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COMBINED SPONGE AND GAS-DELIVERY TUBE
692
CLINICAL NOTES
appendix abscess was therefore dismissed and colic intussusception diagnosed. Rectal examination gave a negative result. The pulse-rate was 100 and the temperature 1006° F. Operation was performed through a right paramedian incision, and the csecum and terminal ileum An intussuscepwere delivered through the wound. tion of the appendix was discovered and was with difficulty reduced and the appendix excised, the stump being buried in the caecum. The boy made an uninterrupted recovery and was discharged twelve days after the operation. The appendix was oedematous and its wall in places necrotic, and the vessels in the meso-appendix were thrombosed. It is nearly a hundred years ago that McKidd reported a case, and it seems difficult to believe that fewer than a hundred have been reported since. BIBLIOGRAPHY
Christopher, F. (1938) Ann. Surg. 108, 1111. Evans, A. (1922) Brit. J. Surg. 9, 565. Hamilton, T. (1931) Med. J. Aust. 9, 408. Hipsley, P. L. (1922) Ibid, 2, 65. Huddy, G. P. B. (1927) Brit. J. Surg. 14, 580. Johnson, G. (1915-16) Ibid, 3, 564. McKidd, J. (1858-59) Edin. med. J. 4, 793.
DIFFUSE SCLERODERMA AND RAYNAUD’S PHENOMENON FROM THE USE OF A PNEUMATIC HAMMER
BY DUNCAN
LEYS, D.M. Oxfd, M.R.C.P.
PHYSICIAN, ROYAL NORTHERN INFIRMARY, INVERNESS
IN 1924, when he
was
42, the patient,
foreman fingers of both He was then working a
arteries in the legs (dorsalis pedis and posterior tibial) could not be felt. The tendon jerks were present in the arms and legs and there was no evidence of any sensory disturbance, nor of muscle weakness. The serum Wassermann reaction was negative. Radio" " grams of the hands showed slight tufting of the terminal phalanges only. DISCUSSION
Scleroderma
.E’.;MM6M)K.—Now 57 years of age, he was a man of middle size with a high colour. The face was expressionless and immobile and the mouth small. The skin over the forehead and cheekbones and round about the mouth was tense, thin, and inelastic. With the utmost effort to open his mouth, the vertical aperture was not more than 1in. The palpebral fissures of both eyes were small. There was diffuse thickening of the subcutaneous tissues in both hands, extending down the fingers, across the palm, and over th3 dorsum of the hand, which prevented closure of the fist and full extension of the hand. All the fingers of both hands were pale. Lewis’s hyperaemia test showed an abrupt cessation of flushing at the base of the palm and at the base of all five fingers on the dorsal aspect in both hands. Radialartery pulsation was easily felt at the wrist in both hands. The blood-pressure in the right arm was 130/70 ; in the left arm the systolic pressure was 140, but no diastolic end-point could be obtained. All the fingernails and the toenails to a less degree showed a convexity in a longitudinal direction ; there was moderate clubbing of all the fingers. The peripheral
Raynaud’s phenomenon
are
commonly associated, and Raynaud’s phenomenon is an occasional sequel to the use of pneumatic tools; but I can find no previous record of the two conditions developing together in a pneumatic-tool worker. The incidence of Raynaud’s phenomenon in these trades is so high that individual susceptibility can play little part in its causation. To the vibration itself (aided by cold) one must ascribe the permanent changes produced in the vessels. Loriga (1929) says that permanent changes in the vessels resulting from the use of compressed-air tools are unknown, but this is not generally agreed, and Hunt (1936) finds no complete recovery from the Raynaud condition even when work is stopped for considerable periods. In the present case the question arises whether vibrations caused the scleroderma as well as the partial ischsemia of the fingers ; or would the patient have developed these if he had never worked vibratory machines Whatever the answer to this particular question, legislation to regulate the use of vibrating tools now seems to be overdue. For most trades tools have been devised which minimise the vibratory effects, and no others should be permitted.
