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BONE DRILLS
20 information to be gleaned by screening and from films. The summary of radiographic technique will be found useful, but unfortunately some of the films are reproduced as if taken from behind the patient, and others as if the patient faced the radiographer. The latter view is, on the whole, more satisfactory, and uniformity is desirable at any rate for the inexperienced observer. Section II. deals with what may be called the radiology of general pathology—degeneration, inflammation, hypertrophy, hyperaemia, and so on. This is a valuable section which supplies a basis on which to study individual cases. In Section III. the thoracic cage is considered; here the references to diseases of bone are too sketchy to be of much value, but they will doubtless be more fully discussed in another volume. Section IV. is the largest and most important, for it deals with diseases of the respiratory system. The author mentions the danger of overfilling by the use of an excessive amount of lipiodol. The thesis that with proper technique the diagnosis of bronchiectasis can most often be made without the use of contrast media will hardly be accepted by most radiologists. Pneumonia is well described, but the right lower lobe extends posteriorly much higher than is here suggested. The author does not sufficiently emphasise the importance of the lateral view or of the lordotic position in demonstrating the interlobar septa. Tuberculosis in children and adults is well described. Dr. Meyer emphasises the rarity of syphilitic lesions .as opposed to lesions occurring in a syphilitic subject.
NEW BONE DRILLS
He ascribes "pleural rings" to pleural adhesions and blebs, rather than to cavities. In Section, V. the lesions of the heart and pericardium are well and concisely described ; the last section is- devoted to a brief account of lesions of the cesophagus and subphrenic region. The book is well printed, and the 68 reproductions of films are excellent. , The line drawings, which are in white on black, as in blackboard illustrations, help the text and economise .
radiograms. Modern General Anaesthesia Second edition. -By JAMES G. PoE, M.D., Lecturer General Anaesthesia, in the Medical and Dental’ Departments of Baylor University, Dallas, Texas. Philadelphia: F. A. Davis Company. Pp. 231. on
$2.50. a useful treatise, though it is written. Generally speaking, for major surgery Dr. Poe’s preference is for closed administration with partial rebreathing, nitrous oxide or ethylene being the basic anaesthetic. Ether is added as necessary to deepen the anaesthesia, and oxygen and carbon dioxide as required by the patient’s condition. Dr. Poe approves of morphia premedication, except in- children under 15 years of age, and has found avertin and sodium amytal satisfactory. His general instructions are admirable. Neither nembutal nor percaine are mentioned, and spinal analgesia is, we think, given too little consideration.
Tzms is
essentially
carelessly
INVENTIONS patella fragments, while
in fractures of the
long
bones, where open reduction by itself fails to give tendon, through stability, binding material (of fascia, autogenous
THE passing of wire, fascia or bone is often beset with difficulty, and an instrument tendon or wire) can be readily introduced. The has been designed to facilitate it, consisting of a drill- small drill-head enables comparatively deeply situated head, A; body, B; and cannula, c. The body B bones to be so drilled, for only a small clearancethe length of the drill-head-is necessary on the
opposite side to the one easily exposed. In the operation of teno-suspension for recurrent dislocation of the shoulder, as practised at the Mayo Clinic, should the surgeon so elect this particular operation, the introduction of the tendinous sling is very easy. Five years ago Messrs. Down Bros., Ltd., St. Thomas’sstreet, London, S.E., prepared a drill for me with the head and shaft made as a single unit, and fitting into a
consists of a proximal shoulder and distal shaft. The shoulder will fit any standard bone drill, whether of the " Colt " pr " Archimedian " pattern as shown, or of the chuck pattern, the jaws of which will grip the shoulder immediately beyond the " step " end. The shaft has a tip with a reverse screw threaded end to receive the detachable drill head A. The cannula c exactly fits over the shaft between the head and shoulder, and is of slightly smaller diameter than the drill-head. The assembled drill is passed through the objective bone so that the drill-head just clears the opposite side. An assistant immediately grasps the drillhead A with a Lane’s screw-holding forceps or other suitable tool. The surgeon reverses the drill action, thereby releasing the drill-head, and then withdraws the parent drill with the shaft B attached in one movement. Thus, in quick sequence of drilling, reversing, and withdrawing, a cannula is left in the bone through which the desired wire or ligature can be passed. Withdrawal of the cannula completes the operation. Thisdevice is applicable to the’ , binding" of
shoulder for universal attachment to all bone drills.
