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THE VALUE OF AVERTIN
1000 and the
extraordinary small amount of unheated serum required for its use, Wyler urges that it should be adopted as a routine. The Kahn micro-method, using only 0-06 c.cm. of serum, compared favourably with the standard Kahn method, which has now stood the test of time well. The Rosenthal reaction is simple to carry out, and very specific, showing accurate agreement with the Wassermann, but it is not so sensitive as the other flocculation tests. In his survey of the results Wyler admits, however, that where but a minute drop of serum is availablesufficient only for one test-it would not be right to rely entirely upon a micro-flocculation method, and the micro-Wassermann remains the method of choice. As all four tests described can be done on a total of 0-15 c.cm. of serum, which is readily obtainable from 0-5 c.cm. of blood, it should be simple for any pathologist having to deal with small amounts of sera to adopt the Wassermann and Kahn reactions here described, and to do a standard flocculation test as well as a complement-fixation test. The prevalent belief that it is difficult to obtain half a cubic centimetre of blood in routine psediatric practice appears rather surprisingly to be shared by Dr. Wyler. This is not the view held by most experienced workers. SURGICAL INSTRUMENT CRAFT
THREE years ago at the annual dinner of the Instrument Manufacturers’ Association, Sir Thomas Dunhill surveyed the relation between instrument maker and surgeon, from the time when the operator was able himself to make the simple tools required for his work. Little by little the two crafts diverged, some becoming more interested in making instruments, others in using them. For himself, he added, while he favoured simple instruments, a patient’s life might depend on the availability of complicated apparatus. Mr. Patrick Maw (of S. Maw, Son and Sons) presided on that occasion, and at the annual dinner last week when Mr. H. Guy Drew (of Down Bros.) presided, Mr. W. H. Ogilvie spoke of the making of surgical instruments as a craft comparable to that of the boat-builder. The motor industry, he said, typified all that he hoped that the surgical instrument maker would never become; every year the design was more beautiful and the quality of the work worse. The maker of motor-cars had ceased to be a craftsman, but surgical instrument making should and would remain the individual work of artists in wood, metal, leather, or glass; and the worker must be not only an artist but something of a chemist, mathematician, and even a fashion expert. Recently Mr. Drew had designed for him a sewing machine which might save half an hour of an operation and a prostate needle which would easily put stitches into impossible positions. Ten minutes in Mr. Drew’s office would turn one of his own Heath
Surgical
-nooinson
arawmgs into a icasicie specmcation. mr. reply said something about the enormous progress in the art of surgery since the war. In a single week, he remarked, British manufacturers might be called upon to produce 100 new designs of surgical instruments. He spoke of the evils of standardisation in arresting progress, and was happy to announce the inauguration, in this the eighteenth year of the Association’s life, of an Institute of British Surgical Technicians with two duties : (1) to evolve a code of professional conduct ; (2) to bring into being an educational scheme with a nationally recognised certificate. It was hoped ultimately to obtain similar recognition to that of other groups of medical auxiliaries. The manufacturers of surgical appliances were working even under a greater
Drew in
disadvantage than surgical instrument
makers because
of the traders who antagonised the public by their No surgical advertising and business methods. appliance maker was admitted to the Association without a certificate of skill, experience, and repute, plus an undertaking that he would not sell or fit any appliance without the instructions, or the subsequent approval, of some qualified medical authority. The Association had started a course of training in anatomy and physiology at the Chelsea Polytechnic, at the end of which examinations would be held and certificates granted. This year the classes had doubled in number and the scheme was already assured of a sufficient number of entrants to make it a success. THE VALUE OF AVERTIN THERE are still anesthetists who doubt the advisability of any wide use of Avertin. They are mostly to be found perhaps among those who have had least experience of the drug and they will find, little support in a recent paper on the subject by Wesley Bourne.1 He gives details of a thousand administrations and they clearly show the value of this basal narcotic when properly employed. Proper employment means in the first place careful discrimination among patents so that the most suitable and the safest dosage may be given. No hard-and-fast determination of dose by body-weight alone can be consistently satisfactory. As with other anaesthetics, so with avertin, the patient’s reaction is in accordance with his nabits, his general physique, and above all with his mental attitude. These must be studied and the amounts given must be lessened or increased in agreement with the anaesthetist’s estimate of the patient’s reaction. Bourne favours a general level of dosage higher than that commonly accepted, and in a third of his patients no other anaesthetic was required. It should rarely be necessary to supplement the avertin with any anaesthetic other than nitrous oxide, and avertin by itself causes no nausea. Among the thousand patients there was no fatality which could be fairly attributed to the drug.
