A NEW SURGICAL SAW

1208 that aural polypi may have an allergic basis, but it had first world war. Between the wars we had tended to not yet been possible to demonstrate an eosinophilic over-emphasise the importance of conservatism ; and he reaction in them. When complications were not wondered whether we were not now tending to swing imminent and cholesteatosis and polypi were absent, again towards too much radical surgery. He agreed with Mr. Livingstone that skilled supervision was the ideal to conservative treatment could be adopted. The organisms be aimed at in conservative treatment, but he could not should be identified and their sensitivity to the antibiotics The appropriate antibiotic was then used, tested. accept Air Vice-Marshal Dickson’s suggestion that the preferably in powder form unless the discharge was very patient should never be allowed to carry out his own profuse or the meatus stenosed (lactose was a suitable aural toilet-sometimes he had to. Careful toilet was an essential preliminary. Mr. S. W. ALLINSON said that 90% of the children that base). A dry ear should now be attained after 90% of mastoid he saw breathed through their mouths and could not operations, so that we could recommend the operation blow their noses gently, one nostril at a time. He more often than in the past. thought that many cases of the " catarrhal " type of chronic otitis media would settle down if the patients Mr. GAVIN LIVINGSTONE said that the decision whether were taught to do this properly. to operate or whether to continue with conservative treatment was always a difficult one. Chronic otitis Mr. TERENCE CAWTHORNE said that 70% of cases of media was common in poorer people, and careful cleansing chronic otitis media in children cleared up with regular was very important and should be done daily if possible. daily treatment. In the Services, Banham and others But the working man could not easily attend hospital had shown that a similar or greater proportion would clear every day, and therefore he rarely came to the otologist up in this way ; and Johnston had shown the same for until his deafness had increased or complications had civilians in factory clinics. Surgery was needed for the arisen. Suction was an ideal method of cleaning the 20 or 30% that failed to respond to conservative treatment. Recent work on chronic otitis media had given ear, and it should be carried out under skilled supervision ; but syringeing could be done by less experienced prominence to the teaching of Cheatle that anatomy people. Mr. Livingstone distinguished a further three" determined pathology. All these cases started as acute infections : if the mastoid was cellular, acute mastoiditis groups of chronic otitis media. The first was the " safe ear with a mucoid discharge : the postnasal space must resulted ; if it was acellular, the infection would " tend be kept healthy, sinusitis must not be overlooked, and to lapse into chronicity." the foci in and mouth must be nose removed, Mr. MCGUCKIN said that chronic infection might someseptic bad teeth. The second group he called the particularly times be discovered by accident and that this insidious " mastoid " group, where the discharge was persistent was sometimes missed. Coliform organisms were type and unpleasant and the hearing was greatly affected. in about two-thirds of his cases. present Infections in the attic formed the third group. Whatever Mr. JAMES agreed with Mr. Tumarkin’s views on the surgery was indicated in chronic otitis media, the guiding acellular mastoid in so far as he was convinced that it factor in each case was the particular pathological lesion was acquired and not inherited. When patients with present. This must be removed entirely, and the aim chronic otitis media were examined radiologically, one must be to produce a safe, hearing, and dry ear. was amazed how often there was a cellular mastoid on Air Vice-Marshal DICKSON agreed with Mr. Livingstone one side and an acellular one on the other. He believed about the importance of trained people treating these that there was some inherent characteristic in the lining ears. It should not be left to the patient. of the middle-ear cleft which was responsible for pneumaFailure of pneumatisation resulted from acute tisation. Mr. A. TuMAREiN discussed the evolution of mastoid otitis media and could be compared with the changes his of and own compared operation permeatal sometimes seen in the surgery, paranasal sinuses, particularly atticotomy with the techniques of Lempert, Popper, and the maxillary antrum. others. He emphasised the association between chronic otitis media and the noorlv nneumatised mastoid. He " felt that " frustration of occurred New Inventions because air was unable to circulate in the pneumatic A NEW SURGICAL SAW system. The cause was to be found in the nose-or, more THERE has long been a need for a light-weight generalspecifically, in nasal catarrh. Chronic nasal catarrh was a disease of the whole upper respiratory tract, and led to purpose saw for smooth, easy, and accurate cutting of blockage of the eustachian tube. Diamant (an otologist) bone or metal. The saw illustrated can cut bone or steel and Dahlberg (a statistician) had recently revived equally well and uses interchangeable miniature hacksaw blades 1/4 in. wide. These blades cost very little and are Cheatle’s theory which attributed the type of pneuavailable in two types-standard and high-speed steel. matic system to inherited characters. They denied the The latter are most suitable for sawing stainless steel of as environmental factors such eustachian importance but are slightly thicker than the standard blades. block. Acceptance of their theory, thought Mr. Tumarkin, The handle is of very simple construction, being made would paralyse any further research into this aspect of of stainless-steel sheet pressed to a shape which enables the problem. it to be held comfortably in the hand. The length of exposed saw can be easily adjusted by means of the Mr. T. B. LAYTON thought that all cases of chronic milled-head screw, which clamps the saw blade in otitis media were due to a primary inflammation. There position. The blade being reversible, the teeth can be should be no new cases nowadays. The primary organisms faced to cut on either forward or backward strokes. were present for the first six weeks of infection ; secondary The saw was evolved for the accurate shaping and organisms appeared after eight weeks. The infection was morticing of bone grafts in plastic surgery, where it has then chronic, and therefore mastoid infection should be been well tried. It should find a wider field of usefulness cleared up between the sixth and eighth weeks. The three-month borderline which Mr. Angell James had suggested was too long. He agreed with Mr. Tumarkin in doubting the hereditary nature of the dense mastoid, but he felt that failure of pneumatisation was caused by an osteitis resulting from minor non-suppurative attacks of otitis media. Mr. R. SCOTT STEVENSON thought that too many radical mastoid operations had been done before the .

