Frozen poultry and staphylococcal food-poisoning.

in the mediastinum becomes excessive and embarrasses the action of the heart. This can be fatal, especially if tension pneumothorax coexists. Other modes of entry of air into the mediastinum include rupture of the trachea, bronchus, or oesophagus from any cause and penetrating wounds of the lung and mediastinal pleura. These are clearly formidable conditions and must always be considered in patients who develop mediastinal emphysema. There are thus two different clinical problems. In the commoner, benign, form a patient may present with no more than a vague precordial ache,' possibly with Hamman's sign and some subcutaneous emphysema of the neck. A careful watch needs to be kept in case complications develop, but usually the prognosis is excellent. If the emphysema spreads or the patient becomes breathless or shows signs of collapse, immediate removal to hospital, preferably to a thoracic surgical unit, is essential. A radiograph of the chest will confirm the mediastinal emphysema; it will also show a pneumothorax and the extent of any preceding trauma. If oesophageal rupture is suspected, surgical treatment is imperative as soon as possible. The diagnosis may not be easy, but a rapidly developing state of shock, and upper abdominal rigidity in cases of perforation of the lower oesophagus, are suggestive and call for x-ray examination by Gastrografin swallow. Only slightly less urgent is oversuture of a rupture of the trachea or bronchus. Malignant mediastinal emphysema may be relieved by needling parallel to the deep surface of the sternum, but cervical mediastinotomy or even a sternal split may be necessary. Tension pneumothorax is best treated with a wide-bore intercostal tube. Extensive subcutaneous emphysema may be relieved by " milking " the air through small incisions in the skin.