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A NEW TONSIL GUILLOTINE
214
trophic disease.-Renal-adrenal Adherence, by T. 13. Davie (Liverpool). The author has met six cases in 1500 autopsies, and points out that the condition may be of serious import in nephrectomy.-Collective Inquiry, by the Fellows of the Association ofSurgeons into Gastrojejunal Ulceration, by Garnett Wright (Manchester). A complete statistical and clinical survey of 176 cases following 2051 operations for duodenal ulceration and of 62 cases following 1382 gastric operations. The incidence, pathology, symptoms, radiological findings and treatment are reviewed.Chronic Interstitial Mastitis, by Frank d’Abreu (Birmingham). Cyst-formation is regarded as a further stage of mazoplasia, and both are said to depend on defective endocrine activity. A stage is recognised which is possibly premalignant.-Interstitial Radium Treatment of Carcinoma of the Breast: Description of a Radical Technique, by R. G. Hutchinson (Manchester). It is claimed that this technique approaches more nearly than any other to the radical operation, and that thereis an optimum dose of radium that will produce complete resolution of the primary and secondary growth. The results in 23 cases are recorded.-Diaphragmatic Hernia, by Sir Thomas Dunhill (London). Clinical records of the various types of diaphragmatic hernia, correlated with a short introduction on the development and anatomy of the diaphragm (Arris and Gale lecture).-Congenital Hernia through the Right Dome of the Diaphragm, by Frank Forty (Birmingham). The clinical history, operative findings, and post-mortem appearances in a case.-Hernia through a Mesenteric Hiatus, by E. S. J. King (Melbourne). On the basis of two cases observed at operation, an inflammatory origin is suggested for mesenteric
defects.—Dyschondroplasia, (Ollier’s Disease), with Report of a Case, by Donald Hunter and Philip
careful discussion of account of radiological appearances, course, and treatment.—Colostomy, by W. 13. Gabriel and O. V.Lloyd-Davies (London). A statistical and clinical account of 500 cases of palliative colostomy in carcinoma of the rectum.-Adenoma,ta of the Pituitary, with special reference to Pituitary Basophilia of Cushing, by William Susman (Manchester). It is concluded that adenomata are comparatively common, and are of no special significance. Also that the basophilic cells do not produce a sex hormone, and that their hypersecretion does not give rise to a special syndrome.Perforation of Carcinoma of the Stomach into the General Peritoneal Cavity, by Ian Aird (Edinburgh). Two clinical types are described : in one the perforation symptoms are typical and acute ; in the other The silent." they are operative mortality approaches 60 per cent.-Bilateral Bipartite Patellae, by Ruggles George (Toronto). A case is recorded. The condition is said to follow non-fusion of multiple centres of ossification.-Osteitis Fibrosa : an Experimental Study, by Hermon Taylor (London). The effect and fate of injected phosphatase are recorded. Changes typical of osteitis fibrosa have been produced in rabbits by injection of parathormone, combined with a high calcium diet.—Etiology of Traumatic Shock, by Laurence O’Shaughnessy and David Slome (London). From experiments in cats the authors conclude that the factors of importance are local fluid loss, and the discharge of nociceptive impulses. The theory of a tnxapmic cause they Wiles (London). 1 ncludes differential diagnosis, and
an
"
reject
NEW INVENTIONS A NEW TONSIL GUILLOTINE
THE guillotine is still extensively used for the enucleation of tonsils in children. When this is done
3. The bevelled edge of the blade prevents the anterior pillar from being drawn into the slot of the head when the blade is driven home. It is a common experience (except when using the reversed guillotine) to find the anterior pillar damaged in spite of a correct application of the guillotine, particularly when
a prolonged general anaesthesia, the expert will succeed in removing the whole tonsil, conserving both anterior and posterior pillars, no matter what type of guillotine is used. Unfortunately tonsillectomies are still performed by the short-ansesthetic method, owing to circumstances beyond the surgeon’s control. He is then called upon to perform the acrobatic feat of enucleating both tonsils and adenoids in a fraction of a minute and to leave both anterior and posterior pillars intact and unblemished. It is then that the type of guillotine used plays an important part in the efficient removal of the tonsils. The guillotine illustrated here has been used by me for some considerable time, and it is claimed that it The features overcomes the difficulties mentioned. of the guillotine are :1. The fenestra is oval and is of sufficient length to permit the longitudinal diameter of the tonsil to dealing with flat or nonbe engaged without undue squeezing (any pressure pedunculated tonsils. required is produced by the transverse diameter of This is in my opinion due the ring, with or without adjustment of the blade). to the anterior pillar This fact makes it very difficult for the upper or lower being dragged towards or poles to escape from the ring the moment the blade into the slot of the head is pushed home, a not uncommon occurrence when where the actual damage often takes place. The small sized guillotines are used, particularly when bevelled blade peels the anterior pillar off the tonsil,
under
flat
tonsils. be regulated by the action of the screw B. This does away with the necessity of employing different blades. The appearance of the tonsil on simple inspection is deceiving and its actual size is often only appreciated after its dislocation from its bed ; it is obviously an advantage to be able to adjust the size of the fenestra with the guillotine actually in the patient’s mouth.
enucleating
or
non-pedunculated
2. The size of the fenestra A
can
the former, as it were, on itself. action of the guillotine is particularly smooth as all the joints are of the ball-and-socket type. It is easily taken to pieces for cleaning purposes. Messrs. Mayer and Phelps of New Cavendish-street, W.l, are the makers of this instrument.
folding
4. The
London, W.