pneumatisation

1209 in other types of bone surgery, since the blade is always sharp and is not blunted by cutting bone or steel. No special sterilising precautions are necessary. The saw is made by Chas. F. Thackray Ltd., 10 Park

Street, Leeds. Plastic Surgeon,

Frenchay Hospital, Bristol

D. C. BODENHAM M.B.

Brist.,

F.B.C.S.E.

Reviews of Books Hamey the Stranger JOHN J. KEEVIL. London : Bles. 1952. Pp. 192. 21s. THE Royal College of Physicians of London owes much to Baldwin Hamey, son of the subject of this book ; for he was one of its chief benefactors. He and his father were both confirmed letter-writers; and their letters, mostly in Latin, are in the archives of the college and the University of Leiden. Dr. Keevil, former library keeper of the college, has drawn on these letters in compiling this biography. Baldwin Hamey the elder-Hamey the Stranger-was born at Bruges in 1568, the year in which Roman Catholic Spain sentenced to death, as heretics, all the inhabitants of the Netherlands. Things became so bad that in 1584, or soon after, the Hamey family migrated to Leiden, where Baldwin received his university education, first in philosophy and letters, and later in medicine. Through the influence of his teacher, Joannes Heurnius, he was appointed, two years after qualifying, as physician to the Czar of Russia ; and found himself plunged into a world of murder and intrigue, where the vast figures of Czar Fedor, Boris Godunow, and the rest of the Godunow family moved in a drama much larger than life. Elizabethan England, to which Hamey soon fled with his promised wife, Sarah Oeils, must have seemed tame in comparison ; and indeed the book partakes of the anticlimax. His graphic account of the Essex rebellion, and his own courage in various plague, smallpox, and typhus epidemics, stand out ; but much space has to be given, unfortunately, to his struggle to persuade the college to examine him and give him an English diploma. It was achieved at last, but not without some undeserved humiliation for him. His son Baldwin, whose life is to form the subject of a second volume, The Stranger’s Son, became M.D. of both Leiden and Oxford, as well as a fellow of the

college. This first tale is well told and worth look forward to the second.

reading, and

we

Surgery of the Chest A Handbook of Operative Surgery. JULIAN JOH11TSON, M.D., D.sc., professor of surgery, school of medicine and graduate school of medicine, University of Pennsylvania. CHARLES K. KIRBY, M.D., associate professor of surgery, school of medicine, University of Pennsylvania. Chicago : .

Year Book Publishers. London : Interscience Publishers. 1952. Pp. 387. 68s.

