A NEW CLAMP FOR USE WITH PLATE ELECTRODES.

674 the hinge of the front splint just corresponds with the joint. The bandage which is now applied must not go beyond the wrist-joint, and when this bandage has been fixed a second bandage should be put on extending to the fingers. When it is deemed desirable to move the wrist-joint, all that is necessary is that the second bandage should be removed, then the

New Inventions. URETHRAL AND RECTAL OINTMENT APPLICATORS. I HAVE found the instruments depicted in the accompanying engravings a most efficient means for the application of ointments to the urethra and rectum. They are an improvement on those at present in use, and possess the advantage of simplicity. Each instrument consists of : a metal tube with lateral slits, the lower end being closed with a conically shaped screw ; a metal obturator equal in diameter to the internal diameter of the tube ; and a metal nozzle with a universal screw at one end which can be screwed on to any ordinary collapsible tube. In using the urethral applicator FIG. 1. (Fig. 1) the patient is placed on a couch and the anterior urethra washed out with a pint of antiseptic solution such as hydrogen peroxide 5 per cent., potassium permanganate 1 in 2000, or (a mercury perchloride 1 in 6000 4-ounce syringe fitted with rubber nozzle should be used). The instrument is sterilised and lubricated with glycerine and is passed without its oocurabor

bulb

as

rar

as

Tine

(sometimes into posteriorurethra).

the

I

brass slide is pushed forward, which will enable the banddesired. to be turned back and the joint manipulated pieceadvantages 1. It claimed for the splint The movement of the joint without interfering with the fracture.

J

as

are:

secures

2. It leaves the fingers free for voluntary movement. 3. IJ deviates the hand to the ulnar border. 4. By being bevelled it corrects the displacement of the radius forwards. 5. It can be applied to either arm. The splints are made in three sizes by Messrs. Mayer and Meltzer, 71, Great Portland-street, London, W. G. M. DAWKIN, M.R.C.S. Eng., L.R.C.P. Lond.

A nozzle is then attached to a collapsible tube containPontypridd. ing the ointment to be A NEW CLAMP FOR USE WITH PLATE used and inserted into the ELECTRODES. as it lies urethral tube, THIS electrode clamp I have found most useful in the in the urethra, squeezing the collapsible tube. The treatment of piles by zinc-mercury ions. For this purpose tube can be partially I take a piece of sheet zinc and cut the electrode to fit filled with the ointment. the case. Messrs. Allen and Hanburys, of Wigmore-street, If the ointment should London, W., who made the clamp from my pattern, require liquefaction the now, however, also supply suitable electrodes for use nozzle may be heated in the with the instrument. In the treatment of piles I use a flame of a bunsen burner. zinc plate about 2 inches long and sinch wide, with a Having introduced the slit about 2 inch long and i inch wide, cut out at the ointment the metal obtu- distal end, thus forming two prongs, the tips of which are rator is passed gradually. bent at right angles into hooks. The object of these hooks. The ointment now exudes is to hold the electrode in the position in which it is first taking place all over through the lateral slits placed, thus ensuring the full reaction of the urethral tube and the area treated, and that of the slit to allow of a view of the entire instrument is a portion of the pile under treatment, thus giving the This zinc electrode I amalga. rotated in the urethra operator his colour index. mate with metallic mercury while local anaesthesia is being to spread the ointment over the obtained by means of tampons soaked in cocaine solution. as urethral surface. The urethra may To obtain a direct contact, I bare the end of the massaged on the surface of the for two or three minutes, at the perineal scrotal junction and working up to the fossa navicuAfter removing the instrument laris. the glans penis should be covered with cotton wool, which should be retained

be instrument

starting

iinf,il tha next urination

The rectal instrument (Fig. 2) is sterilised and lubricated with glycerine and passed with its obturator, and the obturator is then withdrawn. The rectal tube is filled with the ointment to be used by means of the nozzle attached to a collapsible tube. The obturator is then passed, forcing the ointment into the rectum through the lateral slits of the tube, and the entire instrument is rotated in the rectum so as to spread the ointment over the rectal surface. Messrs. Down Bros., 21 and 23, St. Thomas’s-street, London, S. E., are the makers. ANDREW CHARLES, F.R.C.S F. R. C. S. Irel. Dublin.

conductor from the positive pole and pass it through the hole drilled in the clamp. The zinc-mercury electrode is then placed in position and the clamp closed, firmly pressing the copper wire against the zinc. The patient now being ready IMPROVED SPLINT FOR COLLES’S FRACTURE. and the piles having been well strained down the electrode THE illustration given below represents a splint that I have is applied to the part to be treated and the operation carried designed for the treatment of Colles’s fracture. The method out in the usual manner. I have found this method very of using the splint is as follows. The hand piece of the useful also in treating ulcers which are in a position difficult, front splint is locked by the brass slide, then the splints are I to reach with saturated tampons. ALFRED J. H. ILES, M.R.C.S. M. R. C. S. Eng., L.R.C.P. L. R. C. P.Lond. Lond. padded and applied in the usual way, care being taken that the back splint does not go beyond the wrist-joint, and Taunton.

