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PERINEAL SPRAY OR DOUCHE.
185
New Inventions. PERINEAL
SPRAY
OR
DOUCHE.
THIS consists of a flexible metal tube made of pewter which can be easily bent into any fixed position. To one end of this tube is attached a small piece of rubber tubing carrying a glass nozzle, while the other end, which has
a
stopcock
on
-it, is
attached by rubber tubing to the ordinary douche can. The whole apparatus, which can be readily sterilised by boiling, is attached by means of a
sliding bracket to the one of
lithotomy uprights. Saline or antiseptic fluid is run through
hours, an excess of 5 hours. Nottingham and Bath were both nearly 2° colder at night than Kew, and the former
during the daytime also. Bath, howmaximum of 470, had warmer days than the metropolitan station. The extreme south-west of England maintained its reputation for mildness and equability. At Newquay the mean maximum was 48 20, and the mean minimum 42.7°, while at Torquay the corresponding figures were 49° and 41.5°. The Scilly and Channel Isles were milder still. At both places the mean afternoon maximum was 50° and the mean mininum of the nights about 43°. The south coast, as represented by Brighton and Bournemouth, had a mean maximum of 470, while the minimum was 40° at Brighton and 390 at Bournemouth. The duration of sunshine varied a good deal in different parts of the kingdom. In the Midlands there was little, the figure at Nottingham being only 15 hours, or no more than half the normal, but Bath had 45 hours, Newquay 47 hours, and Scilly 41 hours. Brighton, Jersey, Torquay, and especially Bournemouth, were more sunny, the general figure being about 55 hours, and that at Bournemouth exceeding 60 hours. The rainfall varied considerably in the southwest. At Torquay, where the total was 2.1 in., there were only nine rain days, but at Newquay the total equalled 3-9in., and was contributed by as many as 18 days. Scilly had 20 rain days, giving an aggregate of 3-9 in., and Jersey 15 days, with a total of 3.5 in. All these totals are below the normal, that at Torquay being 2 in. below. The frost at the end of the month was felt along the south and south-west coasts generally, but at Scilly and Jersey the sheltered thermometer fell no lower than 33°. was
the apparatus from the douche can and the now is easily regulated by the If the is in the region of the anus the is so bent that the glass nozzle points downwards tube pewter and impinges on the central point of the perineum. If the operation is on the vulva the nozzle is fixed just below the symphysis pubis. From these points the regulated stream of fluid washes away all blood, gives the surgeon a clear view of the field of operation, and saves an assistant from constantly swabbing the wound, and to a certain extent injuring the tissues. It has been found especially useful in operating on haemorrhoids by Whitehead’s method. This apparatus, which is shown in the illustration, was designed by me five years ago at the request of the late Sir Frederick Wallis. It has been in use at St. Mark’s Hospital since that time and has given the utmost satisfaction. Care must be taken in bending the pewter tube to do so always at the nozzle end and not near the joint at the bracket. The apparatus is made by Messrs. Allen and Hanburys, Limited, Wigmore-street, London, W. H. GRAEME ANDERSON, F.R.C.S. F.R.C.S.Eng. Eng. Harley-street,W.
stopcock.
operation
slightly
ever, with
colder
a mean
The Weather Abroad. On the continent the weather was not cold for December, but colder than in the south and south-west of England. At Paris, Brussels, and Berlin the mean maximum temperature was 420 or 430, and the mean minimum 330 at Paris, 340 at Brussels, and 350 at Berlin. The most severe frost was experienced in the eastern and central parts of France. At Paris the thermometer in the screen descended to 18° on the 22nd and 23rd, and to 22° on the 24th and 31st, and at Brussels it went nearly as low on the same dates. Berlin, however, was not so cold, the lowest temperature being 210 on the 19th. Berlin was, nevertheless, more wintry at the end of the month, when an unusually heavy fall of snow occurred. During the month as a whole Berlin had been rainy, the gauge yielding at least as much as 0-04 in. on no less than 20 days, amounting to an aggregate of 4’ 6 in. At Paris, on the other hand, there were only eight days with rain, giving a total of 2. 6 in., and at Brussels 18 days, with a similar total. Many 1913, AT HOME AND ABROAD. days at the French capital were sunless, and the total number of hours for the month was no more than 46 hours. The extreme south-east and south-west of France, as repreThe TVeather at Home. sented by Nice and Biarritz, were colder at night than the UNTIL after the middle of the month the weather was south-west of England, both resorts having a mean minimum unusually mild for the time of the year throughout the temperature of 40°. The days were, however, warmer, the British Islands, the wind being constantly between south- mean maximum at Nice being 540 and that at Biarritz 49°. west and west, and often blowing a gale on various parts of Neither place entirely escaped the frost at the end the coast and sometimes with considerable force inland. of the month, although its visitation was transitory. During the latter part of the period, however, the wind At Nice the month generally was bright and sunny. shifted round to north-west and north, and very occasionally Only six days brought rain, and the total fall was died out