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AN IMPROVED OBSTETRIC BELT
1480
NEW INVENTIONS
sent and conditioned
by peripheral changes. There clinical objections to this assumpweighty tion. Delusional evaluation of parsesthesise conditioned by trophic or vascular or neuritic changes occurs commonly enough-for example, in delirium, in senile or arterio-sclerotic processes, and in other exogenous psychoses. But in such delusional elaborations there is never the uniformity, ceteris paribus, which is so striking in cocaine hallucinations. The significance of this factor is therefore limited. Cocainists scarcely ever complain that electricity is running through their skin, that they are being pricked or given injections, or tickled with hairs, or that they have a skin disease. The question is rather this : are the cutaneous hallucinations dependent, not on peripheral, but on central processes which more or less definitely determine the occurrence and form of the morbid experience If this were so, any tendencies towards delusional elaboration would take effect only within a limited range. This would still obtain, even in states akin to delirium such clinically though tendencies could very well take on a hallucinatory character.
most part quite regular, so that it does not happen that five or six uniform stimuli successively applied I are felt, and then the next five or six not felt. have shown in an earlier paperthat in peripheral lesions fatigue phenomena occur also, but only after much longer series of stimuli, and certainly not so quickly as in this case. The findings here point to a disturbance of function which is conditioned by impairment of central mechanisms. In further investigations the detailed nature of this, disorder of function must be studied to discover what in it is typical for the development of hallucinations.
THE INVESTIGATION
THE obstetric belt here illustrated is devised for use forceps delivery when the left lateral position is the one chosen. Such deliveries have frequently to be undertaken by the general practitioner with inadequate help, and experience of the use of the belt shows that by its application, in conjunction with the midwifery straps to the thighs, the patient is kept
are
To investigate this point tests with von Frey’s hairs were carried out on a chronic cocainist who had also been taking morphine. The patient, who was aged 32, said that following on his injection of cocaine he felt and saw small, whitish flagellate creatures come out of his fingers ; he had tried to flick them off with his nails or by other means. The examination was made 20 hours after the last injection. With von Frey’s hairs for touch and pain, large skin areas, and smaller ones of 5 X 5 mm., were tested carefully. In the larger areas it was sought to discover how often on the average the same stimulus was felt, and in the smaller areas the onset of fatigue for the same strength of stimuli was looked for. (The necessary normal values for each strength of stimulus were known from earlier investigations.) Areas on the chest and upper arm were tested. Touch MM,MK.—On applying Sp. 4 to a largish area of skin (7 X7 cm.) quite irregular and often big gaps were found-i.e., often 6-8 stimuli could not be felt. (The average value for normals is 1.1 to 1’8-i.e., it never happens that even every second stimulus is missed and gaps of the size here found are out of the question.) Even using Sp. 6 (normal average value 1-0 to 1-2) there were found gaps of 3 to 5. Essentially the same was found with pain stimuli of 1-2 g. (average value for normals using 1 g. is 1.0 to 1.2 ; with 2 g. it is 1.0 to 1-5). Here, too, there were gaps. It would happen that there would be five or six applications of the hair which would not be felt by the patient as a prick. On the other hand, especially with touch stimuli, the patient often said wrongly that he was being touched during the one to three seconds’ interval between the applications of the hairs-but this only happened when several stimuli had already been applied. In small areas (5 X 5 mm.) after 30-40 applications (Sp. 4 and Sp. 5) gaps of 12-15 occurred for touch stimuli, and for pain stimuli (1 g. and 2 g.) gaps of 5-6. Complete fatigue, so that small areas were not felt at all, did not occur.
When two days later-i.e., three days after the last dose of cocaine-the investigations were repeated, the patient gave an absolutely normal response in these regards, in spite of severe deprivation symptoms following withdrawal of morphine, which might have impaired his power of attention. Occasionally, however, he would say he was
being
touched when it
was
not so.
CONCLUSIONS
Von Weizsacker
purely testing
3
and Kries have shown that in lesions gaps will occur on peripheral with von Frey’s hairs, but these are for the nerve
REFERENCES
1. Régnier, J. : Compt. rend. Acad. des Sci., 1929, clxxxix., 264. 2. Ide, M., Trans. Japan. Path. Soc., 1929, xviii., 338 (abstr. in Zentralbl. f. d. ges. Neurol. u. Psychiat., 1930, lv., 662. 3. Weizsäcker, V. von, and Stein, J.: Deut. Zeits. f. Nervenheilk., 1927, xcix., 1. 4. Zucker, K.: Monats. f. Psychiat. u. Neurol., 1932, lxxxiv., 200.
NEW INVENTIONS AN IMPROVED OBSTETRIC BELT
in
in the required position and that any " pull " on the belt aids delivery, since it acts like a " tight binder." The belt is wide and is shaped to fit the maternal abdomen, while the ends are prolonged to form straps which are easily fixed to the near top corner of the bed. The advantages of the belt are that the patient is retained in the desired position ; the nurse is released and is available ; the fundal pressure of the belt aids delivery ; and the belt is easily applied. A smaller belt may be used in addition to the abdominal belt if required. This belt fits over the shoulderblades and the ends, passed under the armpits, are fixed to the far lower corner of the bed. In practice it is seldom found necessary to use this further aid. The belts are supplied by Messrs. Allen and
Hanburys Ltd., of Wigmore-street, London, W., together with their " midwifery straps " which are now made with rustless fittings. C. J. PENNY, M.D. Camb.
PROGRESS
OF
BIRMINGHAM HOSPITAL CENTRE.-
the recent annual meeting of this Centre it was reported that the appeal fund now exceeds f696,000, of which f140,000 has been given this year. Preliminary work has actually begun, and a committee of the university is considering the planning of the new medical school.