ARTHUR MILLER, F.R.C.S.
trophic disease.-Renal-adrenal Adherence, by T. 13. Davie (Liverpool). The author has met six cases in 1500 autopsies, and points out that the condition may be of serious import in nephrectomy.-Collective Inquiry, by the Fellows of the Association ofSurgeons into Gastrojejunal Ulceration, by Garnett Wright (Manchester). A complete statistical and clinical survey of 176 cases following 2051 operations for duodenal ulceration and of 62 cases following 1382 gastric operations. The incidence, pathology, symptoms, radiological findings and treatment are reviewed.Chronic Interstitial Mastitis, by Frank d’Abreu (Birmingham). Cyst-formation is regarded as a further stage of mazoplasia, and both are said to depend on defective endocrine activity. A stage is recognised which is possibly premalignant.-Interstitial Radium Treatment of Carcinoma of the Breast: Description of a Radical Technique, by R. G. Hutchinson (Manchester). It is claimed that this technique approaches more nearly than any other to the radical operation, and that thereis an optimum dose of radium that will produce complete resolution of the primary and secondary growth. The results in 23 cases are recorded.-Diaphragmatic Hernia, by Sir Thomas Dunhill (London). Clinical records of the various types of diaphragmatic hernia, correlated with a short introduction on the development and anatomy of the diaphragm (Arris and Gale lecture).-Congenital Hernia through the Right Dome of the Diaphragm, by Frank Forty (Birmingham). The clinical history, operative findings, and post-mortem appearances in a case.-Hernia through a Mesenteric Hiatus, by E. S. J. King (Melbourne). On the basis of two cases observed at operation, an inflammatory origin is suggested for mesenteric
defects.—Dyschondroplasia, (Ollier’s Disease), with Report of a Case, by Donald Hunter and Philip
careful discussion of account of radiological appearances, course, and treatment.—Colostomy, by W. 13. Gabriel and O. V.Lloyd-Davies (London). A statistical and clinical account of 500 cases of palliative colostomy in carcinoma of the rectum.-Adenoma,ta of the Pituitary, with special reference to Pituitary Basophilia of Cushing, by William Susman (Manchester). It is concluded that adenomata are comparatively common, and are of no special significance. Also that the basophilic cells do not produce a sex hormone, and that their hypersecretion does not give rise to a special syndrome.Perforation of Carcinoma of the Stomach into the General Peritoneal Cavity, by Ian Aird (Edinburgh). Two clinical types are described : in one the perforation symptoms are typical and acute ; in the other The silent." they are operative mortality approaches 60 per cent.-Bilateral Bipartite Patellae, by Ruggles George (Toronto). A case is recorded. The condition is said to follow non-fusion of multiple centres of ossification.-Osteitis Fibrosa : an Experimental Study, by Hermon Taylor (London). The effect and fate of injected phosphatase are recorded. Changes typical of osteitis fibrosa have been produced in rabbits by injection of parathormone, combined with a high calcium diet.—Etiology of Traumatic Shock, by Laurence O’Shaughnessy and David Slome (London). From experiments in cats the authors conclude that the factors of importance are local fluid loss, and the discharge of nociceptive impulses. The theory of a tnxapmic cause they Wiles (London). 1 ncludes differential diagnosis, and
an
"
reject
NEW INVENTIONS A NEW TONSIL GUILLOTINE
THE guillotine is still extensively used for the enucleation of tonsils in children. When this is done
3. The bevelled edge of the blade prevents the anterior pillar from being drawn into the slot of the head when the blade is driven home. It is a common experience (except when using the reversed guillotine) to find the anterior pillar damaged in spite of a correct application of the guillotine, particularly when
a prolonged general anaesthesia, the expert will succeed in removing the whole tonsil, conserving both anterior and posterior pillars, no matter what type of guillotine is used. Unfortunately tonsillectomies are still performed by the short-ansesthetic method, owing to circumstances beyond the surgeon’s control. He is then called upon to perform the acrobatic feat of enucleating both tonsils and adenoids in a fraction of a minute and to leave both anterior and posterior pillars intact and unblemished. It is then that the type of guillotine used plays an important part in the efficient removal of the tonsils. The guillotine illustrated here has been used by me for some considerable time, and it is claimed that it The features overcomes the difficulties mentioned. of the guillotine are :1. The fenestra is oval and is of sufficient length to permit the longitudinal diameter of the tonsil to dealing with flat or nonbe engaged without undue squeezing (any pressure pedunculated tonsils. required is produced by the transverse diameter of This is in my opinion due the ring, with or without adjustment of the blade). to the anterior pillar This fact makes it very difficult for the upper or lower being dragged towards or poles to escape from the ring the moment the blade into the slot of the head is pushed home, a not uncommon occurrence when where the actual damage often takes place. The small sized guillotines are used, particularly when bevelled blade peels the anterior pillar off the tonsil,
under
flat
tonsils. be regulated by the action of the screw B. This does away with the necessity of employing different blades. The appearance of the tonsil on simple inspection is deceiving and its actual size is often only appreciated after its dislocation from its bed ; it is obviously an advantage to be able to adjust the size of the fenestra with the guillotine actually in the patient’s mouth.
enucleating
or
non-pedunculated
2. The size of the fenestra A
can
the former, as it were, on itself. action of the guillotine is particularly smooth as all the joints are of the ball-and-socket type. It is easily taken to pieces for cleaning purposes. Messrs. Mayer and Phelps of New Cavendish-street, W.l, are the makers of this instrument.
folding
4. The
London, W.
ARTHUR MILLER, F.R.C.S.