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AN IDEAL OPERATING TABLE LAMP,
1377 in 1901, and by Kirkpatrick in Madras in The affection is known to Western ophthalmobut not in an epidemic form.
great accomplishments for those who have the receptive attention, instruction, and fine thought. The contents of Mr. Hussey’s book consist
Bombay 1920.
logists
necessary
of excellent representations of Mackenzie’s best known work, with a running commentary of appreciation which though enthusiastic appears always to be justified. While the large imaginative groups will command most of our admiration-and rightly so-medical men will be interested in the portrait medallions, for they include representations of, among others, William Osler, Crawford Long, Wilfred Grenfell, Chevalier Jackson, Robert Jones, Weir Mitchell, W. W. Keen, and Charles Brockden Brown. Brockden Brown’s chief claim to public interest is that he is always cited as the first American novelist, with the funny suggestion that he imitated William Godwin, but medically speaking he is remarkable in that he wrote in " Arthur Mervyn " a wonderful description of an epidemic of plague from personal observation of the horrors that fell upon Philadelphia at the end of the eighteenth century.
largely
AN IDEAL OPERATING TABLE LAMP, WHAT the surgeon needs when he is operating is an illumination of the field, concentrated and yet practically shadowless, along with a high vertical component of intensity, ensuring penetration into deep cavities. The intense light must be confined to the wound area, but at the same time the room must be sufficiently illuminated to prevent difficulties from mal-adaptation of the eye. The high intensity should be produced without striations or glare, and the’source of light should be as unobtrusive as possible. At a meeting of the Illuminating Engineering Society, held at the Home Office Industrial Museum on Dec. 10th, Mr. Ernest Stroud described a special unit designed to fulfil all these conditions. It consists of a number of prismatic plates formed into a panel or false ceiling of relatively large area. The construction of the plates is such as to refract the light rays which reach them into a converging beam of high intensity. Each plate is 12 in. square, and made up of quarter-concentric prisms, and four plates are grouped into one large lens 24 in. square of 12 in. focus length. The complete unit contains 15, 18, or 21 of these 4-plate groups, its dimensions being 6 ft.widebylO, 12,or 14 ft. long. Over each group of plates is fitted a lamp and reflector in such relation to each other that the maximum beam strikes the centre of the operating area ; thus with a 15-group system the combined 15 concentrating beams coming from different directions build up and focus their rays over the predetermined area. The method differs from a reflector system in the largeness of the area whence the light comes, which secures adequate diffusion, avoids harmful shadows, and absolutely avoids glare. The overflow from the lens system gives sufficient general illumination to avoid contrast glare, and the optical characteristics of the lens are such as to allow for the varying thicknesses of bodies and heights of tables. With a 15-lens system employing 15 lamps of 150 watts each, or 2250 watts in all, the maximum horizontal illumination is 1050 ft. candles, on a plane 45° from the vertical it is 725 ft. candles, and on a vertical plane facing the centre of the table 175 ft. candles ; these high intensities being developed without any semblance of The smooth sides of the glass plates are glare. towards the source of light, and since the complete unit can be totally enclosed so as to form the ceiling of the operating theatre there need be no collection of dust and no obstruction projecting into the operation theatre. ’
____
The Clinical Interpretation of
Aids A Series
to
Diagnosis.
of Special Articles contributed by Invitation.