This
device can still be used with ease for fractured patella and teno-suspension, but cannot be used where there is not a clearance equal to the whole length of the shaft and head, in the contralateral side of the bone. Its usefulness is therefore only very limited and chiefly applicable to the patella. Mr. Herbert Paterson2 has brought to the notice of the profession a drill somewhat similar to this earlier
pattern. My thanks are due to Mr. E. C. Hughes for allowing me to use this drill on cases under his care, and to Messrs. Down Bros. for their courtesy and patience inthe preparation of numerous bone drills during_ the past five years. A. SIMPSON-SMITH, M.Chir. Camb., F.R.C.S. Eng. Guy’s Hospital.
1 Henderson,
M. J.: Jour. Amer. Med. Assoc., 1930, xcv.,
1653.
2
Paterson, H. J.: THE LANCET, 1930, i., 302.
THE MENTAL DEFECTIVE.—UNIVERSITY OF LONDON : THE NEW HOME
21
They have come to the conclusion, some of the basal arguments advanced that however, in favour of this policy have but little foundation. Procreation by mental defective persons is found to be " not excessive," relative to the average increase of population, and there is said to be ground for believing that " the average number of children who reach adolescence in families where one of the parents is feeble-minded does not significantly exceed that for the community as a. whole." In deciding upon its attitude to sterilisation the Committee confesses that unanimity was found impossible ; it was also impressed by the lack of sufficient knowledge, both of heredity in general and the heredity of mental defect in particular. Hence it is not surprising that the Committee has steered a middle course and is content to record its general view that sterilisation might be an appropriate and desirable procedure -with adequate safeguards-in a small proportion of mental defectives in respect of whom the chief social danger is propagation. Only in one respect is the Committee more dogmatic, when it states that sterilisation, even if widely applied to mental defectives, would cause no appreciable difference in their number for many generations. This opinion appears on the surface to be somewhat inconsistent with its cautious policy, but it is in line with biological knowledge in that it recognises that carriers play a large part in the propagation of mutations. The committee lately appointed by the Board of Control will have the responsibility of further investigation into this question. The B.M.A. Committee rightly emphasises the necessity for clinical teaching on mental defect, both for medical students and in post-graduate schools. By their training practitioners are seldom equipped for the diagnosis of any grade above the. imbecile, and when one considers how much material is possessed by local authorities, both of education and of mental deficiency, in the larger areas where there are medical schools, there seems to be no excuse for this ignorance. This is a point which might perhaps have had more prominence in the report.
courage.
THE LANCET. LONDON:SATURDAY, JULY 2, 1932
THE MENTAL DEFECTIVE on mental defect is now The becoming apparent. report1 just issued by a committee of the British Medical Association strengthens the impression left by the Wood report that the perspective has greatly changed since the Royal Commission -of. -1904-1908, and it shows several ways in which the angle of approach has altered. First of all, the tendency to regard the
A
CHANGE
of outlook
defective as a person separated by a gulf from normal humanity has been replaced by the conception that " there is a continuous curve of variability in mental power and social capacity and behaviour from the idiot to the normal person." In the second place the pioneers of this movement were possessed by the idea that mental defect was at the root of a very large proportion of our problems of poverty and crime ; indeed, it was the antisocial possibilities of the defective that occupied the centre of the picture. The B.M.A. Committee, on the other hand, asserts that " antisocial conduct is not an essential characteristic and : is not necessarily even a common characteristic of mentally defective persons," and that " there are - large numbers of - feeble-minded persons whose behaviour in the community is no more repre: hensible, either socially or sexually, than that of persons who are not classed as mentally defective." The growth of child guidance and other movements: for the psychological treatment of delinquents is further evidence of the realisation that delinquency and mental defect are not necessarily associated. Yet a third change is reflected in treatment. In the earlier years permanent custodial care was regarded as the one and only satisfactory solution, being designed to protect the defective from himself, to protect the community from him, and lastly to prevent the propagation of his defect. It is obviously impracticable, in view of numbers, that such a policy should be applied to all defectives, but in addition experience has shown, both in America and England, that a certain proportion can be successfully trained for ordinary life and can be allowed to rejoin the community under adequate supervision. It is therefore not so much segregation that is demanded now as socialisation " ; though it remains to be seen whether the Committee is right in thinking that this goal can be reached by the great majority. The Committee’s findings on sterilisation will ,
.