altogether, the effect on the temperature being no more than 0- 7 in., but at Biarritz rain fell on twice most marked. In the northern half of the kingdom the as many days and gave a total three times as large. frost was intense, and in the south and south-east the Throughout Italy the weather was mostly fine, but frost was thermometer left its springlike level for a few degrees below experienced at times as far south as Rome, and the temperathe freezing point. The mean temperature for the whole ture of the northern half of the country was usually lower month was, nevertheless, above the average for December in than on the Riviera. Even Naples had some cold days, almost all parts of the kingdom. A mild December generally although as a rule the temperature was about midway means a wet one, but last month formed an exception, Madeira between 50° and 600 during the afternoon. as the total rainfall was below the normal, the deficit remained unaffected by the cold snap that visited the south being very large in many districts. In the metropolitan of Europe. At Funchal the sheltered thermometer rose to area, at Kew, the mean maximum temperature was 45’ 50, 70° or higher on no less than 18 days, and fell no lower than an excess on the average of 1 - 80, while the mean minimum 570 on as many nights. The mean maximum temperature was 38°, an excess of 3°. The first fortnight saw the was as high as 690 and the mean minimum 570. The sheltered thermometer rise to 50° or above on several occasions, weather was also very fine as well as warm. On only five the highest figure being 540 on the 12th, but after the 22nd days was there rain, and the total fall, 2 - 0 in., was nearly it seldom rose to 40°, and the minimum readings were all contributed by the 21st and 26th. Comparing the mostly below 320, the lowest of all being 280 on Christmas December mean temperature with that in the south of morning. The rainfall, which was just below an inch, fell England, it may be said that Funchal was as warm as on 14 days, and was just an inch below the normal, while Brighton is in an average June during the day, and about the sun, which only shone on 14 days, yielded a total of 41 as warm as an average July at night.
DECEMBER,
New Inventions. PERINEAL
SPRAY
OR
DOUCHE.
THIS consists of a flexible metal tube made of pewter which can be easily bent into any fixed position. To one end of this tube is attached a small piece of rubber tubing carrying a glass nozzle, while the other end, which has
a
stopcock
on
-it, is
attached by rubber tubing to the ordinary douche can. The whole apparatus, which can be readily sterilised by boiling, is attached by means of a
sliding bracket to the one of
lithotomy uprights. Saline or antiseptic fluid is run through
hours, an excess of 5 hours. Nottingham and Bath were both nearly 2° colder at night than Kew, and the former
during the daytime also. Bath, howmaximum of 470, had warmer days than the metropolitan station. The extreme south-west of England maintained its reputation for mildness and equability. At Newquay the mean maximum was 48 20, and the mean minimum 42.7°, while at Torquay the corresponding figures were 49° and 41.5°. The Scilly and Channel Isles were milder still. At both places the mean afternoon maximum was 50° and the mean mininum of the nights about 43°. The south coast, as represented by Brighton and Bournemouth, had a mean maximum of 470, while the minimum was 40° at Brighton and 390 at Bournemouth. The duration of sunshine varied a good deal in different parts of the kingdom. In the Midlands there was little, the figure at Nottingham being only 15 hours, or no more than half the normal, but Bath had 45 hours, Newquay 47 hours, and Scilly 41 hours. Brighton, Jersey, Torquay, and especially Bournemouth, were more sunny, the general figure being about 55 hours, and that at Bournemouth exceeding 60 hours. The rainfall varied considerably in the southwest. At Torquay, where the total was 2.1 in., there were only nine rain days, but at Newquay the total equalled 3-9in., and was contributed by as many as 18 days. Scilly had 20 rain days, giving an aggregate of 3-9 in., and Jersey 15 days, with a total of 3.5 in. All these totals are below the normal, that at Torquay being 2 in. below. The frost at the end of the month was felt along the south and south-west coasts generally, but at Scilly and Jersey the sheltered thermometer fell no lower than 33°. was
the apparatus from the douche can and the now is easily regulated by the If the is in the region of the anus the is so bent that the glass nozzle points downwards tube pewter and impinges on the central point of the perineum. If the operation is on the vulva the nozzle is fixed just below the symphysis pubis. From these points the regulated stream of fluid washes away all blood, gives the surgeon a clear view of the field of operation, and saves an assistant from constantly swabbing the wound, and to a certain extent injuring the tissues. It has been found especially useful in operating on haemorrhoids by Whitehead’s method. This apparatus, which is shown in the illustration, was designed by me five years ago at the request of the late Sir Frederick Wallis. It has been in use at St. Mark’s Hospital since that time and has given the utmost satisfaction. Care must be taken in bending the pewter tube to do so always at the nozzle end and not near the joint at the bracket. The apparatus is made by Messrs. Allen and Hanburys, Limited, Wigmore-street, London, W. H. GRAEME ANDERSON, F.R.C.S. F.R.C.S.Eng. Eng. Harley-street,W.
