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A NEW GASTRECTOMY CLAMP.
554 SYMPTOMS OF VISCERAL DISEASE. Third edition. By FRANCIS MARION POTTENC.ER, A.M., M.D., LL.D., Medical Director, Pottenger Sanatorium for Diseases of the Lungs and Throat, Monrovia, California. London : Henry Kimpton. 1925. Pp. 394. 28s. THIS is the third edition of a book which the author in his preface states to cover a unique field in clinical medicine, the uniqueness, we believe, being to make the patient the chief object of study. We confess that we are still puzzled, as we were in previous readings of this suggestive book, to understand in what this claim to particular singularity consists. In general arrangement the book remains as beforethat is, an introduction being followed by three parts entitled (1) Vegetative Nervous System ; (2.) Relationship between this System and Visceral Systems ; and (3) the Innervation of Important Viscera and a Clinical Study of the Germane Reflexes. The reflections are often sound and sometimes obvious, and the work is beautifully illustrated.
A MANUAL OF PHARMACOLOGY. Sixth edition. By WALTER E. DIXON, M.A., M.D., F.R.S., sometime Professor of Materia Medica and Pharmacology at King’s College, London. London : Edward Arnold and Co. 1925. Pp. 478. 18s. WE are glad to receive a new edition of this admirable manual. It has been completely revised in conformity with recent knowledge by Prof. E. Mellanby, Dr. O. Inchley, and Dr. A. J. Copeland, and additions are included covering all accepted knowledge on the subject of pharmacology. The information is imparted in a form useful alike to the student of pharmacy and of medicine. We have noted before the essentially practical nature of the work, which is at the same time an exposition of the relations between physiology and medicine. Looking back on the way in which pharmacology was taught as recently as 25 years ago, we can see how the large and varied researches in physics and chemistry which have taken place in the interval have enabled teaching to assume the logical character which Prof. Dixon and his collaborators give to it. The reader, for example, of Chapter XVII. in this book, which deals with the drugs acting locally on the alimentary canal, will obtain arguments for therapeutic procedures which he may have to undertake daily in the course of practice. He will know both what to do and why he should do it, and throughout the volume consultation will put him in the same position along other lines. The manual is in the first rank of books available on its subject.
,
In other directions words with a technical meaningare used without adequate explanation, a defect if the work is intended for the uninitiated. In scope the work is comprehensive and includes. short accounts of the nature of the main types of manufactured and preserved foods. The causes of food spoilage are discussed, including those from insects and larger animals, micro-organisms, enzyme action, The food and physical and chemical conditions. preservation methods include simple storage, application of cold, dehydration, chemical preservation,
preservation by fermentation, hermetically sealing,. heat sterilisation, In the and pasteurisation. description of these processes the author follows customary lines, but here and there unusual pieces of information are quoted. For instance, it
mentioned that the United States Bureau of war recommended the canning of dog-fish and other members of the shark family under the name of " grey-fish." When acted upon by many canners’it was discovered that the flesh of sharks contained urea which decomposed in time to ammonia, spoiling the flavour of the product and swelling the container. This caused great loss to canners and illustrates well the importance of scientific knowledge in relation to food preservation. is
Fisheries during the
New Inventions. A NEW GASTRECTOMY CLAMP. SURGEONS who have had practical experience of th& modification of the Billroth I. gastrectomy operation introduced by Schoemaker of The Haguel will have found considerable difficulty in applying Schoemaker’& crushing clamp to the stomach in certain cases. That instrument has to be passed across the stomach from the greater curvature, and where the ulcer is. high on the lesser curvature, or the stomach not very mobile, it is sometimes impossible to apply the clamp sufficiently above the lesion. The clamp here illustrated is designed to extend the range of this
ingenious and physiologically admirable operation. It is applied from the upper border or lesser curvature of the stomach, with the inner and outer halves clamped together by the central milled screw and by The an interlocking device at the tip of the blades. SCIENTIFIC PRESERVATION OF FOOD. two upper blades are set on a rocking joint so as to secure even crushing of the stomach, and the up By THOMAS M. RECTOR, Consulting Chemist. and lower blades are so ground as to fit into( h London : Chapman and Hall, Ltd. 1925. Pp. 213. other without risk of side-slipping or shearing -ne 10s. stomach wall. The crushing is effected by tightening IT is not very evident for whom this book isintended. the wing nuts on the ends of the handles. When the It gives a clear, but rather gossipy, account, freed distal portion of the stomach has been cut awa" from technicalities, of the different methods for the as in the Schoemaker operation, the exactly preservation of foods. Indeed, technicalities are so blade is removed by simply releasing its wing eliminated that the book will make but little appeal and the central milled screw. I have found to the chemist, bacteriologist, or medical expert this instrument simplifies the Schoemaker operation interested in the scientific data underlying the considerably. problems of food spoilage and their prevention.
