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IMPROVED SYRINGE FOR TRANSFUSION OF SALINE FLUID INTO THE CELLULAR TISSUE.
1769 the "Portable" are also useful forms, and for noting engage- surface from the lid of the box was about an eighth of an ments, when not more than two or three a day, nothing inch. By the ordinary method it was impossible to percuss out the heart boundaries, but by using my pleximeter their can be better than the Concise" " for vest pocket or purse ; cloth or morocco, gilt edges, 6d. or Is. The "Eclipse," size 5 in. by 2½ in., price 6d. or Is. 6d., according to binding, is also a very useful and handy form of diary with a week to an opening. Space is also provided in the form of a calendar for noting forthcoming events.
positions were exactly defined. In this case the heart was of entirely surrounded by air, and the ordinary percussion method only gave a duller note when that position was
course
reached where the heart almost touched the box. The fact that all these experiments have been repeated many times with invariably uniform results proves the possibility of obtaining an accurate definition of the boundaries of the heart even when it is overlapped by lung tissue. The dulness shown by the pleximeter is always somewhat external to that elicited by finger percussion. A special form of hammer is used with the pleximeter, its head being made of lamb’s wool so compressed that it cannot be beaten out of shape-a necessary condition for the production of an absolutely true note, and it is of such a weight that the required note is obtained A NEW PLEXIMETER. without the absorptive power of the surrounding ring being EvEB since 1761, when percussion as a means of physical overcome. The linger may, however, be employed as a diagnosis was first suggested by Avenbrugger of Vienna, it hammer with equally good results when the wrist is very has been generally recognised that deep percussion of the flexible. In using the pleximeter it must be applied firmly thorax is not free from uncertainties arising-(1) from the to the region to be percussed and there must be no alteration in its position when it is struck with the hammer. The vibrations of the chest-wall veiling the note really given manufacturers are Messrs. Down Brothers, St. Thomas-street, out by the structure underlying the plessor, and (2) from Borough. the fact that percussion, when sufficiently hard to produce ERNEST KINGSCOTE, M.B., C.M., L.R.C.S. Edin. a true note, is apt to hurt the patient. I have devised It a pleximeter which overcomes all these difficulties. consists of a wooden cone (A), made with a shoulder IMPROVED SYRINGE FOR TRANSFUSION OF SALINE to which a thick indiarubber ring is attached in such a FLUID INTO THE CELLULAR TISSUE. manner that when the instrument is firmly pressed against IN an article published in THE LANCET of June 27th, the chest the apex of the cone touches a definite point If the other 1896, Mr. A. H. Dodd described a case in which a patient on the skin in the centre of the ring. end of the cone be now struck smartly with a apparently moribund from haemorrhage due to placenta hammer having a flexible handle (B) the true note of praevia was successfully treated by injection of about a pint the underlying structure is elicited. My results have been of saline fluid into the cellular tissue of the axilla. Sir verified experimentally on recently James Sawyer wrote on the same subject in our correkilled sheep, pigeon-breasted animals, spondence columns on July 4th, and at his suggestion which are by no means easy sub- Messrs. Salt and Son, of Corporation-street, Birmingham, nave m a n u r a cjects for percussion. The lungs not tured an improved being artificially inflated I percussed the’ heart boundaries in the syringe for the usual manner, using the finger as a operation in question. It is of plessor and marking out the boundaries in ink. about 3 oz. capaLong skewers following the ink lines were then city, and, as thrust right through the thorax, and shown in the enon opening the chest they were graving, it has found to be surrounding and touchtwo nozzles. The fluid is drawn into ing the pericardium. On this experiment it by the nozzle at being repeated with my pleximeter a similar result was A, and is expelled obtained. Another similar experithrough the other ment was then made, the difference one, B, entering the tissue by means being that the lungs were artificially of a sharp-pointed inflated, when it was found that the skewers pushed through the cannula at the end boundaries marked by the ordinary of a rubber tube. method of percussion penetrated A carefully conthe heart muscle one inch from the structed valve at A ultimate margin on the left side and allows ingress, but a quarter of an inch on the right not egress, of the side of the heart; but with the fluid, the valve at B being of similar boundaries marked by my pleximeter the skewers pierced the overlapping construction, but with the action lung substance for a distance of reversed. The upabout one and a half inches on the ward stroke of the Left side and half an inch on the piston fills the right side, and were found just syringe from the grazing the actual cardiac boundaries. It was thus proved con- receptacle, and the downward stroke drives the fluid into clusively that the anatomical dimen- the cellular tissues, the action being continued until sufficient sions of the heart had been correctly has been injected. The quantity and pressure of the fluid percussed out, even although over- can be regulated with great precision, the syringe