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TRIAL OF DEQUALINIUM FOR SKIN INFECTIONS BJRITINALstill present. In 10 cases of leg ulcers, various Gramnegative organisms were grown, and these cleared in only four cases. Beta-haemolytic streptococci were cultured in an insufficient number of cases to merit comment. From these routine bacteriological findings it seems likely that, at any rate so far as the staphylococcus is concerned, the clinical improvement obtained in most cases is reflected in the results of routine cultures from the skin. FindingsIn general we found dequalinium to be non-irritant even when applied to mucous membranes and the skin of infants. However, three cases of allergic sensitization were encountered. One of these was to the base and two to the active ingredient. The latter showed positive patch tests to the active cream and no reaction to the bases applied alone. This figure of 1.2% is low enough to be acceptable in practice, but occasional cases of sensitization will probably arise, as with other antibiotic and antiseptic agents.Our findings may be listed as follows. SummaryA new antibacterial agent, dequalinium, has been used on 241 patients suffering from various skin conditions. In the form both of cream and of paint it was used alone, in comparison with the inert bases, and in comparison against standard routine measures of treatment.Dequalinium was found to be of considerable value in pyococcal infections of the skin, notably impetigo and neonatal staphylococcal infections. It was also of considerable value in skin conditions in which pyococcal or monilial infection played a predominant part. It also appeared to be of value in tinea infections in a relatively small number of patients.Non-infective conditions did not respond, but were not made worse.Dequalinium appeared to be as effective as antibiotic preparations and dyes and is pleasant to use, colourless, and relatively cheap. No irritant or toxic properties were observed, and it can be used on the mucous membranes and on the skins of infants. However, three cases of sensitization occurred, an incidence of 1.2%. In one of these the base was responsible.We believe dequalinium to be a useful valuable preparation against pyococcal and monilial infections of the skin, and one that represents a welcome addition to dermatological therapy. Not only does the pattern of disease in Jamaica differ from that encountered in Europe but the response of the Jamaican to shock is poor. Because a difference in endocrine make-up may be concerned, the weight of the adrenal glands in the Jamaican was compared with that of the European. Variations in total adrenal gland weight may be due to cortex or medulla or both, and for this reason the weight of both components was estimated in 10 glands covering the full range of gland weights. In 20 more glands the cortical thickness was measured. Materials and MethodsThe adrenal glands from 105 (67 male and 38 female) adult Jamaicans of all racial groups were examined. The glands, obtained from routine necropsies, included material from 10 male cases of ...

Massage or manual compression of the heart is accepted as a useful procedure when heart action has ceased because of accident or temporarily disordered function. Experience in the operating theatre has shown that manual massage through the open chest should be maintained for over an hour before being abandoned, but the procedure is tiring, and the operator must be relieved at frequent intervals.Because of the resistance of the chest wall in adults, the power required to produce effective compression of the heart through the unopened chest is far greater and is estimated at between a quarter and a half horsepower. This power output cannot be maintained for more than ten minutes by any one person. If it is accepted that external cardiac massage produces a limited but effective circulation and that one hour is the minimum period of treatment, it is obviously desirable that mechanical assistance should be available to take over after the initial emergency manual compression. The procedure lends itself to mechanical substitution and the more precise control available should extend its use and possibly reduce the visceral damage due to uncontrolled violent chest compression. This paper describes a cardiac massage machine and reports a series of experiments on dogs whose hearts had been stopped and whose circulations were then maintained for prolonged periods by it. The apparatus is small, light, portable, and safe, and its action is easy to control. Compressed air or oxygen was considered the most suitable power source as it is convenient for artificial ventilation, and its use is understood by those concerned with the operation of resuscitation apparatus. Electric batteries have not been used because they cannot supply the large power demands of this type of apparatus and might be found to be discharged when required in emergency, especially if stored for prolonged periods in adverse conditions. Mains electric power is rarely available on an accident site and could be dangerous in some situations, and the electro-pneumatic valves available must be controlled by electronic circuits fed by dry batteries which offer another source of failure in an emergency.The machine was accordingly designed so that the timing circuits and the chest compression ram were operated solely by compressed gas. The ram can apply any weight from a few pounds to over a hundred in variable steps by operation of a single control without stopping the machine. The pressure applied can be observed on a simple gauge and the exact degree of chest depression seen by the operator. The machine can stop at suitable intervals to allow inflation of the chest and, if necessary, it can carry this out automatically.As the timing circuits controlling heart compression, rate, and the pause for lung inflation, can be set in advance, the machine is no more difficult to operate than any other mechanical resuscitation apparatus designed for use by semi-skilled persons.

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