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A STANDARD OBSTETRIC FORCEPS
631
A STANDARD OBSTETRIC FORCEPS FORCEPS may vary in the important diameters which grip the foetal head.1 The variation is often seen between different patterns of forceps, but it may sometimes be seen in supposedly identical forceps. The reasons are that: (a) different manufacturers have different standard patterns; (b) modifiers of pre-existing forceps have often not laid down appropriate dimensions; (c) foetal-head sizes may have increased in the past 200 years; (d) most forceps are still handmade; and (e) modern writers of textbooks do not agree on desirable dimensions of
forceps. After measuring foetal heads, and using Macdonald’s figures2 for foetal-head size, theoretical dimensions for forceps for present-day practice were suggested. These, which were not regarded as final, were: Distance apart of tips.......... Widest distance apart of blades........ Length of blade............ Radius of cephalic curve.......... Radius of pelvic curve.......... Length of shanks ............ Width apart of shanks..........
3-0 9-0 16-0 11-25 17-5 6-25
2-5
cm. cm. cm. cm.
cm. cm. cm.
The length of the blade was measured in a.straight line from the tip to the beginning of the shank. There is no difference of note between the construction of these forceps and the general patterns in use, such as Simpson’s, Ferguson’s, Murray’s, and Neville’s (Kielland’s forceps are standardised). But it was also decided to remove the extraneous clutter of the past two centuries and so simplify the forceps (see figure). In particular, the curve in the shanks
Reviews of Books Anatomy and Surgical Approaches Orthopaedic Surgery
An Atlas of
in
Vol. I: Upper Extremity. RUDOLFO CONSENTINO, M.D., assistant professor in orthopaedic surgery, University of La Plata, Argentina. Springfield, Ill.: Charles C. Thomas. Oxford: Blackwell Scientific Publications. 1960. Pp. 192. 84s.
IT is said that Abraham Colles, as a young boy, was playing in some deserted outhouses, when he came upon a discarded anatomical textbook. Its contents and vivid illustrations so fascinated him that thenceforth he could contemplate no other career than that of surgeon. What would he have made of Dr. Consentino’s work ? Here are none of the bold line drawings and multicoloured reticulations of most atlases. The author has depicted human anatomy by photographing a series of dissections-not, of course, a new idea, but the limitations of even an expert photographer and a patient dissector are such that it has very seldom been a practicable one. Many atlases include a few photographs, but this one contains almost 150 pictures of the upper limb, including 20 illustrating the structure of the hand. Everyone who looks at this book and who has wielded a camera or a
scalpel will. want
to
congratulate- Dr. Consentino
his results. The text might, in places, be more happily phrased, and the black-and-white format lacks the appeal to move another youthful Colles; but place before an orthopaedic surgeon, refreshing his memory about some structures he is to expose on the morrow, this book and the conventional polychrome and often rather fanciful atlas, and there is no doubt which he will choose. on
Atrial
Septal
Defect
An Investigation into the Natural History of a Congenital Heart Disease. H. GosTA DAVIDSEN, Rigshopitalet, Copenhagen. Copenhagen: Munksgaard. 1960. Pp. 225. D.Kr. 50.
of the Barnes-Neville
forceps, and indentations in heavy
Axis-traction devices have been discarded because the high forceps operation should not now be performed; this automatically does away with screws to hold the forceps together, and fishtail handles. A similar simplified forceps, devised by De Lee, is figured in Greenhill’s textbook.3 Allen & Hanbury’s Ltd. (7’ and 8, Vere Street, London, W.1) have made a pair of forceps to the above dimensions. In use it was found that, because the widest diameter between the blades is slightly larger than that in most extant forceps, the tips of the blades bit into the baby’s cheek and on one occasion caused a hxmatoma. The distance between the tip was therefore widened to 3-5 cm., and since that time they have caused no trouble in 18 months’ continuous use at the Lambeth
handles,
are no
longer
necessary.