is very lapped by a considerable amount of lung substance. In easy to use, and the necessity for frequently removing it this case even the kidneys were percussed out with the plexi- from the tube for the purpose of refilling it is obviated. The meter from the back and the skewers again showed that the syringe combines several qualities which are highly desirable percussion had been accurate. A fresh sheep’s heart was in an instrument liable to be required on a sudden emergency, then suspended by means of string in a cardboard box and practitioners who have had experience of transfusion eighteen inches long and eight inches deep, such as is used operations will no doubt appreciate the merits of the coitby milliners, the direction of the cardiac diameters being un- struction which Sir James Sawyer has suggested. The paris known to the percussor. The least distance of the heart’s of the syringe may be rendered aseptic by boiling.
New Inventions.
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1770
THE ELECTION OF DIRECT REPRESENTATIVES.
sense that must have impressed all critics with its fairness, and Dr. RENTOUL and Mr. BROWN, who owe their election to their promises in respect of this question, will find it difficult to make the Council do more. Mr. CARTER dwells at length on the change in Dr. GLOVER’S position and attributes it solely to his " entangling alliance," as he terms his consent to be adopted as ajoint candidate with Dr. DRAGE Dr. WOODCOCK by the Medical Defence Union. The and LONDON: SATURDAY, DECEMBER 19, 1896. explanation of this change is probably much more complex than Mr. CARTER thinks. But all who understand what WE have now before us the facts of the poll of the election of Direct Representatives to the General Medical the General Medical Council is for and what it is not for Council for 1896 and are able to put a proper construction will rejoice that Dr. GLOVER still remains a member of the on them in the light of the discussions and of the Council, thus holding for the third time his membership, with the satisfaction that he has stuck to his opinions and electioneering methods of the last six months. We have the that on the whole his friends have stuck well to him. more freedom in doing so that we have not hesitated to Election on buch terms, even at the foot of the poll, is not to throw open our columns to all sides and all candidates. The result may not be altogether according to our taste. With be lightly esteemed. Mr. CARTER is more forcible when he analyses the figures that we have little responsibility. There is a responsibility of silence and absolute neutrality in such matters, and this which show the divided state of the profession and its inThere difference to direct representation. It is a serious argus the responsibility of some of our contemporaries. ment in the hands of the enemies of the principle of Direct s another responsibility-that of measured criticism and deliberate preference of candidates. This is our responsi- Representation that the gentleman who heads the poll on this so with a number of votes much less than bility. Journalism will have commenced its decadence and occasion does its fall in public estimation when it ceases to have a soul and one-third of the whole profession and little more than half voice of its own without reference to temporary politics and the whole number recorded in the election. It is still more serious to find that the numbers of the profession who care immediate triumphs. For better or for worse the General Medical Council is to register their votes have again diminished. In 1886 they the central and governing body of the profession. It has were 74 11 per cent. of the voting-papers sent out, in 1891 relations with the Crown and duties towards the public 61’28 per cent., and in 1896 54 2 per cent. The first obvious which give it an importance in the State attaching to no difficulty against which the principle of Direct Representaindividual corporation. Whatever we may think of its con- tion had to contend was the want of experience and stitution it comprises the leading teachers and practitioners organisation in the medical profession. Is there any proof of the profession, to whose guidance the profession and the that this difficulty has been lessened since 1886 ? We cannot public will surely look with respect and confidence. It see, any. One of the unfortunate features of the recent must always be a matter of moment that the members of election is the fragmentary nature of the support of candisuch a body sent up directly by the profession should dates, as the figures given elsewhere will show, varying as do from 6646 to 143. The election seems to have had possess two qualifications: firstly, they should represent they a disrupting effect. Every organisation of the profession a substantial section of the profession ; and secondly, they should be the best available representatives of the order seems to have been divided by it into parties and each party of registered practitioners, as distinguished from the con- to have been weakened by divided councils. It remains to sultants and teachers who naturally find themselves pre- be seen whether the gentlemen who have been elected will dominantly represented through the various Corporations and stay or hasten this obvious tendency on the part of the Universities, and who have been fortunate in England, so far, profession at large to neglect their privilege of using a voice in the favour of the Crown in its nominations. in the selection of their rulers. Upon that will depend very
THE LANCET.
