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14 SPECULUM SIGMA PRESCRIPTION SPECIALTIES represent Applied Pharmacology They represent : for safe, effective, modern therapies + SAFE CHEMOTHERAPY ÷ QUALITY AND PURITY RIGID STANDARDS AND LABORATORY CONTROL CONSISTENT PHARMACOLOGICAL AND PHARMACEUTICAL PROPERTIES UNIFORM PRESENTATION + CLINICALLY TESTED AND MEDICALLY ACCEPTED WELL BALANCED FORMULAE SIGMA COMPANY LIMITED Makers of Fine Pharmaceutical Products MELBOURNE AUSTRALIA Samples and Literature available on request frc fin he sp he m( oc (fi; sy lai frc sp br tal mi cli sy an mi ao br no wl an Fib
SPECULUM 15 E.C.G. DIAGNOSIS OF CONGENITAL HEART DISEASE Dr. E. R. Trethewie M.D., D.Sc., M.B., M.R.A.C.P. Reader in Physiology, University of Melbourne The lesion in congenital heart disease is frequently able to be diagnosed by considering the stethoscopic and electrocardiographic findings alone. In many instances a bruit is heard in the vicinity of the second left interspace close to the sternum and it may be heard over a wide area. The bruit of pulmonary stenosis is harsh, superficial, and occupies a considerable period of systole (fig. 1). The bruit of interatrial defect has a rumbling crescendo quality with rapid diminuendo and occupies the early stage of systole (fig. 4). The bruit of interventricular defect may be harsh or soft and is frequently best heard in the fourth left interspace close to the sternum. The classical bruit of patent ductus can never be mistaken; it is a continuous machine-hum murmur; but of course, it may not produce this classical sound. It may even only be systolic in time and sometimes we think we are listening to an atypical patent ductus murmur when in reality we hear the bruit of aorto-pulmonary communication. Having decided we have heard a basal bruit, usually in a young person, often, btit not necessarily, of inferior physique and one who has never had rheumatic fever, an examination of the electrocardiogram is Pig. 1—Phonocardiogram of the bruit in pure pulmonary stenosis. (i), (ii) timing of first and second heart sounds. Note the prolonged, well-sustained, late systolic bruit. usually very illuminating. Interatrial and interventricular septal defect become diagnosed almost always. Pure pulmonary stenosis can be confirmed. The combination of pulmonary stenosis and interventricular defect can commonly be recognised. Patent ductus in a young person produces only a slight degree of right axis deviation with perhaps some strain pattern. The pressure in the right ventricle can be estimated approximately in all instances. The lesion of coarctation of the aorta, already largely diagnosed by the absence of femoral pulses, can also be recognised. However, to make a satisfactory electrocardiographic diagnosis it is essential to perform three dimensional electrocardiography. The leads chosen here are the ABC leads where lead A: manubrium sternum (M) to xiphisternum (X); B: left axilla (L) to xiphisternum (X); C: right chest at base (R) to xiphisternum (X); such that MXL = LXR = RXM = 1 rt. angle. We shall consider the types of tracings for the following defects: 1. Pulmonary Stenosis. 2. Interatrial Defect. 3. Interventricular Defect. 4. Patent Ductus Arteriosis. 5. Coarctation of the Aorta. For comparison the normal electrocardiogram is shown in fig. 2. Note the large P(A) and the normal distribution of R to S potentials. Large R- and small S-waves occur in right axis deviation and large S- and small R-waves in left axis deviation. This applies to all leads. Another normal electrocardiogram is shown in fig. 10, the E.C.G. after tying a patent ductus, while the prior tracing is shown in fig. 9; note the inverted normal T(B), which is found in more than half the subjects.
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Page 27 and 28: SPECULUM 25 PRE-ANAESTHETIC MEDICAT
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Page 31 and 32: • SPECULUM 29 MEDICAL EDUCATION K
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Page 41 and 42: SPECULUM 39 INFAMOUS CONDUCT IN A P
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Page 49 and 50: SPECULUM 47 SOME CONTRACEPTIVE TECH
Page 51 and 52: SPECULUM 49 Post-coital douching ha
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Page 55 and 56: SPECULUM 53 BOOK REVIEWS RADIOLOGIC
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Page 63 and 64: SPECULUM 6t SURGERY Professor Ewing
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SPECULUM 65 MI-1,DICAL Alf,DLI -;rY
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SPECULUM 67 ANSWERS TO DIAGNOSTIC Q
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SPECULUM 69 Int.BYtant M. S. S. CHR
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SPECULUM 71 ANNUAL DINNER JUNE 13th
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SPECULUM 73 MEDLLY'S '57 Dear S. &
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SPECULUM 75 The Stately Homes of Ca
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SPECULUM 77 PRE-MEDICINE This year
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SPECULUM 79 play as they had to swo
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SPECULUM 81 ROYAL MELBOURNE HOSPITA
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SPECULUM 83 ALFRED HOSPITAL THIRD Y
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SPECULUM 85 THIRD YEAR ST. VINCENT'
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SPECULUM 87 PRINCE HENRY'S HOSPITAL
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SPECULUM 89 spicula Surgeon, to pat
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SPECULUM 91 Gallup pole clerk visit
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SPECULUM 93 After a man finds out t
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SPECULUM 95 e y Girl's voice heard
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SPECULUM 97 Is it true that storks
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SPECULUM 99 What would you do if a
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