821FREEZING AND THAWING THE TISSUES

so successful that the museum has hopelessly out-grown its accommodation which is limited to the

topmost of the three floors of the building of whichit needs the whole. The bottom and middle floorsare occupied by the Bodleian Library and by thelexicographers who are engaged on a new edition ofLewis and Short. If these can be moved elsewhere,which should not be difficult, the Old Ashmoleanwill at comparatively small cost be able to blossomout into what it is quite ready to be-one of the mostattractive institutions in the university.

HISTAMINE AND RENAL LESIONS FOLLOWINGSHOCK

SINCE the circulatory depression resulting frominjection of histamine is likely to diminish the secre-tion of urine, Bjering 1 has investigated the fallof blood pressure and the reduction of the urea andcreatinine clearance that follow injection of hista-mine. He finds that the reduction of the renalfunction is not always proportional to the fall inblood pressure, and he concludes that histamine musthave some direct action on the renal blood-vessels.It is to be noted, however, that the experimentswere done on patients suffering from various diseasesthat might modify the findings. In a further paperHusfeldt and Bjering 2 describe two cases ofpatients dying in uraemia eight days after receivingsevere injuries. Post-mortem section of the kidneysshowed absence of blood from the glomerular tuftsand some degeneration of the tubules. On the histo-

logical appearances the authors dispose of trauma tothe kidneys or incompatible blood transfusion as

causes of this lesion, and they suggest that it is duedirectly to defective renal circulation during shock ;they mention that histamine may cause albuminuriaas well as deficient function. Adrenaline and Ephe-tonin (synthetic ephedrine) may also produce albu-minuria, and it is interesting to note that signs ofrenal damage did not develop fully until three daysafter the injury, with a rising blood pressure indicatingvasoconstriction.

THERE are many people able and willing whenthey are ill to pay the cost of maintenance in a hos-pital, as well as a reasonable fee for medical attend-ance, but who cannot afford the usual charges of anursing-home. In many of the London voluntaryhospitals beds are now available, either in cubicles,single rooms, or small wards, for persons of moderatemeans. The number of such pay beds has increasedfrom 590 in 1920 to 2112 last year, and details aregiven in the new edition of a list 3 issued by KingEdward’s Hospital Fund for London. Medical and

surgical fees are not as a rule included in the weeklycharge; they are arranged between patient andconsultant, or more commonly through the familydoctor. The normal weekly charge as given in thelist does not include anaesthetist, extra nursing,exceptionally expensive drugs or dressings, treat-ment by electricity or light, radium or X rays, patho-logical examinations, or operating theatre expenses.The list calls attention to the two contributoryschemes which facilitate for all parties the use ofthese pay beds. For persons with incomes not ex-ceeding :E6 a week (for a married man with childrenunder 16) there is the Hospital Saving Association ;for persons whose incomes exceed this limit there

1 Bjering, T. (1937) Acta med. scand. 91, 267.2 Husfeldt, E., and Bjering, T., Ibid, p. 279.3 Copies may be obtained from Messrs. George Barber & Son,

Ltd., Furnival-street, E.C.4, 3d. post free.

is the British Provident Association. A numberof societies approved under the national healthinsurance scheme also provide hospital treat-ment for their members. It is difficult to state

precisely how many approved societies do so, for

quite a number of them exclude women from hospitalbenefit and others only pay in respect of memberswho were in the society during a more spacious timewhen money for this purpose was accumulating.A useful list of these societies and of the limitationin the benefit provided has just been issued 4 by theCentral Bureau of Hospital Information.

FREEZING AND THAWING THE TISSUES

WE are familiar in this country with the work ofSir Thomas Lewis on the reaction of the tissues tolocal injuries, and with Sir William Bayliss’s humoraltheory of secondary shock. The former demonstratesthe liberation of a histamine-like substance at thesite of injury, and the latter postulated the dissemina-tion of a chemical substance from areas of massive

injury causing a general loss of plasma from blood-vessels to tissues. A similar condition was broughtabout by histamine, and " histamine shock " and

secondary surgical shock were thought to be identical.Nowadays this interpretation of secondary shockhas been practically discarded, with the reservationthat it may account for some features of the condi-tion. A view which is gaining ground, chiefly due towork from America, is that the loss of fluid from thecirculation can be sufficiently accounted for byexudation into the injured tissues themselves. The

original experiment of Cannon and Bayliss, whooccluded the circulation to an injured limb and statedthat shock was absent until the circulation wasreleased, has not, it is said, been satisfactorilyrepeated. This is curious, for if the modern theoryis correct loss of fluid from the blood stream into theinjured tissues could not take place unless these wereincluded in the circulation, and if they were tem-porarily excluded it would be reasonable to expectshock to occur on restoration of the blood flow.

There seems no doubt, however, that extensivelocal injury can abstract sufficient fluid to con-

centrate the blood as much as 50 per cent. and lowerthe blood pressure to about 80 mm. Hg in

experimental animals. This has been confirmed byH. N. Harkins and P. H. Harmon 5 of Chicago for

injury by freezing in anaesthetised dogs, and they saythat the exudate resembles blood plasma very closelyin composition. They also point out that althoughthis brings freezing into line with burning andmechanical injury, the exposure to extreme cold ofsufficient of the body to produce shock in the humanwould bring about death from other causes.

Their communication is interesting from a moreimmediately practical point of view in that it castsdoubt on the traditional conservative treatment offrozen tissues. The evidence they have collected upto the present suggests that rapid thawing is no lesseffective and no more harmful than slow thawing.Their criterion is the extent of gangrene and so forthin narcotised animals ; but in ordinary therapeuticsthe factor of pain would have to be taken into accountand might well be decisive in determining whichtreatment to adopt. This again brings us back tothe question of shock. It has been shown in Cannon’slaboratory that repeated injections of adrenalinewill ultimately cause a fall of blood pressure andincreased blood concentration ; this is supposed to

4 Memo. No. 108 from the director of the Bureau, 12,Grosvenor-crescent, London, S.W.1. 4d.

5 J. clin. Invest. 1937, 16, 213.