THE authors set out to provide an atlas of thoracic operations, and have adopted the general pattern of a The book is page of illustrations to a page of text. straightforward and easy to read and understand, since the illustrations are clear and precise. For anyone likely to become interested in thoracic work it gives a very good idea of the scope of the subject. Almost every routine thoracic operation is described briefly and illustrated from the technical aspect, and the reader is ,

given the choice of studying the operation of lobectomy in the supine, lateral, and prone positions, with special reference to the important anatomy of the lung root. In addition, such unhappy incidents as haemorrhage from the aorta are considered, with the appropriate method for dealing with them. There is little to criticise, though it is strange that an elaborate plastic form of treatment should be described for cardiospasm in preference to the more simple Heller’s type which is hardly mentioned. These clear descriptions and the apparent sixnplicity of modern heart operations should not, however, encourage the inexperienced surgeon to embark on them, thinking they are necessarily easy. There is

an

well-produced

attractive lack of pretension about this and well-illustrated book.

Microbial Growth and its Inhibition First International Symposium on Chemical Microbiology. World Health Organisation Monograph Series No. 10. Geneva: World Health Organisation. 1952.

Pp. 285. 15s. IN June, 1951,

an international symposium was held in Rome on chemical microbiology, with particular reference to antibiotics and the various problems concerned with their inhibition of bacterial growth. It was organised by the Instituto Superiore di Sanita in collaboration with the Council for the Coordination of International Congresses of Medical Sciences and the World Health Organisation. The papers, read by leading specialists, have now been published in book form. They cover a wide range, including the origin and nature of drug-resistance in bacteria, vitamin-B-group substances in bacterial metabolism, the liberation of nucleic acid when

cells

are

heated, penicillin-fermentation, the chemistry of

antibiotics against fungi and antibiotics as stimulants of animal growth, the biological standardisation of antibiotic preparations, the lag-phase in bacterial growth, and similar subjects. The papers are mostly short reviews of subjects in which the authors were particularly interested, but the references are chosen with discrimination.

terramycin,

Each of the articles thus presents the considered of a well-known authority. They are lucid and easy to read, and so should stimulate those working on chemical microbiology, and inform those not conversant with this field of research.

opinion

Refresher Course for General Practitioners

By various authors ; reprinted from the British Medical Journal. London : British Medical Association. 1952. Pp. 486. 25s. Tms volume isa " first collection " of articles which appeared in the British Medical Journal under their present title between October, 1949, and December, 1950. Their publication in book form should be welcome to many practitioners, whether or not they read them as they came out. The authors, drawn from many hospitals and teaching centres in London, the provinces, and beyond, have maintained a remarkably high level not only in the content but in the presentation of their matter. The articles are informed, readable and to the point, and well calculated either to supplement the reader’s knowledge of the subject or to stimulate him to consider it afresh. They are illustrated where necessary with diagrams and photographs, well reproduced. The subjects of the 55 articles, though all relevant to general practice, cover no defined field and are arranged in-no logical order. This makes for easy reading, but the random selection limits the usefulness of the book for reference. Metabolism of Protein Constituents in the Mammalian

Body S. J.

BACH,

PH.D., F.R.I.C.,

University of Bristol. Pp. 272. 40s.

department

of

physiology,

Oxford : Clarendon Press.

1952.

IN this book Dr. Bach has confined himself to a review of our knowledge of some aspects of the metabolism of alanine, glycine, serine, threonine, valine, leucine, isoleucine, methionine, cysteine, and cystine. There are sections on the formation and reactions in vivo of haem pigments, bile pigments, porphyrins, uric acid, glutathione, and other metabolites ; and an interesting The nutritional account of cystinuria is included. value and use of these amino-acids for glycogen formation are considered, and there is an exhaustive account (about 53 pages) of "biological methylation." On this subject Dr. Bach is evidently a scholar, and his review-including as it does references to pathological consequences, in man and other species, of deficiencies in methylating processes-could hardly be bettered. In other respects. the book is less satisfactory, for in spite of the many references to original papers the treatment of some subjects is scrappy and inadequate. Thus the account of conjugated bile acids is inaccurate, and would not do for a student’s textbook ; and Dr. Bach does not mention the recent work of Friedman and Byers on the excretion of