monopolising Opinions will differ as to on the present occasion
how far the candidates elected possess the two qualifications which we have defined, and which we believe to be essential to the reputation of the principle of Direct Representation if it is to be extended or even maintained. Its opponents are already rejoicing and see with delight in the facts of last week’s poll the practical extinction of all fear of any increase in the number of Direct Representatives.
much the future of Direct Representation. Meantime, it may safely be said that each of the Direct Representatives has been appointed by a larger number of votes of members of the medical profession than any of the other members of the General Medical Council.
WE have received a copy of a pamphlet or booklet bearing the title Medical and Sanitary Reform in India."l It is by Such an increase has passed, Mr. BRUDENELL CARTER an anonymous author who advocates a bold, comprehensive, tells us in a letter published in another column, beyond ind radical scheme of reform. " Tinkering is," he says, the domain of practical politics. His rejoicing we cannot and worse than useless. The question is far too " useless, but think a little premature. The election which is just arge for half measures. Each single branch or department over has turned almost exclusively upon a question which )f medical work--military, civil, sanitary, educational and deeply affects the interests of the profession, but on which scientific-requires complete overhauling and readjustment, the General Medical Council has practically no more t) and in the cases of sanitary and scientific appointments say. In regard to the registration of midwives the Council 1 Publishers, Messrs. Thacker, has expressed itself with iteration for twenty years in a Spink, and Co.
positions were exactly defined. In this case the heart was of entirely surrounded by air, and the ordinary percussion method only gave a duller note when that position was
course
reached where the heart almost touched the box. The fact that all these experiments have been repeated many times with invariably uniform results proves the possibility of obtaining an accurate definition of the boundaries of the heart even when it is overlapped by lung tissue. The dulness shown by the pleximeter is always somewhat external to that elicited by finger percussion. A special form of hammer is used with the pleximeter, its head being made of lamb’s wool so compressed that it cannot be beaten out of shape-a necessary condition for the production of an absolutely true note, and it is of such a weight that the required note is obtained A NEW PLEXIMETER. without the absorptive power of the surrounding ring being EvEB since 1761, when percussion as a means of physical overcome. The linger may, however, be employed as a diagnosis was first suggested by Avenbrugger of Vienna, it hammer with equally good results when the wrist is very has been generally recognised that deep percussion of the flexible. In using the pleximeter it must be applied firmly thorax is not free from uncertainties arising-(1) from the to the region to be percussed and there must be no alteration in its position when it is struck with the hammer. The vibrations of the chest-wall veiling the note really given manufacturers are Messrs. Down Brothers, St. Thomas-street, out by the structure underlying the plessor, and (2) from Borough. the fact that percussion, when sufficiently hard to produce ERNEST KINGSCOTE, M.B., C.M., L.R.C.S. Edin. a true note, is apt to hurt the patient. I have devised It a pleximeter which overcomes all these difficulties. consists of a wooden cone (A), made with a shoulder IMPROVED SYRINGE FOR TRANSFUSION OF SALINE to which a thick indiarubber ring is attached in such a FLUID INTO THE CELLULAR TISSUE. manner that when the instrument is