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BOURGEOIS BABIES
247 number of cases of phthisis seems to be increasing. The mortality-rate from tuberculosis is now 2 per 1000, the same as it was in the United States thirty Control is extremely difficult in this years ago. scattered population with no proper travel facilities, and a large number of people with active and open lesions are at large and a source of danger to their families and friends. More hospital beds are urgently needed both for early treatment and the isolation of chronic cases. Dr. Curtis would like authority to compel infectious patients, too poor or too ignorant to observe the rules of hygiene, to enter an institution. BOURGEOIS BABIES THOSE non-members who read the new edition of the little book written for the Chelsea Babies Club by its medical officers (Recipes for Food and Conduct. London: Chelsea Babies Club, 35, Danvers Street, Chelsea. 1938. Pp. 84. 2s. 6d.) will envy the children and mothers of the professional classes in Chelsea who can enjoy advice and help of a type hitherto reserved for the working-class at welfare centres. The book consists of sixteen short chapters on prenatal care, breast-feeding, weaning, diet, exercise, clothing, and general management. Simply written, so that directions can be followed by those unused to medical terms, it yet contains the essentials of modern paediatrics. The directions for prenatal care are practical and unalarming ; the rules for breast-feeding are excellent, keeping the balance between the need for regularity and the avoidance of depressing monotony in the mother’s life. Simple directions are given for calculating the amount of breast-milk required by the infant and methods of test-weighing are given in detail. Weaning, balanced diets, vitamins, patent foods, and protective inoculation are sensibly reviewed and the essential differences between the various commercial milks sold and the dangers of raw milk are made clear. The modern views on sound tooth formation are embodied in the against excess of cereals in the diet. There warning is an excellent chapter on exercise in infancy, with a sympathetic plea for babies too much confined to play-pens or strapped into perambulators with little possibility of either physical or mental exercise. The section on sun-bathing contains a salutary warning against over-enthusiastic exposure, especially at the seaside. The book throughout is balanced in outlook and the apt quotations from the works of the sixteenthcentury French physician, Saint-Martin, add to its attractiveness. Many medical readers will find instruction in it.
CATALOGUING IN SPECIAL LIBRARIES
Mr. J. L. Thornton, the librarian of St. Bartholomew’s Hospital medical college, has made a concise of the methods of cataloguing adopted in the survey " special " libraries in this country (London : Grafton and Co. 1938. Pp. 268. 10s. 6d.). He uses the term special to indicate all other than public and county libraries, and he covers the large field comprehensively though without pretence to completeness. Although the book is intended to deal mainly with one particular branch of librarianship-cataloguingMr. Thornton manages to include a mass of useful information on other aspects of the subject in many of the sections devoted to individual libraries. Beginning with the university and college libraries, he goes on to discuss in turn medical and scientific libraries (such as those of St. Bart.’s, the School of Hygiene, and the Royal College of Surgeons) ; those attached to scientific and learned institutions and
societies; government libraries ; business, commercial, and technical libraries; and finally polytechnic and other libraries catering for the more general types of student. At present the methods of
cataloguing are widely divergent and the achievement of a satisfactory degree of cooperation and uniformity amongst such a varied collection of libraries will be no
easy task.
Yet this is what Mr. Thornton is even partially in
aiming at, and if his book succeeds
order out of chaos it will have performed a useful service. The book may not interest every doctor, but those who are constantly using scientific libraries, and more particularly the special librarians themselves, will find it rich meat.
making
THORACIC SURGICAL IMPLEMENTS IN a lecture given to the Institute of British Surgical Technicians on Jan. 20, Mr. T. HOLMES SELLORS said that his object was to try to help bridge the gap between the user and the maker of surgical implements. Thoracic surgery was an extremely specialised branch requiring special tools. Rib resection involved freeing of the bone from its attached soft tissues without injuring the pleura or lung. All rib rugines raspatories, or strippers were based on the Faraboeuf periosteal elevator. The short curved stripper generally sufficed, but modifications were necessary in dealing with a rib hidden deep beneath muscle or under the scapula, and the angle at which the rib lay in relation to the operator determined the shape of other forms. Another tool, which was needed to reach the deep surface of the rib, was the Doyen raspatory, invented fifty years ago and never since improved, except by cranking the handle or changing the size of the hook. The rib, after being freed, had to be cut. Rib shears fell into two main types : guillotine and forceps. The guillotine type with a hook or a complete ring made a clean true cut, but could not be used round corners. In these circumstances, or when the rib was unduly tough, the compound double-action Swedish patterns were invaluable. There were also punch and gouge forceps for clearing sharp or projecting stumps of
bone. After resection of the rib the opening had to be with a rib spreader, generally based on the Tuffier or the De Quervain types, to allow of intrathoracic manipulations, for which the instruments had to be longer and lighter than usual and safe from any chance of springing or slipping off. The tying of ligatures constituted a problem, and for this reason most forceps were curved to let the surgeon see the tips. There were two ways of controlling the thin-walled vessels at the hilum: (1) isolating each vessel tediously and ligaturing it, and (2) grasping. vessels and bronchi together in a special snare or tourniquet, which was left in place until stitches could be slipped round the vessels and lung stump. Lighting the operation field was sometimes a problem. The big shadowless or multiple-unit lights were valueless. Lighted retractors or a small lamp were almost essential. With reference to thoracoscopes, bronchoscopes, and all other electrical implements Mr. Sellors emphasised the possibility of a breakdown due to faulty cable or to a lamp blowing out. There was one motto : " Duplicate everything." Electrical connexions should be more or less standardised. The operating-table as used in general surgery was too high for chest work. The patient lay on his side for most of the thoracic procedures, and it was difficult for the surgeon to stand over the operation field without using a platform. A lower base was now being fitted on many tables for this reason, with fittings to keep the patient on his side. One of the latest problems to be solved was that of continuous suction needed in the treatment of chronic empyema. Hand-pumps and water siphonage were not wholly efficient. Electric suction was the only feasible method, and a small, low-consumption, silent, and reliable motor had been produced. He had had one " ticking over " continuously for six months. Mr. Sellors ended with a plea for the invention of a substitute for rubber tubing-something with thin walls and an effective lumen, flexible, and not hard enough to erode the tissues. He also put forward the " hopeless request " for an instrument that would tie a half-hitch knot round the tip of a curved forceps at a good distance from the surgeon’s fingers.