But to the medical man who wishes to obtain a broad general idea of the methods employed in food preservation, this book may make appeal, and it will be found of considerable interest to laymen. It is, however, a serious defect in a book issued in 1925 that the important subject of vitamins and the extent to which they are destroyed or damaged by food preservation methods is entirely ignored.
Vitamins, indeed,
are
only incidentally mentioned.
I am indebted to Dr. K. B. Pinson, anaesthetist to the Manchester Royal Infirmary, for designing it, and it has been made for me by the General Radio-
logical Great
and Surgical Apparatus Co., Ltd., 204-6, Portland-street, London, W. 1. JOHN MORLEY, Ch.M. Manch., F.R.C.S. Eng.
1 Surgery, Gynecology, and Obstetrics, December, 1921, pp. 591-596.
555 raise in
a
proportional
number of centres the level of
routine, but such sporadic instruction would be
THE
LANCET.
LONDON: SATURDAY, SEPTEMBER 12, 1925.
THE TREATMENT OF FRACTURES. THE important series of lectures by Sir WILLIAM COURCY WHEELER which has been appearing in our recent issues and terminates to-day, and the discussion on the subject at the meeting of the British Medical Association at Bath, have combined to awaken a widespread interest in the treatment of fractures, and especially in that treatment as carried out in our great hospitals and as taught to our students. That this treatment might be greatly improved no surgeon will deny, but as to how it should be improved opinions differ, and, broadly speaking, there are three schools of thought. First, there are those who would retain the present system of treatment in general wards by general surgeons ; secondly, those who would treat these cases in a special department under general surgeons ; and thirdly, those who advocate a department controlled by specialists. The first school claims that specialisation has already gone too far ; that it is to the great general surgeons of the past that we owe most of our knowledge of fractures; and that, from the point of view of the student, the removal of these cases to a separate department would withdraw them entirely from his range of educational subjects-for no one would be found to suggest that intensive attention to fractures should form another special subject in the ordinary curriculum. The second school would seem to find a happy mean and to be in a very strong position, were it not that the third maintains that the general surgeons would never go near the fracture department, and that in any case the average general surgeon, despite his position on the hospital staff, often knows little specially about fractures or their treatment. And there is occasionally just enough truth in this final argument to give very serious point to their contention. The matter might be left to academic discussion, we can see directions in which entertaining would ensue, were it not that it is in reality one of the most serious problems of practical surgery at;the present day. With the increase of machinery and of mechanical transport and the general speeding up of life the number of fractures has enormously increased. Their occurrence forms a serious item in DE
the industrial problems of to-day, and, quite apart from individual considerations, their mismanagement may be a source of serious loss to the community. The vast majority of these cases will of necessity come to be treated neither by fracture specialists nor by general surgeons at hospitals, but by general practitioners who have so wide a range of professional and scientific duties that they can only pursue routine of the proper standard. The careful segregation of a few of these cases of fracture into special departments at the great teaching hospitals would certainly
a
in the ocean of real need-namely, that ourstudents in the mass should receive better instruction in the treatment of fractures. It is undeniablv the case that the student cannot be well taught on cases which are badly treated, while at the present time the treatment of fractures in general surgical wards is often left entirely to the house surgeon,. who cannot possibly have the knowledge required to do the best for the case, and whose unfailing’ enthusiasm will not supply the experience wanted. The present system, indeed, when closely examined, has practically nothing to commend it, for it is often unfair alike to the patient and to the student, whilst it is