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SPLINTAGE OF THE HAND DURING OPERATION
1013
(45-1%) the intensity of the pains was lessened considerably, the patient became cooperative, and cervical dilatation was rapid. In 31 (20-3%) the pains were made In more bearable and the patient became cooperative. 14 (9-1%), though the intensity of the pains was not diminished, in all but 6 cases apprehension was allayed and cooperation achieved. ’
EFFECT ON BABY
Some degree of asphyxia was seen in 23 babies, of whom 6 (3.9%) were slightly asphyxiated, 8 (5-2%) were in blue asphyxia, and 8 (5-2%) were in white asphyxia. In 6 cases the asphyxia was -due to the cord being tight round the neck ; in 5 cases to excess of mucus in the air passages, in 1 case to congenital heart disease (proved at necropsy), and in 1 case to prematurity (in a twin) ; leaving 10 (6-5%) cases in which there was no obvious cause of asphyxia. In these 10 cases 1 mother had had one injection (100 mg.), 4 had had two injections, 3 had had three injections, and 2 had had four injections of pethidine. We may conclude that the total dosage bears no direct relationship to asphyxia in the infant, even if we presuppose that pethidine may be a causal factor. Of the 10 infants 3 had slight asphyxia, 4 had blue asphyxia, and 3 had white asphyxia. All 23 infants except 1 recovered with simple routine treatment. In 153 unselected deliveries in 1942, when the only " analgesic " in use was potassium bromide, the number of babies born with asphyxia was 13- (8-5%). In the present series the number of stillbirths was 3 (1-9%). Of these, one was a macerated twin, one was syphilitic, and the third was a shoulder presentation which had undergone combined version.
New Inventions SPLINTAGE OF THE HAND DURING OPERATION
EFFECTIVE fixation of the hand during operations it is always difficult and often a source of irritation. Many surgeons have an assistant to hold the hand in the required position ; some are content to try and control the limb with strips of gauze, towel clips, strapping, &c. ; while others use a rigid metal or wooden splint. But such methods do not permit of ready adjustment during operations which are commonly long and tedious and likely to involve alterations in position. At their best they restrict the surgeon’s field of operation and tend to block his view. The splint described here overcomes these disadvantages and is extremely simple. It consists merely of a fiat shape cut from a sheet of lead 12 in. by 14 in. and 1/16 in. thick (fig. 1). The hand is laid on the splint, which is then accurately moulded round it. The fingers are fixed on
tips of the splint
by bending
the
if necessary
they
can
be held
over them (fig. 2), or straight by making gutters
CONCLUSIONS
Mother.-At least by intramuscular administration the toxic effects of pethidine are slight and infrequent It is my impression that and may be discounted. pethidine hastens dilatation and accelerates delivery. Apart from its analgesic properties, we were struck by the manner in which it allayed apprehension and helped to achieve the patient’s cooperation. We have found that, combined with heroin and trilene, it is a most useful and helpful drug during labour. with the 153 cases in 1942 seems J5o&.—Comparison to show an increase in the incidence of asphyxia. This was not unduly high, however, and most of the babies responded quickly to simple treatment. SUMMARY
The use of pethidine hydrochloride - in combination with heroin and trilene is described in 153 successive deliveries. This combination was effective in 70-6% of cases.
Apart from being a potent analgesic, pethidine has a striking effect in allaying apprehension and achieving the patient’s cooperation.
Though the incidence of foetal asphyxia was somewhat higher than in a previous year, in which pethidine was not used, this is not a contra-indication to its use. I am grateful to Dr. S. W. Savage, county medical officer of health, for permission to publish these findings. My sincere thanks are due to the matron, Mrs. M. Middleton, and to our keen and competent staff midwives, Nurses Foley, Mellon,
Driscoll, Booden, and Robson, without whose cheerful cooperation and helpful criticism it would have been impossible to
keep
our
records.