’
UNIVERSITY OF LONDON: THE NEW HOME A
phase of an arduous undertaking has; definitely commenced, for, according to a statement, emanating from Lord ATHLONE, Chancellor of the University of London, and made in unison with the principal officers of the University, a splendid scheme has been embarked upon for the erection of a central building to house corporate’ activities. For years throughout the columns of FINAL
now
the press, and reflected in these pages, a discussion went on as to where this centre was to be placed, and whence the money for its construction Rival claims were put forward, was to be drawn. sometimes with deliberation and sometimes at the naturally attract much attention, and in some instance of romance, for the acquisition of Holland quarters its members may be accused of lack of House, Ken Wood, the Foundling Hospital, and Report of Mental Deficiency Committee. Appointed by even Somerset House, while certain obvious claimsthe Council of the B.M.A. in 1930 (Chairman: Prof. R. J. A. for remaining at South Kensington were forcibly Berry ; hon. secretary: Dr. R. G. Gordon). Brit. Med. Jour. Suppl., June 25th, p. 322. put forward. There were urged, sometimes from, "
1
NEW BONE DRILLS
He ascribes "pleural rings" to pleural adhesions and blebs, rather than to cavities. In Section, V. the lesions of the heart and pericardium are well and concisely described ; the last section is- devoted to a brief account of lesions of the cesophagus and subphrenic region. The book is well printed, and the 68 reproductions of films are excellent. , The line drawings, which are in white on black, as in blackboard illustrations, help the text and economise .
radiograms. Modern General Anaesthesia Second edition. -By JAMES G. PoE, M.D., Lecturer General Anaesthesia, in the Medical and Dental’ Departments of Baylor University, Dallas, Texas. Philadelphia: F. A. Davis Company. Pp. 231. on
$2.50. a useful treatise, though it is written. Generally speaking, for major surgery Dr. Poe’s preference is for closed administration with partial rebreathing, nitrous oxide or ethylene being the basic anaesthetic. Ether is added as necessary to deepen the anaesthesia, and oxygen and carbon dioxide as required by the patient’s condition. Dr. Poe approves of morphia premedication, except in- children under 15 years of age, and has found avertin and sodium amytal satisfactory. His general instructions are admirable. Neither nembutal nor percaine are mentioned, and spinal analgesia is, we think, given too little consideration.
Tzms is
essentially
carelessly
INVENTIONS patella fragments, while
in fractures of the
long
bones, where open reduction by itself fails to give tendon, through stability, binding material (of fascia, autogenous
THE passing of wire, fascia or bone is often beset with difficulty, and an instrument tendon or wire) can be readily introduced. The has been designed to facilitate it, consisting of a drill- small drill-head enables comparatively deeply situated head, A; body, B; and cannula, c. The body B bones to be so drilled, for only a small clearancethe length of the drill-head-is necessary on the
opposite side to the one easily exposed. In the operation of teno-suspension for recurrent dislocation of the shoulder, as practised at the Mayo Clinic, should the surgeon so elect this particular operation, the introduction of the tendinous sling is very easy. Five years ago Messrs. Down Bros., Ltd., St. Thomas’sstreet, London, S.E., prepared a drill for me with the head and shaft made as a single unit, and fitting into a
consists of a proximal shoulder and distal shaft. The shoulder will fit any standard bone drill, whether of the " Colt " pr " Archimedian " pattern as shown, or of the chuck pattern, the jaws of which will grip the shoulder immediately beyond the " step " end. The shaft has a tip with a reverse screw threaded end to receive the detachable drill head A. The cannula c exactly fits over the shaft between the head and shoulder, and is of slightly smaller diameter than the drill-head. The assembled drill is passed through the objective bone so that the drill-head just clears the opposite side. An assistant immediately grasps the drillhead A with a Lane’s screw-holding forceps or other suitable tool. The surgeon reverses the drill action, thereby releasing the drill-head, and then withdraws the parent drill with the shaft B attached in one movement. Thus, in quick sequence of drilling, reversing, and withdrawing, a cannula is left in the bone through which the desired wire or ligature can be passed. Withdrawal of the cannula completes the operation. Thisdevice is applicable to the’ , binding" of
shoulder for universal attachment to all bone drills.
This
device can still be used with ease for fractured patella and teno-suspension, but cannot be used where there is not a clearance equal to the whole length of the shaft and head, in the contralateral side of the bone. Its usefulness is therefore only very limited and chiefly applicable to the patella. Mr. Herbert Paterson2 has brought to the notice of the profession a drill somewhat similar to this earlier
pattern. My thanks are due to Mr. E. C. Hughes for allowing me to use this drill on cases under his care, and to Messrs. Down Bros. for their courtesy and patience inthe preparation of numerous bone drills during_ the past five years. A. SIMPSON-SMITH, M.Chir. Camb., F.R.C.S. Eng. Guy’s Hospital.
1 Henderson,
M. J.: Jour. Amer. Med. Assoc., 1930, xcv.,
1653.
2
Paterson, H. J.: THE LANCET, 1930, i., 302.
