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A FINGER GONIOMETER
435
downwards. The position after rotation therefore ensures that the plane of the bevel is parallel with that of the blood-flow. So that the needle shall not protrude beyond the inner lining of the plastic tube, the distance between the opening in the adaptor and the inner surface of the tube is previously measured (1’9 cm. in this particular model). It is then a simple matter to mark this distance on the needles used. A screw on the top of the adaptor, when tightened, fixes the needle firmly in position. This adaptor has now been used in fifty dialyses involving regional heparinisation, and it has proved extremely useful.
New Inventions A FINGER GONIOMETER
injury or operation,. measurement of interphalangeal estimating the speed of recovery, or for medicolegal purposes, can only be recorded accurately by drawing each joint-angle at the limit of flexion and extension or by the commoner practice of describing the angle numerically. This can be very confusing, particularly in cases of multiple injuries to the hands, when the movements of all fourteen phalangeal joints of each hand are recorded, and each joint has two After
movement for
numbers
to
I should like to thank Mr. F. H. Caldwell for constructing the adaptor; and Mr. E. Mackay and Mr. T. Gonczol for the photograph. University Department of Surgery, JACK NAYMAN Alfred Hospital,
indicate the limits of flexion and extension.
Melbourne, Australia
M.B.
W’srand,
F.R.C.S.
Reviews of Books The Economic Circumstances of Old People Occasional Papers on Social Administration, no. 4. DOROTHY COLE, with JOHN UTTING. Welwyn, Hertfordshire: Codicote Press. 1962.
The finger goniometer (see figure) is an articulated rubber stamp, which can be matched to the bent and straight positions of the finger, and then stamped on the case-sheet, where it prints a line, bent to conform with the position of the joints. This method is no less accurate than any other, it is rapid, and it records the information directly and visually. The goniometer, which is constructed of aluminium with nylon joints, has been made for me by Down Bros. and Mayer & Phelps Ltd., 32, New Cavendish Street, London, W.1. GEOFFREY OSBORNE M.B., M.CH. ORTH. Lpool, F.R.C.S.E. Liverpool Royal Infirmary A NEEDLE ADAPTOR FOR REGIONAL HEPARINISATION THE heparinisation of the region of the extracorporeal circuit only1 has greatly facilitated the haemodialysis of surgical cases, and of patients with trauma or coagulation anomalies. For this technique needles must be inserted into the outflow and inflow cannulas for the inof and
respective fusion
heparin protamine sulphate. In
the Kolff twincoil disposable artificial kidney, needles can be inserted via rubber sleeves over the plastic tubing to obtain blood samples. In our unit an adaptor has been designed which fits on to this rubber sleeve and keeps the needle securely in position. The adaptor (see figure) is clamped by means of two screws on its under surface. The hole for the needle is centred on a plane inclined at 120° to the direction of the flow of blood. Because the needle passes at right angles to this plane, the angle between its shaft and the direction of blood-flow is 30°. A no. 21 needle, with a bevel of 120°, is used. The needle is inserted with the bevel pointing upwards, and when it has gone through the plastic tube (as determined by a change in resistance) the shaft is rotated through 180° so that the bevel faces 1.
Gordon, L. A., Simon, E. R., Rukes, J. M., Richards, V., Perkins, H. Engl. J. Med. 1956, 255, 1063.
New
A.
Pp.
133. 12s. 6d.
THIS report, produced under the auspices of the Nuffield Foundation, presents the preliminary findings of an economic survey of 400 individuals chosen by a careful sampling system in different areas as representative of the elderly population of this country. Nearly a third of those interviewed had no assets and depended for their entire income on the State. More than half had incomes of under E4 10s. a week with an average of E3 4s., but only a quarter were receiving National Assistance. As many again, with incomes no higher, were not getting National Assistance, either because of ignorance of their rights or a reluctance to use them, or because their incomes were derived from sources which the National Assistance Board is not empowered to disregard-for example, increments to retirement pensions, investment income, or income from lodgers. If the rules were altered to include all people with incomes of less than E4 10s. per week, then half the elderly population of this country would qualify for National Assistance. The greatest hardship was found among widows and single women, half of whom had incomes of under E310s. per week. Men were better off because more had been able to save something for their retirement or else had a private pension. Those over 70, both men and women, were generally worse off than people who had more recently retired. They were getting past the age when they could supplement their income by odd jobs, their clothes and furniture were wearing out, and they found it harder and harder to replace them. The authors suggest that a general increase in pensions over the age of 70 might be the most effective way of helping those in greatest need, especially since almost half the population over 70 consists of widows and single women. The sample on which this investigation is based is very small; but the inquiry has evidently been conducted with the greatest care, and the authors produce convincing evidence to show that their results are truly representative. We hope that their findings and suggestions will be carefully studied by those who determine economic and social policy. Justice certainly demands that the elderly should have a larger share in the life of our affluent society from which many are at present excluded. The
Story of Insulin G. A. WRENSHALL, PH.D., G. HETENYI, PH.D., of the department of medical research, Frederick G. Banting and Charles H. Best Institutes, University of Toronto; W. R. FEASBY, M.D., medical director, Canadian Diabetic Association. London: Bodley Head. 1962. Pp. 232. 21s.