not unusual for a hospital surgeon, whose interest is attracted to other branches of surgery, to regard the fractures in his beds as mere encumbrances of the ground at his therapeutic disposal. A far better arrangement, and one likely to meet the reasonable requirements of all concerned, would be the setting aside of special wards for the treatment, of fractures, to which the patients would be admitted under the charge of the various surgeons on the staff, but ensuring that these wards should be under the charge of a senior medical officer of the standing of a registrar, with an aptitude for the special work. The house surgeons of the different members of the staffs would look after the cases of their respective chiefs as they do at present, but their work would be carried on under the eye of this senior medical officer, to whose advice they would be expected to defer. The members of the staff really interested in the treatment of fractures would have the inestimable advantage of the assistance of an expert, whilst the student would be presented with an object-lesson in systematic treatment which he would be scarcely likely to forget. All the experience of the war in the treatment of fractures went to show how much better this was carried out when the cases were grouped together in one ward and under one control, and far from nursing being more difficult, under these conditions, it became easier from the systematic arrangements which could be made for its requirements. We think that these are the sound lines on which to employ and develop specialism in any important or more or less general branch of medicine, especially in those hospitals which are responsible for the training of our medical students. At the present time the student may be too much at the mercy of men of high scientific attainment, each of them convinced that his own is the only subject that matters. They may load him up with knowledge which would be worth its weight in gold if he could use it, but to him it is heavier than lead and just about as useful ; and thus his frail barque, blown from one department. to another, is finally wrecked by a brutal examiner who asks him practical questions. The fact that so many of our students succeed in arriving at port, and later in becoming really useful and practical men, says more for their power of endurance than for the wisdom of their educational training in many schools, though there are teachers in those schools whose devotion minimises the difficulties. It is the to to ’devote his specialist, undoubtedly willing energies to a limited field, that surgery owes some of its greatest advances, but it is from the teaching of the general clinician, the man who speaks from a wide experience spread over many branches of his art, that the student will learn the principles upon which he will ultimately rely. It is, we think, a matter for real regret that many surgeons have mere
drop
A MANUAL OF PHARMACOLOGY. Sixth edition. By WALTER E. DIXON, M.A., M.D., F.R.S., sometime Professor of Materia Medica and Pharmacology at King’s College, London. London : Edward Arnold and Co. 1925. Pp. 478. 18s. WE are glad to receive a new edition of this admirable manual. It has been completely revised in conformity with recent knowledge by Prof. E. Mellanby, Dr. O. Inchley, and Dr. A. J. Copeland, and additions are included covering all accepted knowledge on the subject of pharmacology. The information is imparted in a form useful alike to the student of pharmacy and of medicine. We have noted before the essentially practical nature of the work, which is at the same time an exposition of the relations between physiology and medicine. Looking back on the way in which pharmacology was taught as recently as 25 years ago, we can see how the large and varied researches in physics and chemistry which have taken place in the interval have enabled teaching to assume the logical character which Prof. Dixon and his collaborators give to it. The reader, for example, of Chapter XVII. in this book, which deals with the drugs acting locally on the alimentary canal, will obtain arguments for therapeutic procedures which he may have to undertake daily in the course of practice. He will know both what to do and why he should do it, and throughout the volume consultation will put him in the same position along other lines. The manual is in the first rank of books available on its subject.