firmly pressed against IN an article published in THE LANCET of June 27th, the chest the apex of the cone touches a definite point If the other 1896, Mr. A. H. Dodd described a case in which a patient on the skin in the centre of the ring. end of the cone be now struck smartly with a apparently moribund from haemorrhage due to placenta hammer having a flexible handle (B) the true note of praevia was successfully treated by injection of about a pint the underlying structure is elicited. My results have been of saline fluid into the cellular tissue of the axilla. Sir verified experimentally on recently James Sawyer wrote on the same subject in our correkilled sheep, pigeon-breasted animals, spondence columns on July 4th, and at his suggestion which are by no means easy sub- Messrs. Salt and Son, of Corporation-street, Birmingham, nave m a n u r a cjects for percussion. The lungs not tured an improved being artificially inflated I percussed the’ heart boundaries in the syringe for the usual manner, using the finger as a operation in question. It is of plessor and marking out the boundaries in ink. about 3 oz. capaLong skewers following the ink lines were then city, and, as thrust right through the thorax, and shown in the enon opening the chest they were graving, it has found to be surrounding and touchtwo nozzles. The fluid is drawn into ing the pericardium. On this experiment it by the nozzle at being repeated with my pleximeter a similar result was A, and is expelled obtained. Another similar experithrough the other ment was then made, the difference one, B, entering the tissue by means being that the lungs were artificially of a sharp-pointed inflated, when it was found that the skewers pushed through the cannula at the end boundaries marked by the ordinary of a rubber tube. method of percussion penetrated A carefully conthe heart muscle one inch from the structed valve at A ultimate margin on the left side and allows ingress, but a quarter of an inch on the right not egress, of the side of the heart; but with the fluid, the valve at B being of similar boundaries marked by my pleximeter the skewers pierced the overlapping construction, but with the action lung substance for a distance of reversed. The upabout one and a half inches on the ward stroke of the Left side and half an inch on the piston fills the right side, and were found just syringe from the grazing the actual cardiac boundaries. It was thus proved con- receptacle, and the downward stroke drives the fluid into clusively that the anatomical dimen- the cellular tissues, the action being continued until sufficient sions of the heart had been correctly has been injected. The quantity and pressure of the fluid percussed out, even although over- can be regulated with great precision, the syringe is very lapped by a considerable amount of lung substance. In easy to use, and the necessity for frequently removing it this case even the kidneys were percussed out with the plexi- from the tube for the purpose of refilling it is obviated. The meter from the back and the skewers again showed that the syringe combines several qualities which are highly desirable percussion had been accurate. A fresh sheep’s heart was in an instrument liable to be required on a sudden emergency, then suspended by means of string in a cardboard box and practitioners who have had experience of transfusion eighteen inches long and eight inches deep, such as is used operations will no doubt appreciate the merits of the coitby milliners, the direction of the cardiac diameters being un- struction which Sir James Sawyer has suggested. The paris known to the percussor. The least distance of the heart’s of the syringe may be rendered aseptic by boiling.
New Inventions.
_
_
_
_
_.
_
_
- --
~
---
.......
....._
~
-
-..
--
-
1770
THE ELECTION OF DIRECT REPRESENTATIVES.