LVIII. INTERPRETATION OF RADIOGRAMS OF THE ALIMENTARY TRACT, PART V.*-LARGE INTESTINES. THE food arrives in the caecum in about four hours and should be somewhere near the splenic flexure in nine hours, but the times at which it arrives at different parts are so extremely variable that even approximate figures are far too definite. The normal colon as seen after feeding with barium is shown on Fig. 23. A typical picture of a normal colon distended by an enema is shown in Fig. 24. Individuals vary to an amazing degree, and even yet the movements of the large intestine are not clearly understood. There is no peristalsis in the ordinary sense and the shadow of the food in the colon remains inert hour after hour. Wingate Tod, using serial films over a long period (a very risky procedure for the subject), thinks that he detects a very slow rhythmic peristaltic movement which we certainly do not detect on screen examination. Whether it is or is not present, however, the main factor in the movement of food through the large bowel is one that is unique and is not comparable to any other in the body. It is difficult to obtain observations, for the movement occurs only occasionally, at no fixed time, and without the slightest sub-
A SCULPTOR OF YOUTH.1 the shadow, A BEAUTIFUL book has recently appeared describing and that, quite suddenly, the whole column disappear the work in marble and bronze of that accomplished makes a forward rush, usually from the region of the sculptor, Tait Mackenzie, a professor in the medical hepatic flexure, the column passing quite rapidly on, The school of the University of Pennsylvania. as far as the sigmoid or even to the rectum. importance of Tait Mackenzie’s sculpture lies in the perhaps Sometimes there is a partial rebound, but within a fact, as Mr. Christopher Hussey says in a critical minute or so the haustral segmentation has again resume of Mackenzie’s work, that we have here the appeared and it is once more a picture of still life. Movefirst considerable attempt since the marvellous ments such as this-mass movements as are called accomplishments of Athens to take for the sculptor’s - occurs perhaps three times a day, but wethey do not know, main subject the athletic ideal. For many years for we only detect that they have occurred by the before his present appointment Mackenzie was altered disposition of the shadows. The completely director of physical education at McGill University, first mass movements that were seen were estimated and in 1894, when he first occupied that chair, he to have occurred in three seconds, but later observahad made few or no attempts in sculpture, though tions a quarter of a minute as a more usual undoubtedly it was then that he was receiving the time. suggest therefore, the rate of progress Naturally, formative influences which enable him to-day to the large bowel cannot be gauged accurately. through express his ideals of motion and rhythm in the The limits of the normal, which are wide enough in human body. When, as now, athletics occupy so the further stomach, become wider and wider as we prominent a place in educational life it is certain down the alimentary tract until in the largegointestine that the Greeks have once again shown the way to 1 Parts I., II., III., and IV., respectively on the Œsophagus, 1 Tait Mackenzie, a Sculptor of Youth. By Christopher the Stomach, the Duodenum, and the Small Intestine with the 1930. London: Country Life, Ltd. Pp. 107. Appendix, appeared in THE LANCET of Nov. 30th, Dec. 7th, 14th, Hussey. and 21st. With 14 figures and 91 plates. 25s.
shadows,
divisions in the intestinal.
great accomplishments for those who have the receptive attention, instruction, and fine thought. The contents of Mr. Hussey’s book consist
Bombay 1920.
logists
necessary
of excellent representations of Mackenzie’s best known work, with a running commentary of appreciation which though enthusiastic appears always to be justified. While the large imaginative groups will command most of our admiration-and rightly so-medical men will be interested in the portrait medallions, for they include representations of, among others, William Osler, Crawford Long, Wilfred Grenfell, Chevalier Jackson, Robert Jones, Weir Mitchell, W. W. Keen, and Charles Brockden Brown. Brockden Brown’s chief claim to public interest is that he is always cited as the first American novelist, with the funny suggestion that he imitated William Godwin, but medically speaking he is remarkable in that he wrote in " Arthur Mervyn " a wonderful description of an epidemic of plague from personal observation of the horrors that fell upon Philadelphia at the end of the eighteenth century.
largely
AN IDEAL OPERATING TABLE LAMP, WHAT the surgeon needs when he is operating is an illumination of the field, concentrated and yet practically shadowless, along with a high vertical component of intensity, ensuring penetration into deep cavities. The intense light must be confined to the wound area, but at the same time the room must be sufficiently illuminated to prevent difficulties from mal-adaptation of the eye. The high intensity should be produced without striations or glare, and the’source of light should be as unobtrusive as possible. At a meeting of the Illuminating Engineering Society, held at the Home Office Industrial Museum on Dec. 10th, Mr. Ernest Stroud described a special unit designed to fulfil all these conditions. It consists of a number of prismatic plates formed into a panel or false ceiling of relatively large area. The construction of the plates is such as to refract the light rays which reach them into a converging beam of high intensity. Each plate is 12 in. square, and made up of quarter-concentric prisms, and four plates are grouped into one large lens 24 in. square of 12 in. focus length. The complete unit contains 15, 18, or 21 of these 4-plate groups, its dimensions being 6 ft.widebylO, 12,or 14 ft. long. Over each group of plates is fitted a lamp and reflector in such relation to each other that the maximum beam strikes the centre of the operating area ; thus with a 15-group system the combined 15 concentrating beams coming from different directions build up and focus their rays over the predetermined area. The method differs from a reflector system in the largeness of the area whence the light comes, which secures adequate diffusion, avoids harmful shadows, and absolutely avoids glare. The overflow from the lens system gives sufficient general illumination to avoid contrast glare, and the optical characteristics of the lens are such as to allow for the varying thicknesses of bodies and heights of tables. With a 15-lens system employing 15 lamps of 150 watts each, or 2250 watts in all, the maximum horizontal illumination is 1050 ft. candles, on a plane 45° from the vertical it is 725 ft. candles, and on a vertical plane facing the centre of the table 175 ft. candles ; these high intensities being developed without any semblance of The smooth sides of the glass plates are glare. towards the source of light, and since the complete unit can be totally enclosed so as to form the ceiling of the operating theatre there need be no collection of dust and no obstruction projecting into the operation theatre. ’
____
The Clinical Interpretation of
Aids A Series
to
Diagnosis.