Manchester Royal Infirmary has opened its resident posts to women on equal terms with men. Dr. Mabel L. Ramsay is standing in opposition to Sir Henry Bracken bury for the seat on the General Medical Council, as a direct representative for England and Wales. Dr. Ramsay has been engaged in general practice for the past 28 years, 26 of these in Plymouth, where she is now specialising in obstetrics and gynaecology. She has been president of the Medical Women’s Federation and represents it on the Insurance Acts Committee, and she is a member of the disciplinary procedure committee (N.H.I.) of the Ministry of Health. Dr. Ramsay believes the time is opportune for the appointment of a woman Councillor, for of the total number of names on the than 5000 are women. Dr. Leonard Kidd is inviting registered medical practitioners resident in Ireland to elect him again as their representative on the General Medical Council when his term of office expires on Dec. 31st. He has sat on the Council since 1906 and has served on the examination, education, public health, and pharmacopoeia committees. He stands as a provincial general practitioner, having always held that the elected members were intended by the legislature to be general practitioners, not connected directly or indirectly with the teaching and qualifying bodies, each of which nominates its own member. Dr. Kidd is a past president of the Irish Medical Association.
Register more
Canad. Med. Assoc. Jour.,
September, 1934,
p. 276.
extraordinary small amount of unheated serum required for its use, Wyler urges that it should be adopted as a routine. The Kahn micro-method, using only 0-06 c.cm. of serum, compared favourably with the standard Kahn method, which has now stood the test of time well. The Rosenthal reaction is simple to carry out, and very specific, showing accurate agreement with the Wassermann, but it is not so sensitive as the other flocculation tests. In his survey of the results Wyler admits, however, that where but a minute drop of serum is availablesufficient only for one test-it would not be right to rely entirely upon a micro-flocculation method, and the micro-Wassermann remains the method of choice. As all four tests described can be done on a total of 0-15 c.cm. of serum, which is readily obtainable from 0-5 c.cm. of blood, it should be simple for any pathologist having to deal with small amounts of sera to adopt the Wassermann and Kahn reactions here described, and to do a standard flocculation test as well as a complement-fixation test. The prevalent belief that it is difficult to obtain half a cubic centimetre of blood in routine psediatric practice appears rather surprisingly to be shared by Dr. Wyler. This is not the view held by most experienced workers. SURGICAL INSTRUMENT CRAFT
THREE years ago at the annual dinner of the Instrument Manufacturers’ Association, Sir Thomas Dunhill surveyed the relation between instrument maker and surgeon, from the time when the operator was able himself to make the simple tools required for his work. Little by little the two crafts diverged, some becoming more interested in making instruments, others in using them. For himself, he added, while he favoured simple instruments, a patient’s life might depend on the availability of complicated apparatus. Mr. Patrick Maw (of S. Maw, Son and Sons) presided on that occasion, and at the annual dinner last week when Mr. H. Guy Drew (of Down Bros.) presided, Mr. W. H. Ogilvie spoke of the making of surgical instruments as a craft comparable to that of the boat-builder. The motor industry, he said, typified all that he hoped that the surgical instrument maker would never become; every year the design was more beautiful and the quality of the work worse. The maker of motor-cars had ceased to be a craftsman, but surgical instrument making should and would remain the individual work of artists in wood, metal, leather, or glass; and the worker must be not only an artist but something of a chemist, mathematician, and even a fashion expert. Recently Mr. Drew had designed for him a sewing machine which might save half an hour of an operation and a prostate needle which would easily put stitches into impossible positions. Ten minutes in Mr. Drew’s office would turn one of his own Heath
Surgical
-nooinson