-
Hospital. The object of this communication is to draw attention to the variation in measurements of present-day obstetric forceps, and to lay down what seem to be reasonable standards for those who would like themPHILIP RHODES Lambeth Hospital, M.A., M.B. Cantab., F.R.C.S., M.R.C.O.G. London, S.E.11 1. Rhodes, P. J. Obstet. Gynœc. Brit. Emp. 1958, 65, 353. 2. Macdonald, I. ibid. 1953, 60, 61. 3. Greenhill, J. P. Obstetrics. Philadelphia, 1955.
IN this book Dr. Davidsen analyses postmortem reports of 190 cases of atrial septal defect which he has collected from the literature and describes 132 cases which he himself has studied clinically. His aim is to determine the natural morbidity and mortality of this condition as a yardstick for the assessment of surgical treatment. Though he presents a great deal of information about the postmortem and the clinical series, he is largely frustrated in his intention, as he admits, by the diversity of the defect and its complicating anomalies, and by the impossibility, now that surgery is established, of finding an adequate series of untreated patients. He has broken down his own series of 132 cases according to the anatomy of the defect, the presence of pulmonary hypertension, and the coexistence of other cardiovascular anomalies. Even in this large initial series, many of these special groups are too small to yield significant results. The value of the analysis of the 190 necropsy cases is also doubtful. Dr. Davidsen admits that they are probably not typical of the condition as a whole, as is apparent from the high prevalence of associated anomalies-particularly lesions of the mitral and tricuspid valves. Probably many were reported because they were unusual, and are not typical of the general run of cases. Though he has not achieved his main object, his extensive and thorough survey, and his selective and critical review of significant cases, will interest cardiologists. The figures are excellent, and the book can be recommended as a reference work. ’
The Divided Self An existential study in sanity and madness. R. D. LAING, M.B., D.P.M., assistant physician, Tavistock Clinic, London. London: Tavistock Publications. 1960. Pp. 240. 25s.
THE first of
a
series of studies in existential
psychology
and
psychiatry, this b ok is concerned with schizoid and schizoits aim is to make madness and the process phrenic persons, of going mad comprehensible. Looking at the schizophrenic
imd
A STANDARD OBSTETRIC FORCEPS FORCEPS may vary in the important diameters which grip the foetal head.1 The variation is often seen between different patterns of forceps, but it may sometimes be seen in supposedly identical forceps. The reasons are that: (a) different manufacturers have different standard patterns; (b) modifiers of pre-existing forceps have often not laid down appropriate dimensions; (c) foetal-head sizes may have increased in the past 200 years; (d) most forceps are still handmade; and (e) modern writers of textbooks do not agree on desirable dimensions of
forceps. After measuring foetal heads, and using Macdonald’s figures2 for foetal-head size, theoretical dimensions for forceps for present-day practice were suggested. These, which were not regarded as final, were: Distance apart of tips.......... Widest distance apart of blades........ Length of blade............ Radius of cephalic curve.......... Radius of pelvic curve.......... Length of shanks ............ Width apart of shanks..........
3-0 9-0 16-0 11-25 17-5 6-25
2-5
cm. cm. cm. cm.
cm. cm. cm.
The length of the blade was measured in a.straight line from the tip to the beginning of the shank. There is no difference of note between the construction of these forceps and the general patterns in use, such as Simpson’s, Ferguson’s, Murray’s, and Neville’s (Kielland’s forceps are standardised). But it was also decided to remove the extraneous clutter of the past two centuries and so simplify the forceps (see figure). In particular, the curve in the shanks
Reviews of Books Anatomy and Surgical Approaches Orthopaedic Surgery
An Atlas of
in
Vol. I: Upper Extremity. RUDOLFO CONSENTINO, M.D., assistant professor in orthopaedic surgery, University of La Plata, Argentina. Springfield, Ill.: Charles C. Thomas. Oxford: Blackwell Scientific Publications. 1960. Pp. 192. 84s.