,
In other directions words with a technical meaningare used without adequate explanation, a defect if the work is intended for the uninitiated. In scope the work is comprehensive and includes. short accounts of the nature of the main types of manufactured and preserved foods. The causes of food spoilage are discussed, including those from insects and larger animals, micro-organisms, enzyme action, The food and physical and chemical conditions. preservation methods include simple storage, application of cold, dehydration, chemical preservation,
preservation by fermentation, hermetically sealing,. heat sterilisation, In the and pasteurisation. description of these processes the author follows customary lines, but here and there unusual pieces of information are quoted. For instance, it
mentioned that the United States Bureau of war recommended the canning of dog-fish and other members of the shark family under the name of " grey-fish." When acted upon by many canners’it was discovered that the flesh of sharks contained urea which decomposed in time to ammonia, spoiling the flavour of the product and swelling the container. This caused great loss to canners and illustrates well the importance of scientific knowledge in relation to food preservation. is
Fisheries during the
New Inventions. A NEW GASTRECTOMY CLAMP. SURGEONS who have had practical experience of th& modification of the Billroth I. gastrectomy operation introduced by Schoemaker of The Haguel will have found considerable difficulty in applying Schoemaker’& crushing clamp to the stomach in certain cases. That instrument has to be passed across the stomach from the greater curvature, and where the ulcer is. high on the lesser curvature, or the stomach not very mobile, it is sometimes impossible to apply the clamp sufficiently above the lesion. The clamp here illustrated is designed to extend the range of this
ingenious and physiologically admirable operation. It is applied from the upper border or lesser curvature of the stomach, with the inner and outer halves clamped together by the central milled screw and by The an interlocking device at the tip of the blades. SCIENTIFIC PRESERVATION OF FOOD. two upper blades are set on a rocking joint so as to secure even crushing of the stomach, and the up By THOMAS M. RECTOR, Consulting Chemist. and lower blades are so ground as to fit into( h London : Chapman and Hall, Ltd. 1925. Pp. 213. other without risk of side-slipping or shearing -ne 10s. stomach wall. The crushing is effected by tightening IT is not very evident for whom this book isintended. the wing nuts on the ends of the handles. When the It gives a clear, but rather gossipy, account, freed distal portion of the stomach has been cut awa" from technicalities, of the different methods for the as in the Schoemaker operation, the exactly preservation of foods. Indeed, technicalities are so blade is removed by simply releasing its wing eliminated that the book will make but little appeal and the central milled screw. I have found to the chemist, bacteriologist, or medical expert this instrument simplifies the Schoemaker operation interested in the scientific data underlying the considerably. problems of food spoilage and their prevention.
But to the medical man who wishes to obtain a broad general idea of the methods employed in food preservation, this book may make appeal, and it will be found of considerable interest to laymen. It is, however, a serious defect in a book issued in 1925 that the important subject of vitamins and the extent to which they are destroyed or damaged by food preservation methods is entirely ignored.
Vitamins, indeed,
are
only incidentally mentioned.
I am indebted to Dr. K. B. Pinson, anaesthetist to the Manchester Royal Infirmary, for designing it, and it has been made for me by the General Radio-
logical Great
and Surgical Apparatus Co., Ltd., 204-6, Portland-street, London, W. 1. JOHN MORLEY, Ch.M. Manch., F.R.C.S. Eng.
1 Surgery, Gynecology, and Obstetrics, December, 1921, pp. 591-596.
555 raise in
a
proportional
number of centres the level of
routine, but such sporadic instruction would be
THE
LANCET.
LONDON: SATURDAY, SEPTEMBER 12, 1925.