At
NEW INVENTIONS
sent and conditioned
by peripheral changes. There clinical objections to this assumpweighty tion. Delusional evaluation of parsesthesise conditioned by trophic or vascular or neuritic changes occurs commonly enough-for example, in delirium, in senile or arterio-sclerotic processes, and in other exogenous psychoses. But in such delusional elaborations there is never the uniformity, ceteris paribus, which is so striking in cocaine hallucinations. The significance of this factor is therefore limited. Cocainists scarcely ever complain that electricity is running through their skin, that they are being pricked or given injections, or tickled with hairs, or that they have a skin disease. The question is rather this : are the cutaneous hallucinations dependent, not on peripheral, but on central processes which more or less definitely determine the occurrence and form of the morbid experience If this were so, any tendencies towards delusional elaboration would take effect only within a limited range. This would still obtain, even in states akin to delirium such clinically though tendencies could very well take on a hallucinatory character.
most part quite regular, so that it does not happen that five or six uniform stimuli successively applied I are felt, and then the next five or six not felt. have shown in an earlier paperthat in peripheral lesions fatigue phenomena occur also, but only after much longer series of stimuli, and certainly not so quickly as in this case. The findings here point to a disturbance of function which is conditioned by impairment of central mechanisms. In further investigations the detailed nature of this, disorder of function must be studied to discover what in it is typical for the development of hallucinations.
THE INVESTIGATION
THE obstetric belt here illustrated is devised for use forceps delivery when the left lateral position is the one chosen. Such deliveries have frequently to be undertaken by the general practitioner with inadequate help, and experience of the use of the belt shows that by its application, in conjunction with the midwifery straps to the thighs, the patient is kept
are
To investigate this point tests with von Frey’s hairs were carried out on a chronic cocainist who had also been taking morphine. The patient, who was aged 32, said that following on his injection of cocaine he felt and saw small, whitish flagellate creatures come out of his fingers ; he had tried to flick them off with his nails or by other means. The examination was made 20 hours after the last injection. With von Frey’s hairs for touch and pain, large skin areas, and smaller ones of 5 X 5 mm., were tested carefully. In the larger areas it was sought to discover how often on the average the same stimulus was felt, and in the smaller areas the onset of fatigue for the same strength of stimuli was looked for. (The necessary normal values for each strength of stimulus were known from earlier investigations.) Areas on the chest and upper arm were tested. Touch MM,MK.—On applying Sp. 4 to a largish area of skin (7 X7 cm.) quite irregular and often big gaps were found-i.e., often 6-8 stimuli could not be felt. (The average value for normals is 1.1 to 1’8-i.e., it never happens that even every second stimulus is missed and gaps of the size here found are out of the question.) Even using Sp. 6 (normal average value 1-0 to 1-2) there were found gaps of 3 to 5. Essentially the same was found with pain stimuli of 1-2 g. (average value for normals using 1 g. is 1.0 to 1.2 ; with 2 g. it is 1.0 to 1-5). Here, too, there were gaps. It would happen that there would be five or six applications of the hair which would not be felt by the patient as a prick. On the other hand, especially with touch stimuli, the patient often said wrongly that he was being touched during the one to three seconds’ interval between the applications of the hairs-but this only happened when several stimuli had already been applied. In small areas (5 X 5 mm.) after 30-40 applications (Sp. 4 and Sp. 5) gaps of 12-15 occurred for touch stimuli, and for pain stimuli (1 g. and 2 g.) gaps of 5-6. Complete fatigue, so that small areas were not felt at all, did not occur.
When two days later-i.e., three days after the last dose of cocaine-the investigations were repeated, the patient gave an absolutely normal response in these regards, in spite of severe deprivation symptoms following withdrawal of morphine, which might have impaired his power of attention. Occasionally, however, he would say he was
being
touched when it
was
not so.
CONCLUSIONS
Von Weizsacker
purely testing
3
and Kries have shown that in lesions gaps will occur on peripheral with von Frey’s hairs, but these are for the nerve
REFERENCES
1. Régnier, J. : Compt. rend. Acad. des Sci., 1929, clxxxix., 264. 2. Ide, M., Trans. Japan. Path. Soc., 1929, xviii., 338 (abstr. in Zentralbl. f. d. ges. Neurol. u. Psychiat., 1930, lv., 662. 3. Weizsäcker, V. von, and Stein, J.: Deut. Zeits. f. Nervenheilk., 1927, xcix., 1. 4. Zucker, K.: Monats. f. Psychiat. u. Neurol., 1932, lxxxiv., 200.
NEW INVENTIONS AN IMPROVED OBSTETRIC BELT
in
in the required position and that any " pull " on the belt aids delivery, since it acts like a " tight binder." The belt is wide and is shaped to fit the maternal abdomen, while the ends are prolonged to form straps which are easily fixed to the near top corner of the bed. The advantages of the belt are that the patient is retained in the desired position ; the nurse is released and is available ; the fundal pressure of the belt aids delivery ; and the belt is easily applied. A smaller belt may be used in addition to the abdominal belt if required. This belt fits over the shoulderblades and the ends, passed under the armpits, are fixed to the far lower corner of the bed. In practice it is seldom found necessary to use this further aid. The belts are supplied by Messrs. Allen and
Hanburys Ltd., of Wigmore-street, London, W., together with their " midwifery straps " which are now made with rustless fittings. C. J. PENNY, M.D. Camb.
PROGRESS
OF
BIRMINGHAM HOSPITAL CENTRE.-
the recent annual meeting of this Centre it was reported that the appeal fund now exceeds f696,000, of which f140,000 has been given this year. Preliminary work has actually begun, and a committee of the university is considering the planning of the new medical school.
At