arawmgs into a icasicie specmcation. mr. reply said something about the enormous progress in the art of surgery since the war. In a single week, he remarked, British manufacturers might be called upon to produce 100 new designs of surgical instruments. He spoke of the evils of standardisation in arresting progress, and was happy to announce the inauguration, in this the eighteenth year of the Association’s life, of an Institute of British Surgical Technicians with two duties : (1) to evolve a code of professional conduct ; (2) to bring into being an educational scheme with a nationally recognised certificate. It was hoped ultimately to obtain similar recognition to that of other groups of medical auxiliaries. The manufacturers of surgical appliances were working even under a greater
Drew in
disadvantage than surgical instrument
makers because
of the traders who antagonised the public by their No surgical advertising and business methods. appliance maker was admitted to the Association without a certificate of skill, experience, and repute, plus an undertaking that he would not sell or fit any appliance without the instructions, or the subsequent approval, of some qualified medical authority. The Association had started a course of training in anatomy and physiology at the Chelsea Polytechnic, at the end of which examinations would be held and certificates granted. This year the classes had doubled in number and the scheme was already assured of a sufficient number of entrants to make it a success. THE VALUE OF AVERTIN THERE are still anesthetists who doubt the advisability of any wide use of Avertin. They are mostly to be found perhaps among those who have had least experience of the drug and they will find, little support in a recent paper on the subject by Wesley Bourne.1 He gives details of a thousand administrations and they clearly show the value of this basal narcotic when properly employed. Proper employment means in the first place careful discrimination among patents so that the most suitable and the safest dosage may be given. No hard-and-fast determination of dose by body-weight alone can be consistently satisfactory. As with other anaesthetics, so with avertin, the patient’s reaction is in accordance with his nabits, his general physique, and above all with his mental attitude. These must be studied and the amounts given must be lessened or increased in agreement with the anaesthetist’s estimate of the patient’s reaction. Bourne favours a general level of dosage higher than that commonly accepted, and in a third of his patients no other anaesthetic was required. It should rarely be necessary to supplement the avertin with any anaesthetic other than nitrous oxide, and avertin by itself causes no nausea. Among the thousand patients there was no fatality which could be fairly attributed to the drug.
Manchester Royal Infirmary has opened its resident posts to women on equal terms with men. Dr. Mabel L. Ramsay is standing in opposition to Sir Henry Bracken bury for the seat on the General Medical Council, as a direct representative for England and Wales. Dr. Ramsay has been engaged in general practice for the past 28 years, 26 of these in Plymouth, where she is now specialising in obstetrics and gynaecology. She has been president of the Medical Women’s Federation and represents it on the Insurance Acts Committee, and she is a member of the disciplinary procedure committee (N.H.I.) of the Ministry of Health. Dr. Ramsay believes the time is opportune for the appointment of a woman Councillor, for of the total number of names on the than 5000 are women. Dr. Leonard Kidd is inviting registered medical practitioners resident in Ireland to elect him again as their representative on the General Medical Council when his term of office expires on Dec. 31st. He has sat on the Council since 1906 and has served on the examination, education, public health, and pharmacopoeia committees. He stands as a provincial general practitioner, having always held that the elected members were intended by the legislature to be general practitioners, not connected directly or indirectly with the teaching and qualifying bodies, each of which nominates its own member. Dr. Kidd is a past president of the Irish Medical Association.
Register more
Canad. Med. Assoc. Jour.,
September, 1934,
p. 276.