THE MENTAL DEFECTIVE.—UNIVERSITY OF LONDON : THE NEW HOME
21
They have come to the conclusion, some of the basal arguments advanced that however, in favour of this policy have but little foundation. Procreation by mental defective persons is found to be " not excessive," relative to the average increase of population, and there is said to be ground for believing that " the average number of children who reach adolescence in families where one of the parents is feeble-minded does not significantly exceed that for the community as a. whole." In deciding upon its attitude to sterilisation the Committee confesses that unanimity was found impossible ; it was also impressed by the lack of sufficient knowledge, both of heredity in general and the heredity of mental defect in particular. Hence it is not surprising that the Committee has steered a middle course and is content to record its general view that sterilisation might be an appropriate and desirable procedure -with adequate safeguards-in a small proportion of mental defectives in respect of whom the chief social danger is propagation. Only in one respect is the Committee more dogmatic, when it states that sterilisation, even if widely applied to mental defectives, would cause no appreciable difference in their number for many generations. This opinion appears on the surface to be somewhat inconsistent with its cautious policy, but it is in line with biological knowledge in that it recognises that carriers play a large part in the propagation of mutations. The committee lately appointed by the Board of Control will have the responsibility of further investigation into this question. The B.M.A. Committee rightly emphasises the necessity for clinical teaching on mental defect, both for medical students and in post-graduate schools. By their training practitioners are seldom equipped for the diagnosis of any grade above the. imbecile, and when one considers how much material is possessed by local authorities, both of education and of mental deficiency, in the larger areas where there are medical schools, there seems to be no excuse for this ignorance. This is a point which might perhaps have had more prominence in the report.
courage.
THE LANCET. LONDON:SATURDAY, JULY 2, 1932
THE MENTAL DEFECTIVE on mental defect is now The becoming apparent. report1 just issued by a committee of the British Medical Association strengthens the impression left by the Wood report that the perspective has greatly changed since the Royal Commission -of. -1904-1908, and it shows several ways in which the angle of approach has altered. First of all, the tendency to regard the
A
CHANGE
of outlook
defective as a person separated by a gulf from normal humanity has been replaced by the conception that " there is a continuous curve of variability in mental power and social capacity and behaviour from the idiot to the normal person." In the second place the pioneers of this movement were possessed by the idea that mental defect was at the root of a very large proportion of our problems of poverty and crime ; indeed, it was the antisocial possibilities of the defective that occupied the centre of the picture. The B.M.A. Committee, on the other hand, asserts that " antisocial conduct is not an essential characteristic and : is not necessarily even a common characteristic of mentally defective persons," and that " there are - large numbers of - feeble-minded persons whose behaviour in the community is no more repre: hensible, either socially or sexually, than that of persons who are not classed as mentally defective." The growth of child guidance and other movements: for the psychological treatment of delinquents is further evidence of the realisation that delinquency and mental defect are not necessarily associated. Yet a third change is reflected in treatment. In the earlier years permanent custodial care was regarded as the one and only satisfactory solution, being designed to protect the defective from himself, to protect the community from him, and lastly to prevent the propagation of his defect. It is obviously impracticable, in view of numbers, that such a policy should be applied to all defectives, but in addition experience has shown, both in America and England, that a certain proportion can be successfully trained for ordinary life and can be allowed to rejoin the community under adequate supervision. It is therefore not so much segregation that is demanded now as socialisation " ; though it remains to be seen whether the Committee is right in thinking that this goal can be reached by the great majority. The Committee’s findings on sterilisation will ,
.
’
UNIVERSITY OF LONDON: THE NEW HOME A
phase of an arduous undertaking has; definitely commenced, for, according to a statement, emanating from Lord ATHLONE, Chancellor of the University of London, and made in unison with the principal officers of the University, a splendid scheme has been embarked upon for the erection of a central building to house corporate’ activities. For years throughout the columns of FINAL
now
the press, and reflected in these pages, a discussion went on as to where this centre was to be placed, and whence the money for its construction Rival claims were put forward, was to be drawn. sometimes with deliberation and sometimes at the naturally attract much attention, and in some instance of romance, for the acquisition of Holland quarters its members may be accused of lack of House, Ken Wood, the Foundling Hospital, and Report of Mental Deficiency Committee. Appointed by even Somerset House, while certain obvious claimsthe Council of the B.M.A. in 1930 (Chairman: Prof. R. J. A. for remaining at South Kensington were forcibly Berry ; hon. secretary: Dr. R. G. Gordon). Brit. Med. Jour. Suppl., June 25th, p. 322. put forward. There were urged, sometimes from, "
1