kind referred to, often but not invariably associated with oligoand amenorrhoea, constitutes a fairly well defined syndrome that is probably endocrine in origin. Lest false hopes be raised it is necessary to add that none of the symptoms of this syndrome appear to respond to alkaline therapy so readily as amenorrhoea.-I am, etc.,

ENDOTRACHEAL manipulations have frequently been shown to cause reflex cardiac derangements. Cases of complete inhibition of the heart are recorded on intubation;3 lo l1 l 7 24 26 on inflation of the cuff of an endotracheal tube;2 22 and on aspiration of secretions through an endotracheal tube.18 21 ConverseQ et a1 have recorded cardiac arrhythmias during extubation, and two cases of cardiac arrest have been reported following withdrawal of an endotracheal tube.21The following two cases of reflex disturbance of the heart rhythm were associated with aspiration through, and withdrawal of an endotracheal tube. CASE IIn the first case complete cardiac arrest occurred at the end of a prolonged operation. The patient was an unmarried woman of 26 years, weighing 10 stone 6 Ibs, and who underwent pleuropneumonectomy for extensive tuberculo$s of the right lung OR 30thApril 1953. Her cardiogram report before operation was within normal limits , and her resting blood pressure was 126/76. The operation, which was performed with the patient in the prone position supported by sorbo cushions under the upper sternum and pelvis lasted 3 hours 45 minutes, and was accompanied by considerable blood loss.She was given an injection of omnopon gr. 114 with scopolamine gr. 1/200, one and a quarter hours before induction of anzesthesia. The anathetic drugs in us(: were sodium thiopentone and pethidine intravenously, nitrous oxide, with oxygen by the endotracheal route in a closed, Waters-type circuit, and relaxation was obtained initially by succinyldicholine chloride, and maintained throughout operation by laudolissin.After induction with 500 mg. thiopentone, 70 mg. succinyldicholine were injected, and the larynx and trachea sprayed with 2 % amethocaine hydrochloride before intubation with a cuffed size 10 Magill's tube. Apnoea was obtained in one minute and lasted for eight minutes, when 40 mg. laudolissin were injected. No further thiopentone was given, and 40 mg. of pethidine were required in intermittent doses to reinforce anzsthesia with nitrous oxide. Eight minutes after the laudolissin there was again complete apnaea, and the respiration was controlled throughout for one hour and 47 minutes, after which spontaneous respiration was resumed. Atropine gr. ljl00 was injected intramuscularly one hour and 40 minutes before the end of the operation.Although the operation involved considerable loss of blood, this was not excessive for the type of operation, and it was estimated that the four pints of blood transfused during its course were sufficient to replace the blood lost. The patient's general condition during operation did not give cause for undue anxiety, although her blood pressure was always rather low, between 90 and 100 systolic, and 70 to 75 diastolic. Her pulse rate remained between 90 and 100 per minute, until the last hour of operation when it tended to rise slightly, probably due to lightening anesthesia. Her colour was good throughout, and bronchial secretions were aspirated intermittently through a Cobb's connection. At...