enlarged
CATALOGUING IN SPECIAL LIBRARIES
Mr. J. L. Thornton, the librarian of St. Bartholomew’s Hospital medical college, has made a concise of the methods of cataloguing adopted in the survey " special " libraries in this country (London : Grafton and Co. 1938. Pp. 268. 10s. 6d.). He uses the term special to indicate all other than public and county libraries, and he covers the large field comprehensively though without pretence to completeness. Although the book is intended to deal mainly with one particular branch of librarianship-cataloguingMr. Thornton manages to include a mass of useful information on other aspects of the subject in many of the sections devoted to individual libraries. Beginning with the university and college libraries, he goes on to discuss in turn medical and scientific libraries (such as those of St. Bart.’s, the School of Hygiene, and the Royal College of Surgeons) ; those attached to scientific and learned institutions and
societies; government libraries ; business, commercial, and technical libraries; and finally polytechnic and other libraries catering for the more general types of student. At present the methods of
cataloguing are widely divergent and the achievement of a satisfactory degree of cooperation and uniformity amongst such a varied collection of libraries will be no
easy task.
Yet this is what Mr. Thornton is even partially in
aiming at, and if his book succeeds
order out of chaos it will have performed a useful service. The book may not interest every doctor, but those who are constantly using scientific libraries, and more particularly the special librarians themselves, will find it rich meat.
making
THORACIC SURGICAL IMPLEMENTS IN a lecture given to the Institute of British Surgical Technicians on Jan. 20, Mr. T. HOLMES SELLORS said that his object was to try to help bridge the gap between the user and the maker of surgical implements. Thoracic surgery was an extremely specialised branch requiring special tools. Rib resection involved freeing of the bone from its attached soft tissues without injuring the pleura or lung. All rib rugines raspatories, or strippers were based on the Faraboeuf periosteal elevator. The short curved stripper generally sufficed, but modifications were necessary in dealing with a rib hidden deep beneath muscle or under the scapula, and the angle at which the rib lay in relation to the operator determined the shape of other forms. Another tool, which was needed to reach the deep surface of the rib, was the Doyen raspatory, invented fifty years ago and never since improved, except by cranking the handle or changing the size of the hook. The rib, after being freed, had to be cut. Rib shears fell into two main types : guillotine and forceps. The guillotine type with a hook or a complete ring made a clean true cut, but could not be used round corners. In these circumstances, or when the rib was unduly tough, the compound double-action Swedish patterns were invaluable. There were also punch and gouge forceps for clearing sharp or projecting stumps of
bone. After resection of the rib the opening had to be with a rib spreader, generally based on the Tuffier or the De Quervain types, to allow of intrathoracic manipulations, for which the instruments had to be longer and lighter than usual and safe from any chance of springing or slipping off. The tying of ligatures constituted a problem, and for this reason most forceps were curved to let the surgeon see the tips. There were two ways of controlling the thin-walled vessels at the hilum: (1) isolating each vessel tediously and ligaturing it, and (2) grasping. vessels and bronchi together in a special snare or tourniquet, which was left in place until stitches could be slipped round the vessels and lung stump. Lighting the operation field was sometimes a problem. The big shadowless or multiple-unit lights were valueless. Lighted retractors or a small lamp were almost essential. With reference to thoracoscopes, bronchoscopes, and all other electrical implements Mr. Sellors emphasised the possibility of a breakdown due to faulty cable or to a lamp blowing out. There was one motto : " Duplicate everything." Electrical connexions should be more or less standardised. The operating-table as used in general surgery was too high for chest work. The patient lay on his side for most of the thoracic procedures, and it was difficult for the surgeon to stand over the operation field without using a platform. A lower base was now being fitted on many tables for this reason, with fittings to keep the patient on his side. One of the latest problems to be solved was that of continuous suction needed in the treatment of chronic empyema. Hand-pumps and water siphonage were not wholly efficient. Electric suction was the only feasible method, and a small, low-consumption, silent, and reliable motor had been produced. He had had one " ticking over " continuously for six months. Mr. Sellors ended with a plea for the invention of a substitute for rubber tubing-something with thin walls and an effective lumen, flexible, and not hard enough to erode the tissues. He also put forward the " hopeless request " for an instrument that would tie a half-hitch knot round the tip of a curved forceps at a good distance from the surgeon’s fingers.
enlarged