that

675

STATE INSURANCE AGAINST SICKNESS AND INVALIDITY.

schemes of medical attendance under friendly societies’ control, and in preparation for the probable eventuality of being consulted by the authorities before any Government scheme is

THE LANCET.

definitely proposed,

as

well

with

as

the

useful

purpose of directing the minds of legislators and the public along desirable and satisfactory lines, the British Medical

Association, through LONDON: SATURDAY, MARCH 11, 1911.

prepared and "Organisation Insurance

or

State Insurance against Sickness and Invalidity.

the

opinion

a

committee of

its Council,

has

submitted to its divisions a report on the of Medical Attendance on the Provident

Principle,"

and is desirous

of the medical

of

obtaining adopting a various plans

before

profession supporting or opposing the suggest themselves. The report

final attitude in

which will is a valuable THE comprehensive survey of the economic and socialand instructive document divided into four sections. conditions of the people of England and Wales which Section A deals with the reasons which make it necessary for the medical profession to ensure that the views constitutes the report (Majority and Minority documents) of of medical practitioners shall be ascertained and their the Royal Commission on the Poor-laws, has revealed the interests respected, and contains a paragraph defining comparative failure in many directions of existing systems of the attitude which the profession, in the opinion of Poor-law medical relief, medical charities, and contract the at the should medical

practice,

and has created

a

growing

demand from

Association, adopt present juncture. the considered, says report, whether simple

It has to be

resistance to any provident medical organisation underthe wage-earning classes. In the report it is disclosed that taken by the community is likely to be of any avail, and whether it might not cause the community to seek a large proportion of the poorer classes do not obtain that other methods of making the desired provision which prompt and efficient medical attendance which it is to the The would be even less satisfactory to the profession. interest of the community that they should receive ; and it is alternative recommended by the Minority Report of the now believed that were the necessary organisation in existPoor-law Commission-namely, the employment of a few ence these people, with a little help from the State, could whole-time or part-time officers, selected by local health provide themselves with efficient medical service by some authorities to carry out the work of treating the sick scheme of insurance. Since the appearance of the Poor-law poor, which would thus be taken entirely out of the report the Government has made known that it has hands of independent private practitionera, is not rethe public for the better

under consideration There is

no

a

provision

of medical attendance for

scheme of State sickness insurance.

certainty as yet

that this will include

provision

for medical attendance, but the belief is general that such will be the case, and there have been statements in the press

purporting to give details of the proposals of the Chancellor of the Exchequer for State insurance against sickness and invalidity, based upon the result of a number i of private conferences between Mr. LLOYD GEORGE and the members of certain friendly societies. In answering a question recently asked by Mr. BOOTH in the House of Commons, Mr. HOBHOUSE replied that the reports on this matter were issued entirely without the authority and knowledge of the Chancellor of the Exchequer, but he did not deny the accuracy of them. The main features of the scheme are the compulsory insurance of the whole working-class population of the country between 16 and 70 years of age whose incomes are below the income-tax level of E160 a year against sickness

the

and

invalidity

to

minimum

amount of

in

of the

Council of

their

desirable either the

report

now

the

made

by

the committee

British Medical Association

in the interests of

the profession additional reason for

and

bad; and the establishment of a Central Administrative Council composed of representatives of the Government, the friendly societies, and the employers of labour to deal with all questions which may arise under the working of the scheme. ,In view of the serious extent to which the interests of medical practitioners may be affected by the adoption of

as

or

affords an not public, throwing obstacles in the way of the development of medical services on provident or insurance lines. Section B deals with the general considerations by which the action of the Association must be guided, which is of necessity bound up with previous declarations of its policy. Section C, which forms the largest part of the report, deals with questions affecting the actual organisation of a medical service on an insurance or provident basis. consideration of the constitution of the bodies which may control and carry out the detailed management of the provident service, the part to be taken by the medical proIt is

a

fession in such control and management, a definition of the persons for whose requirements the service is to provide, of the benefits to be provided; the sources and amount of contributions to the insurance fund, the principles of selection of medical practitioners employed to attend the insured, and

5s. ;; acceptance of the risks of all lives good and the method and amount of remuneration of those engaged a

weekly

garded

the work.

Section D is

a

résumé of the

the scheme in the interests of the medical

in

possible effects of profession and the

There are indications in the report of the line of action which the committee of the Council of the Association, which prepared the report, considers it desirable that

community.

the members should

must

take,

all questions opinions have been

but the decision

be left to the divisions whose

on