stopcock.
operation
slightly
ever, with
colder
a mean
The Weather Abroad. On the continent the weather was not cold for December, but colder than in the south and south-west of England. At Paris, Brussels, and Berlin the mean maximum temperature was 420 or 430, and the mean minimum 330 at Paris, 340 at Brussels, and 350 at Berlin. The most severe frost was experienced in the eastern and central parts of France. At Paris the thermometer in the screen descended to 18° on the 22nd and 23rd, and to 22° on the 24th and 31st, and at Brussels it went nearly as low on the same dates. Berlin, however, was not so cold, the lowest temperature being 210 on the 19th. Berlin was, nevertheless, more wintry at the end of the month, when an unusually heavy fall of snow occurred. During the month as a whole Berlin had been rainy, the gauge yielding at least as much as 0-04 in. on no less than 20 days, amounting to an aggregate of 4’ 6 in. At Paris, on the other hand, there were only eight days with rain, giving a total of 2. 6 in., and at Brussels 18 days, with a similar total. Many 1913, AT HOME AND ABROAD. days at the French capital were sunless, and the total number of hours for the month was no more than 46 hours. The extreme south-east and south-west of France, as repreThe TVeather at Home. sented by Nice and Biarritz, were colder at night than the UNTIL after the middle of the month the weather was south-west of England, both resorts having a mean minimum unusually mild for the time of the year throughout the temperature of 40°. The days were, however, warmer, the British Islands, the wind being constantly between south- mean maximum at Nice being 540 and that at Biarritz 49°. west and west, and often blowing a gale on various parts of Neither place entirely escaped the frost at the end the coast and sometimes with considerable force inland. of the month, although its visitation was transitory. During the latter part of the period, however, the wind At Nice the month generally was bright and sunny. shifted round to north-west and north, and very occasionally Only six days brought rain, and the total fall was died out altogether, the effect on the temperature being no more than 0- 7 in., but at Biarritz rain fell on twice most marked. In the northern half of the kingdom the as many days and gave a total three times as large. frost was intense, and in the south and south-east the Throughout Italy the weather was mostly fine, but frost was thermometer left its springlike level for a few degrees below experienced at times as far south as Rome, and the temperathe freezing point. The mean temperature for the whole ture of the northern half of the country was usually lower month was, nevertheless, above the average for December in than on the Riviera. Even Naples had some cold days, almost all parts of the kingdom. A mild December generally although as a rule the temperature was about midway means a wet one, but last month formed an exception, Madeira between 50° and 600 during the afternoon. as the total rainfall was below the normal, the deficit remained unaffected by the cold snap that visited the south being very large in many districts. In the metropolitan of Europe. At Funchal the sheltered thermometer rose to area, at Kew, the mean maximum temperature was 45’ 50, 70° or higher on no less than 18 days, and fell no lower than an excess on the average of 1 - 80, while the mean minimum 570 on as many nights. The mean maximum temperature was 38°, an excess of 3°. The first fortnight saw the was as high as 690 and the mean minimum 570. The sheltered thermometer rise to 50° or above on several occasions, weather was also very fine as well as warm. On only five the highest figure being 540 on the 12th, but after the 22nd days was there rain, and the total fall, 2 - 0 in., was nearly it seldom rose to 40°, and the minimum readings were all contributed by the 21st and 26th. Comparing the mostly below 320, the lowest of all being 280 on Christmas December mean temperature with that in the south of morning. The rainfall, which was just below an inch, fell England, it may be said that Funchal was as warm as on 14 days, and was just an inch below the normal, while Brighton is in an average June during the day, and about the sun, which only shone on 14 days, yielded a total of 41 as warm as an average July at night.
DECEMBER,