IT is said that Abraham Colles, as a young boy, was playing in some deserted outhouses, when he came upon a discarded anatomical textbook. Its contents and vivid illustrations so fascinated him that thenceforth he could contemplate no other career than that of surgeon. What would he have made of Dr. Consentino’s work ? Here are none of the bold line drawings and multicoloured reticulations of most atlases. The author has depicted human anatomy by photographing a series of dissections-not, of course, a new idea, but the limitations of even an expert photographer and a patient dissector are such that it has very seldom been a practicable one. Many atlases include a few photographs, but this one contains almost 150 pictures of the upper limb, including 20 illustrating the structure of the hand. Everyone who looks at this book and who has wielded a camera or a
scalpel will. want
to
congratulate- Dr. Consentino
his results. The text might, in places, be more happily phrased, and the black-and-white format lacks the appeal to move another youthful Colles; but place before an orthopaedic surgeon, refreshing his memory about some structures he is to expose on the morrow, this book and the conventional polychrome and often rather fanciful atlas, and there is no doubt which he will choose. on
Atrial
Septal
Defect
An Investigation into the Natural History of a Congenital Heart Disease. H. GosTA DAVIDSEN, Rigshopitalet, Copenhagen. Copenhagen: Munksgaard. 1960. Pp. 225. D.Kr. 50.
of the Barnes-Neville
forceps, and indentations in heavy
Axis-traction devices have been discarded because the high forceps operation should not now be performed; this automatically does away with screws to hold the forceps together, and fishtail handles. A similar simplified forceps, devised by De Lee, is figured in Greenhill’s textbook.3 Allen & Hanbury’s Ltd. (7’ and 8, Vere Street, London, W.1) have made a pair of forceps to the above dimensions. In use it was found that, because the widest diameter between the blades is slightly larger than that in most extant forceps, the tips of the blades bit into the baby’s cheek and on one occasion caused a hxmatoma. The distance between the tip was therefore widened to 3-5 cm., and since that time they have caused no trouble in 18 months’ continuous use at the Lambeth
handles,
are no
longer
necessary.
-
Hospital. The object of this communication is to draw attention to the variation in measurements of present-day obstetric forceps, and to lay down what seem to be reasonable standards for those who would like themPHILIP RHODES Lambeth Hospital, M.A., M.B. Cantab., F.R.C.S., M.R.C.O.G. London, S.E.11 1. Rhodes, P. J. Obstet. Gynœc. Brit. Emp. 1958, 65, 353. 2. Macdonald, I. ibid. 1953, 60, 61. 3. Greenhill, J. P. Obstetrics. Philadelphia, 1955.
IN this book Dr. Davidsen analyses postmortem reports of 190 cases of atrial septal defect which he has collected from the literature and describes 132 cases which he himself has studied clinically. His aim is to determine the natural morbidity and mortality of this condition as a yardstick for the assessment of surgical treatment. Though he presents a great deal of information about the postmortem and the clinical series, he is largely frustrated in his intention, as he admits, by the diversity of the defect and its complicating anomalies, and by the impossibility, now that surgery is established, of finding an adequate series of untreated patients. He has broken down his own series of 132 cases according to the anatomy of the defect, the presence of pulmonary hypertension, and the coexistence of other cardiovascular anomalies. Even in this large initial series, many of these special groups are too small to yield significant results. The value of the analysis of the 190 necropsy cases is also doubtful. Dr. Davidsen admits that they are probably not typical of the condition as a whole, as is apparent from the high prevalence of associated anomalies-particularly lesions of the mitral and tricuspid valves. Probably many were reported because they were unusual, and are not typical of the general run of cases. Though he has not achieved his main object, his extensive and thorough survey, and his selective and critical review of significant cases, will interest cardiologists. The figures are excellent, and the book can be recommended as a reference work. ’
The Divided Self An existential study in sanity and madness. R. D. LAING, M.B., D.P.M., assistant physician, Tavistock Clinic, London. London: Tavistock Publications. 1960. Pp. 240. 25s.
THE first of
a
series of studies in existential
psychology
and
psychiatry, this b ok is concerned with schizoid and schizoits aim is to make madness and the process phrenic persons, of going mad comprehensible. Looking at the schizophrenic
imd