’0’
Fig. 1.-outline of splint sheet lead.
cut
from
Fig. 2.- The splint applied.
of the metal tongues. The thumb is’held by an additional piece at the side. The wrist is bent into the required position, and the side bars are folded obliquely round the forearm. The following advantages are claimed for this form of leaden splint: (1) It can be quickly and accurately moulded into any position. It may be applied equally well to the back The or front of either hand and to a limb of any size. hand and fingers are firmly held without the use of clips, straps, or retractors. It is particularly useful in operations on the side of the finger, since the other digits can be-held effectively out of the way. (2) Sheet lead of this thickness is sufficiently malleable to be easily bent by hand, and is soft enough not to damage the tissues by pressure or to tear the surgeon’s, gloves. At the same time it is sufficiently rigid to fix the hand in the position required. If further support is needed, the hand encased in the splint may be rested on a folded towel. (3) The splint is easily sterilised by boiling and may be applied safely either directly to the hand or over a stockinette glove. (4) It is quickly and cheaply made, is durable, and can be rapidly bent or hammered flat again after use. (5) It releases an assistant and affords the surgeon a clearer field of operation. My thanks are -due to Mr. R. G. Pulvertaft, both because his work on the surgery of the hand stimulated me to develop this splint, and for his willingness to try it and later to adopt it as a regular part of his equipment. GEOFFREY R. FISK M.B. Lond., F.R.C.S.E. Cambridge. ’
,
’
REFERENCES
Carter, H. M. (1945) Wisconsin med. J. 44, 1170. Cripps, J. A. R., Hall, B., Haultain, W. F. T. (1944) Brit. med. J. ii, 498. Flatt, W. D. (1946) Canad. med. Ass. J. 55, 43. Gallen, B., Prescott, F. (1944) Brit. med. J. i, 176. Gilbert, G., Dixon, A. B. (1943) Amer. J. Obstet. Gynec. 45, 320. Hingson, R. A. (1945) Surg. Clin. N. Amer. 25, 1352. Schumann, W. R. (1944) Amer. J. Obstet. Gynec. 47, 93.
’",
.
(45-1%) the intensity of the pains was lessened considerably, the patient became cooperative, and cervical dilatation was rapid. In 31 (20-3%) the pains were made In more bearable and the patient became cooperative. 14 (9-1%), though the intensity of the pains was not diminished, in all but 6 cases apprehension was allayed and cooperation achieved. ’
EFFECT ON BABY
Some degree of asphyxia was seen in 23 babies, of whom 6 (3.9%) were slightly asphyxiated, 8 (5-2%) were in blue asphyxia, and 8 (5-2%) were in white asphyxia. In 6 cases the asphyxia was -due to the cord being tight round the neck ; in 5 cases to excess of mucus in the air passages, in 1 case to congenital heart disease (proved at necropsy), and in 1 case to prematurity (in a twin) ; leaving 10 (6-5%) cases in which there was no obvious cause of asphyxia. In these 10 cases 1 mother had had one injection (100 mg.), 4 had had two injections, 3 had had three injections, and 2 had had four injections of pethidine. We may conclude that the total dosage bears no direct relationship to asphyxia in the infant, even if we presuppose that pethidine may be a causal factor. Of the 10 infants 3 had slight asphyxia, 4 had blue asphyxia, and 3 had white asphyxia. All 23 infants except 1 recovered with simple routine treatment. In 153 unselected deliveries in 1942, when the only " analgesic " in use was potassium bromide, the number of babies born with asphyxia was 13- (8-5%). In the present series the number of stillbirths was 3 (1-9%). Of these, one was a macerated twin, one was syphilitic, and the third was a shoulder presentation which had undergone combined version.