mason, first,noticed numbness of the
hands during cold weather. in the United States, and had begun to use a compressed-air hammer the previous year. The instrument was held in the right hand and a chisel in the left. He continued to use the tool until 1930. Many of his mates had noticed similar symptoms and were annoyed by them, but nobody regarded the condition very seriously. When he returned to Scotland in 1934 he went on working as a mason, but not with a compressed-air tool. His hands still worried him in cold weather, but he noticed no other disability, except that the skin of the hands appeared to be getting thick, and there was some stiffness of the hands, which made flexion and extension of the fingers difficult. In January, 1939, he had a fall on the ice when he was watching some curling, and about a week later he found that the numbness of the fingers in the left hand was worse, and that the grip seemed weak.
and
REFERENCES
Hunt, J. H. (1936) Proc. R. Soc. Med. 30, 171. Loriga, G. (1929) Occupation and Health. International Labour Office, p. 162.
New Inventions COMBINED SPONGE AND GAS-DELIVERY TUBE I HAVE been using for the past few years the attachment illustrated here for prolonged administration of nasal gas for dental purposes. With this
device gas is administered both through the throat sponge which is normally used by the dentist and through the nose by the orthodox nose-piece.
The figure is self-explanatory. The sponge (c) is held between the collar on the male tube (A) and that on the female tube (B). The rubber junction tube (E)
fits over tube (A) jamming tube (B) into place. Induction is carried out in the ordinary way with a nose-piece. As soon as the patient is adequately anaesthetised, the damped sponge, ready mounted on the fitting and connected by rubber tubing to the gas. apparatus, is pushed over the tongue and into the pharynx. It is then immaterial whether the patient breathes through the nose or mouth. Since I have used this method I have had no difficulty in keeping any patient quiet for an indefinite time once I have succeeded in getting him really aneesthetised. The fitting was made for me by Messrs. A. Charles. Kino,
4. TtvrtrtOiT tT’’’þt
T,nnrlnn
W1
W. H. MARSHALL, M.B. Camb.
CLINICAL NOTES
appendix abscess was therefore dismissed and colic intussusception diagnosed. Rectal examination gave a negative result. The pulse-rate was 100 and the temperature 1006° F. Operation was performed through a right paramedian incision, and the csecum and terminal ileum An intussuscepwere delivered through the wound. tion of the appendix was discovered and was with difficulty reduced and the appendix excised, the stump being buried in the caecum. The boy made an uninterrupted recovery and was discharged twelve days after the operation. The appendix was oedematous and its wall in places necrotic, and the vessels in the meso-appendix were thrombosed. It is nearly a hundred years ago that McKidd reported a case, and it seems difficult to believe that fewer than a hundred have been reported since. BIBLIOGRAPHY
Christopher, F. (1938) Ann. Surg. 108, 1111. Evans, A. (1922) Brit. J. Surg. 9, 565. Hamilton, T. (1931) Med. J. Aust. 9, 408. Hipsley, P. L. (1922) Ibid, 2, 65. Huddy, G. P. B. (1927) Brit. J. Surg. 14, 580. Johnson, G. (1915-16) Ibid, 3, 564. McKidd, J. (1858-59) Edin. med. J. 4, 793.
DIFFUSE SCLERODERMA AND RAYNAUD’S PHENOMENON FROM THE USE OF A PNEUMATIC HAMMER
BY DUNCAN
LEYS, D.M. Oxfd, M.R.C.P.