sense that must have impressed all critics with its fairness, and Dr. RENTOUL and Mr. BROWN, who owe their election to their promises in respect of this question, will find it difficult to make the Council do more. Mr. CARTER dwells at length on the change in Dr. GLOVER’S position and attributes it solely to his " entangling alliance," as he terms his consent to be adopted as ajoint candidate with Dr. DRAGE Dr. WOODCOCK by the Medical Defence Union. The and LONDON: SATURDAY, DECEMBER 19, 1896. explanation of this change is probably much more complex than Mr. CARTER thinks. But all who understand what WE have now before us the facts of the poll of the election of Direct Representatives to the General Medical the General Medical Council is for and what it is not for Council for 1896 and are able to put a proper construction will rejoice that Dr. GLOVER still remains a member of the on them in the light of the discussions and of the Council, thus holding for the third time his membership, with the satisfaction that he has stuck to his opinions and electioneering methods of the last six months. We have the that on the whole his friends have stuck well to him. more freedom in doing so that we have not hesitated to Election on buch terms, even at the foot of the poll, is not to throw open our columns to all sides and all candidates. The result may not be altogether according to our taste. With be lightly esteemed. Mr. CARTER is more forcible when he analyses the figures that we have little responsibility. There is a responsibility of silence and absolute neutrality in such matters, and this which show the divided state of the profession and its inThere difference to direct representation. It is a serious argus the responsibility of some of our contemporaries. ment in the hands of the enemies of the principle of Direct s another responsibility-that of measured criticism and deliberate preference of candidates. This is our responsi- Representation that the gentleman who heads the poll on this so with a number of votes much less than bility. Journalism will have commenced its decadence and occasion does its fall in public estimation when it ceases to have a soul and one-third of the whole profession and little more than half voice of its own without reference to temporary politics and the whole number recorded in the election. It is still more serious to find that the numbers of the profession who care immediate triumphs. For better or for worse the General Medical Council is to register their votes have again diminished. In 1886 they the central and governing body of the profession. It has were 74 11 per cent. of the voting-papers sent out, in 1891 relations with the Crown and duties towards the public 61’28 per cent., and in 1896 54 2 per cent. The first obvious which give it an importance in the State attaching to no difficulty against which the principle of Direct Representaindividual corporation. Whatever we may think of its con- tion had to contend was the want of experience and stitution it comprises the leading teachers and practitioners organisation in the medical profession. Is there any proof of the profession, to whose guidance the profession and the that this difficulty has been lessened since 1886 ? We cannot public will surely look with respect and confidence. It see, any. One of the unfortunate features of the recent must always be a matter of moment that the members of election is the fragmentary nature of the support of candisuch a body sent up directly by the profession should dates, as the figures given elsewhere will show, varying as do from 6646 to 143. The election seems to have had possess two qualifications: firstly, they should represent they a disrupting effect. Every organisation of the profession a substantial section of the profession ; and secondly, they should be the best available representatives of the order seems to have been divided by it into parties and each party of registered practitioners, as distinguished from the con- to have been weakened by divided councils. It remains to sultants and teachers who naturally find themselves pre- be seen whether the gentlemen who have been elected will dominantly represented through the various Corporations and stay or hasten this obvious tendency on the part of the Universities, and who have been fortunate in England, so far, profession at large to neglect their privilege of using a voice in the favour of the Crown in its nominations. in the selection of their rulers. Upon that will depend very
THE LANCET.
monopolising Opinions will differ as to on the present occasion
how far the candidates elected possess the two qualifications which we have defined, and which we believe to be essential to the reputation of the principle of Direct Representation if it is to be extended or even maintained. Its opponents are already rejoicing and see with delight in the facts of last week’s poll the practical extinction of all fear of any increase in the number of Direct Representatives.
much the future of Direct Representation. Meantime, it may safely be said that each of the Direct Representatives has been appointed by a larger number of votes of members of the medical profession than any of the other members of the General Medical Council.
WE have received a copy of a pamphlet or booklet bearing the title Medical and Sanitary Reform in India."l It is by Such an increase has passed, Mr. BRUDENELL CARTER an anonymous author who advocates a bold, comprehensive, tells us in a letter published in another column, beyond ind radical scheme of reform. " Tinkering is," he says, the domain of practical politics. His rejoicing we cannot and worse than useless. The question is far too " useless, but think a little premature. The election which is just arge for half measures. Each single branch or department over has turned almost exclusively upon a question which )f medical work--military, civil, sanitary, educational and deeply affects the interests of the profession, but on which scientific-requires complete overhauling and readjustment, the General Medical Council has practically no more t) and in the cases of sanitary and scientific appointments say. In regard to the registration of midwives the Council 1 Publishers, Messrs. Thacker, has expressed itself with iteration for twenty years in a Spink, and Co.