New Inventions SPLINTAGE OF THE HAND DURING OPERATION
EFFECTIVE fixation of the hand during operations it is always difficult and often a source of irritation. Many surgeons have an assistant to hold the hand in the required position ; some are content to try and control the limb with strips of gauze, towel clips, strapping, &c. ; while others use a rigid metal or wooden splint. But such methods do not permit of ready adjustment during operations which are commonly long and tedious and likely to involve alterations in position. At their best they restrict the surgeon’s field of operation and tend to block his view. The splint described here overcomes these disadvantages and is extremely simple. It consists merely of a fiat shape cut from a sheet of lead 12 in. by 14 in. and 1/16 in. thick (fig. 1). The hand is laid on the splint, which is then accurately moulded round it. The fingers are fixed on
tips of the splint
by bending
the
if necessary
they
can
be held
over them (fig. 2), or straight by making gutters
CONCLUSIONS
Mother.-At least by intramuscular administration the toxic effects of pethidine are slight and infrequent It is my impression that and may be discounted. pethidine hastens dilatation and accelerates delivery. Apart from its analgesic properties, we were struck by the manner in which it allayed apprehension and helped to achieve the patient’s cooperation. We have found that, combined with heroin and trilene, it is a most useful and helpful drug during labour. with the 153 cases in 1942 seems J5o&.—Comparison to show an increase in the incidence of asphyxia. This was not unduly high, however, and most of the babies responded quickly to simple treatment. SUMMARY
The use of pethidine hydrochloride - in combination with heroin and trilene is described in 153 successive deliveries. This combination was effective in 70-6% of cases.
Apart from being a potent analgesic, pethidine has a striking effect in allaying apprehension and achieving the patient’s cooperation.
Though the incidence of foetal asphyxia was somewhat higher than in a previous year, in which pethidine was not used, this is not a contra-indication to its use. I am grateful to Dr. S. W. Savage, county medical officer of health, for permission to publish these findings. My sincere thanks are due to the matron, Mrs. M. Middleton, and to our keen and competent staff midwives, Nurses Foley, Mellon,
Driscoll, Booden, and Robson, without whose cheerful cooperation and helpful criticism it would have been impossible to
keep
our
records.
’0’
Fig. 1.-outline of splint sheet lead.
cut
from
Fig. 2.- The splint applied.
of the metal tongues. The thumb is’held by an additional piece at the side. The wrist is bent into the required position, and the side bars are folded obliquely round the forearm. The following advantages are claimed for this form of leaden splint: (1) It can be quickly and accurately moulded into any position. It may be applied equally well to the back The or front of either hand and to a limb of any size. hand and fingers are firmly held without the use of clips, straps, or retractors. It is particularly useful in operations on the side of the finger, since the other digits can be-held effectively out of the way. (2) Sheet lead of this thickness is sufficiently malleable to be easily bent by hand, and is soft enough not to damage the tissues by pressure or to tear the surgeon’s, gloves. At the same time it is sufficiently rigid to fix the hand in the position required. If further support is needed, the hand encased in the splint may be rested on a folded towel. (3) The splint is easily sterilised by boiling and may be applied safely either directly to the hand or over a stockinette glove. (4) It is quickly and cheaply made, is durable, and can be rapidly bent or hammered flat again after use. (5) It releases an assistant and affords the surgeon a clearer field of operation. My thanks are -due to Mr. R. G. Pulvertaft, both because his work on the surgery of the hand stimulated me to develop this splint, and for his willingness to try it and later to adopt it as a regular part of his equipment. GEOFFREY R. FISK M.B. Lond., F.R.C.S.E. Cambridge. ’
,
’
REFERENCES
Carter, H. M. (1945) Wisconsin med. J. 44, 1170. Cripps, J. A. R., Hall, B., Haultain, W. F. T. (1944) Brit. med. J. ii, 498. Flatt, W. D. (1946) Canad. med. Ass. J. 55, 43. Gallen, B., Prescott, F. (1944) Brit. med. J. i, 176. Gilbert, G., Dixon, A. B. (1943) Amer. J. Obstet. Gynec. 45, 320. Hingson, R. A. (1945) Surg. Clin. N. Amer. 25, 1352. Schumann, W. R. (1944) Amer. J. Obstet. Gynec. 47, 93.
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.