PHYSICIAN, ROYAL NORTHERN INFIRMARY, INVERNESS
IN 1924, when he
was
42, the patient,
foreman fingers of both He was then working a
arteries in the legs (dorsalis pedis and posterior tibial) could not be felt. The tendon jerks were present in the arms and legs and there was no evidence of any sensory disturbance, nor of muscle weakness. The serum Wassermann reaction was negative. Radio" " grams of the hands showed slight tufting of the terminal phalanges only. DISCUSSION
Scleroderma
.E’.;MM6M)K.—Now 57 years of age, he was a man of middle size with a high colour. The face was expressionless and immobile and the mouth small. The skin over the forehead and cheekbones and round about the mouth was tense, thin, and inelastic. With the utmost effort to open his mouth, the vertical aperture was not more than 1in. The palpebral fissures of both eyes were small. There was diffuse thickening of the subcutaneous tissues in both hands, extending down the fingers, across the palm, and over th3 dorsum of the hand, which prevented closure of the fist and full extension of the hand. All the fingers of both hands were pale. Lewis’s hyperaemia test showed an abrupt cessation of flushing at the base of the palm and at the base of all five fingers on the dorsal aspect in both hands. Radialartery pulsation was easily felt at the wrist in both hands. The blood-pressure in the right arm was 130/70 ; in the left arm the systolic pressure was 140, but no diastolic end-point could be obtained. All the fingernails and the toenails to a less degree showed a convexity in a longitudinal direction ; there was moderate clubbing of all the fingers. The peripheral
Raynaud’s phenomenon
are
commonly associated, and Raynaud’s phenomenon is an occasional sequel to the use of pneumatic tools; but I can find no previous record of the two conditions developing together in a pneumatic-tool worker. The incidence of Raynaud’s phenomenon in these trades is so high that individual susceptibility can play little part in its causation. To the vibration itself (aided by cold) one must ascribe the permanent changes produced in the vessels. Loriga (1929) says that permanent changes in the vessels resulting from the use of compressed-air tools are unknown, but this is not generally agreed, and Hunt (1936) finds no complete recovery from the Raynaud condition even when work is stopped for considerable periods. In the present case the question arises whether vibrations caused the scleroderma as well as the partial ischsemia of the fingers ; or would the patient have developed these if he had never worked vibratory machines Whatever the answer to this particular question, legislation to regulate the use of vibrating tools now seems to be overdue. For most trades tools have been devised which minimise the vibratory effects, and no others should be permitted.
mason, first,noticed numbness of the
hands during cold weather. in the United States, and had begun to use a compressed-air hammer the previous year. The instrument was held in the right hand and a chisel in the left. He continued to use the tool until 1930. Many of his mates had noticed similar symptoms and were annoyed by them, but nobody regarded the condition very seriously. When he returned to Scotland in 1934 he went on working as a mason, but not with a compressed-air tool. His hands still worried him in cold weather, but he noticed no other disability, except that the skin of the hands appeared to be getting thick, and there was some stiffness of the hands, which made flexion and extension of the fingers difficult. In January, 1939, he had a fall on the ice when he was watching some curling, and about a week later he found that the numbness of the fingers in the left hand was worse, and that the grip seemed weak.
and
REFERENCES
Hunt, J. H. (1936) Proc. R. Soc. Med. 30, 171. Loriga, G. (1929) Occupation and Health. International Labour Office, p. 162.
New Inventions COMBINED SPONGE AND GAS-DELIVERY TUBE I HAVE been using for the past few years the attachment illustrated here for prolonged administration of nasal gas for dental purposes. With this
device gas is administered both through the throat sponge which is normally used by the dentist and through the nose by the orthodox nose-piece.
The figure is self-explanatory. The sponge (c) is held between the collar on the male tube (A) and that on the female tube (B). The rubber junction tube (E)
fits over tube (A) jamming tube (B) into place. Induction is carried out in the ordinary way with a nose-piece. As soon as the patient is adequately anaesthetised, the damped sponge, ready mounted on the fitting and connected by rubber tubing to the gas. apparatus, is pushed over the tongue and into the pharynx. It is then immaterial whether the patient breathes through the nose or mouth. Since I have used this method I have had no difficulty in keeping any patient quiet for an indefinite time once I have succeeded in getting him really aneesthetised. The fitting was made for me by Messrs. A. Charles. Kino,
4. TtvrtrtOiT tT’’’þt
T,nnrlnn
W1
W. H. MARSHALL, M.B. Camb.