of Special Articles contributed by Invitation.
LVIII. INTERPRETATION OF RADIOGRAMS OF THE ALIMENTARY TRACT, PART V.*-LARGE INTESTINES. THE food arrives in the caecum in about four hours and should be somewhere near the splenic flexure in nine hours, but the times at which it arrives at different parts are so extremely variable that even approximate figures are far too definite. The normal colon as seen after feeding with barium is shown on Fig. 23. A typical picture of a normal colon distended by an enema is shown in Fig. 24. Individuals vary to an amazing degree, and even yet the movements of the large intestine are not clearly understood. There is no peristalsis in the ordinary sense and the shadow of the food in the colon remains inert hour after hour. Wingate Tod, using serial films over a long period (a very risky procedure for the subject), thinks that he detects a very slow rhythmic peristaltic movement which we certainly do not detect on screen examination. Whether it is or is not present, however, the main factor in the movement of food through the large bowel is one that is unique and is not comparable to any other in the body. It is difficult to obtain observations, for the movement occurs only occasionally, at no fixed time, and without the slightest sub-
A SCULPTOR OF YOUTH.1 the shadow, A BEAUTIFUL book has recently appeared describing and that, quite suddenly, the whole column disappear the work in marble and bronze of that accomplished makes a forward rush, usually from the region of the sculptor, Tait Mackenzie, a professor in the medical hepatic flexure, the column passing quite rapidly on, The school of the University of Pennsylvania. as far as the sigmoid or even to the rectum. importance of Tait Mackenzie’s sculpture lies in the perhaps Sometimes there is a partial rebound, but within a fact, as Mr. Christopher Hussey says in a critical minute or so the haustral segmentation has again resume of Mackenzie’s work, that we have here the appeared and it is once more a picture of still life. Movefirst considerable attempt since the marvellous ments such as this-mass movements as are called accomplishments of Athens to take for the sculptor’s - occurs perhaps three times a day, but wethey do not know, main subject the athletic ideal. For many years for we only detect that they have occurred by the before his present appointment Mackenzie was altered disposition of the shadows. The completely director of physical education at McGill University, first mass movements that were seen were estimated and in 1894, when he first occupied that chair, he to have occurred in three seconds, but later observahad made few or no attempts in sculpture, though tions a quarter of a minute as a more usual undoubtedly it was then that he was receiving the time. suggest therefore, the rate of progress Naturally, formative influences which enable him to-day to the large bowel cannot be gauged accurately. through express his ideals of motion and rhythm in the The limits of the normal, which are wide enough in human body. When, as now, athletics occupy so the further stomach, become wider and wider as we prominent a place in educational life it is certain down the alimentary tract until in the largegointestine that the Greeks have once again shown the way to 1 Parts I., II., III., and IV., respectively on the Œsophagus, 1 Tait Mackenzie, a Sculptor of Youth. By Christopher the Stomach, the Duodenum, and the Small Intestine with the 1930. London: Country Life, Ltd. Pp. 107. Appendix, appeared in THE LANCET of Nov. 30th, Dec. 7th, 14th, Hussey. and 21st. With 14 figures and 91 plates. 25s.
shadows,
divisions in the intestinal.