"
wrote a physician in the early ’20s, referring to the for diabetes then in common use, " should a patient be subjected to continued underfeeding, and thus his life made miserable ? In the long run there is no hope anyway." It was a justifiable comment on the only method then known of prolonging a diabetic’s existence for a few months: but even as
WHY,"
treatment
’
downwards. The position after rotation therefore ensures that the plane of the bevel is parallel with that of the blood-flow. So that the needle shall not protrude beyond the inner lining of the plastic tube, the distance between the opening in the adaptor and the inner surface of the tube is previously measured (1’9 cm. in this particular model). It is then a simple matter to mark this distance on the needles used. A screw on the top of the adaptor, when tightened, fixes the needle firmly in position. This adaptor has now been used in fifty dialyses involving regional heparinisation, and it has proved extremely useful.
New Inventions A FINGER GONIOMETER
injury or operation,. measurement of interphalangeal estimating the speed of recovery, or for medicolegal purposes, can only be recorded accurately by drawing each joint-angle at the limit of flexion and extension or by the commoner practice of describing the angle numerically. This can be very confusing, particularly in cases of multiple injuries to the hands, when the movements of all fourteen phalangeal joints of each hand are recorded, and each joint has two After
movement for
numbers
to
I should like to thank Mr. F. H. Caldwell for constructing the adaptor; and Mr. E. Mackay and Mr. T. Gonczol for the photograph. University Department of Surgery, JACK NAYMAN Alfred Hospital,
indicate the limits of flexion and extension.
Melbourne, Australia
M.B.
W’srand,
F.R.C.S.
Reviews of Books The Economic Circumstances of Old People Occasional Papers on Social Administration, no. 4. DOROTHY COLE, with JOHN UTTING. Welwyn, Hertfordshire: Codicote Press. 1962.
The finger goniometer (see figure) is an articulated rubber stamp, which can be matched to the bent and straight positions of the finger, and then stamped on the case-sheet, where it prints a line, bent to conform with the position of the joints. This method is no less accurate than any other, it is rapid, and it records the information directly and visually. The goniometer, which is constructed of aluminium with nylon joints, has been made for me by Down Bros. and Mayer & Phelps Ltd., 32, New Cavendish Street, London, W.1. GEOFFREY OSBORNE M.B., M.CH. ORTH. Lpool, F.R.C.S.E. Liverpool Royal Infirmary A NEEDLE ADAPTOR FOR REGIONAL HEPARINISATION THE heparinisation of the region of the extracorporeal circuit only1 has greatly facilitated the haemodialysis of surgical cases, and of patients with trauma or coagulation anomalies. For this technique needles must be inserted into the outflow and inflow cannulas for the inof and
respective fusion
heparin protamine sulphate. In
the Kolff twincoil disposable artificial kidney, needles can be inserted via rubber sleeves over the plastic tubing to obtain blood samples. In our unit an adaptor has been designed which fits on to this rubber sleeve and keeps the needle securely in position. The adaptor (see figure) is clamped by means of two screws on its under surface. The hole for the needle is centred on a plane inclined at 120° to the direction of the flow of blood. Because the needle passes at right angles to this plane, the angle between its shaft and the direction of blood-flow is 30°. A no. 21 needle, with a bevel of 120°, is used. The needle is inserted with the bevel pointing upwards, and when it has gone through the plastic tube (as determined by a change in resistance) the shaft is rotated through 180° so that the bevel faces 1.
Gordon, L. A., Simon, E. R., Rukes, J. M., Richards, V., Perkins, H. Engl. J. Med. 1956, 255, 1063.
New
A.
Pp.
133. 12s. 6d.
THIS report, produced under the auspices of the Nuffield Foundation, presents the preliminary findings of an economic survey of 400 individuals chosen by a careful sampling system in different areas as representative of the elderly population of this country. Nearly a third of those interviewed had no assets and depended for their entire income on the State. More than half had incomes of under E4 10s. a week with an average of E3 4s., but only a quarter were receiving National Assistance. As many again, with incomes no higher, were not getting National Assistance, either because of ignorance of their rights or a reluctance to use them, or because their incomes were derived from sources which the National Assistance Board is not empowered to disregard-for example, increments to retirement pensions, investment income, or income from lodgers. If the rules were altered to include all people with incomes of less than E4 10s. per week, then half the elderly population of this country would qualify for National Assistance. The greatest hardship was found among widows and single women, half of whom had incomes of under E310s. per week. Men were better off because more had been able to save something for their retirement or else had a private pension. Those over 70, both men and women, were generally worse off than people who had more recently retired. They were getting past the age when they could supplement their income by odd jobs, their clothes and furniture were wearing out, and they found it harder and harder to replace them. The authors suggest that a general increase in pensions over the age of 70 might be the most effective way of helping those in greatest need, especially since almost half the population over 70 consists of widows and single women. The sample on which this investigation is based is very small; but the inquiry has evidently been conducted with the greatest care, and the authors produce convincing evidence to show that their results are truly representative. We hope that their findings and suggestions will be carefully studied by those who determine economic and social policy. Justice certainly demands that the elderly should have a larger share in the life of our affluent society from which many are at present excluded. The
Story of Insulin G. A. WRENSHALL, PH.D., G. HETENYI, PH.D., of the department of medical research, Frederick G. Banting and Charles H. Best Institutes, University of Toronto; W. R. FEASBY, M.D., medical director, Canadian Diabetic Association. London: Bodley Head. 1962. Pp. 232. 21s.
"
wrote a physician in the early ’20s, referring to the for diabetes then in common use, " should a patient be subjected to continued underfeeding, and thus his life made miserable ? In the long run there is no hope anyway." It was a justifiable comment on the only method then known of prolonging a diabetic’s existence for a few months: but even as
WHY,"
treatment
’