THE TREATMENT OF FRACTURES. THE important series of lectures by Sir WILLIAM COURCY WHEELER which has been appearing in our recent issues and terminates to-day, and the discussion on the subject at the meeting of the British Medical Association at Bath, have combined to awaken a widespread interest in the treatment of fractures, and especially in that treatment as carried out in our great hospitals and as taught to our students. That this treatment might be greatly improved no surgeon will deny, but as to how it should be improved opinions differ, and, broadly speaking, there are three schools of thought. First, there are those who would retain the present system of treatment in general wards by general surgeons ; secondly, those who would treat these cases in a special department under general surgeons ; and thirdly, those who advocate a department controlled by specialists. The first school claims that specialisation has already gone too far ; that it is to the great general surgeons of the past that we owe most of our knowledge of fractures; and that, from the point of view of the student, the removal of these cases to a separate department would withdraw them entirely from his range of educational subjects-for no one would be found to suggest that intensive attention to fractures should form another special subject in the ordinary curriculum. The second school would seem to find a happy mean and to be in a very strong position, were it not that the third maintains that the general surgeons would never go near the fracture department, and that in any case the average general surgeon, despite his position on the hospital staff, often knows little specially about fractures or their treatment. And there is occasionally just enough truth in this final argument to give very serious point to their contention. The matter might be left to academic discussion, we can see directions in which entertaining would ensue, were it not that it is in reality one of the most serious problems of practical surgery at;the present day. With the increase of machinery and of mechanical transport and the general speeding up of life the number of fractures has enormously increased. Their occurrence forms a serious item in DE
the industrial problems of to-day, and, quite apart from individual considerations, their mismanagement may be a source of serious loss to the community. The vast majority of these cases will of necessity come to be treated neither by fracture specialists nor by general surgeons at hospitals, but by general practitioners who have so wide a range of professional and scientific duties that they can only pursue routine of the proper standard. The careful segregation of a few of these cases of fracture into special departments at the great teaching hospitals would certainly
a
in the ocean of real need-namely, that ourstudents in the mass should receive better instruction in the treatment of fractures. It is undeniablv the case that the student cannot be well taught on cases which are badly treated, while at the present time the treatment of fractures in general surgical wards is often left entirely to the house surgeon,. who cannot possibly have the knowledge required to do the best for the case, and whose unfailing’ enthusiasm will not supply the experience wanted. The present system, indeed, when closely examined, has practically nothing to commend it, for it is often unfair alike to the patient and to the student, whilst it is not unusual for a hospital surgeon, whose interest is attracted to other branches of surgery, to regard the fractures in his beds as mere encumbrances of the ground at his therapeutic disposal. A far better arrangement, and one likely to meet the reasonable requirements of all concerned, would be the setting aside of special wards for the treatment, of fractures, to which the patients would be admitted under the charge of the various surgeons on the staff, but ensuring that these wards should be under the charge of a senior medical officer of the standing of a registrar, with an aptitude for the special work. The house surgeons of the different members of the staffs would look after the cases of their respective chiefs as they do at present, but their work would be carried on under the eye of this senior medical officer, to whose advice they would be expected to defer. The members of the staff really interested in the treatment of fractures would have the inestimable advantage of the assistance of an expert, whilst the student would be presented with an object-lesson in systematic treatment which he would be scarcely likely to forget. All the experience of the war in the treatment of fractures went to show how much better this was carried out when the cases were grouped together in one ward and under one control, and far from nursing being more difficult, under these conditions, it became easier from the systematic arrangements which could be made for its requirements. We think that these are the sound lines on which to employ and develop specialism in any important or more or less general branch of medicine, especially in those hospitals which are responsible for the training of our medical students. At the present time the student may be too much at the mercy of men of high scientific attainment, each of them convinced that his own is the only subject that matters. They may load him up with knowledge which would be worth its weight in gold if he could use it, but to him it is heavier than lead and just about as useful ; and thus his frail barque, blown from one department. to another, is finally wrecked by a brutal examiner who asks him practical questions. The fact that so many of our students succeed in arriving at port, and later in becoming really useful and practical men, says more for their power of endurance than for the wisdom of their educational training in many schools, though there are teachers in those schools whose devotion minimises the difficulties. It is the to to ’devote his specialist, undoubtedly willing energies to a limited field, that surgery owes some of its greatest advances, but it is from the teaching of the general clinician, the man who speaks from a wide experience spread over many branches of his art, that the student will learn the principles upon which he will ultimately rely. It is, we think, a matter for real regret that many surgeons have mere
drop